Laryngeal mask airway position and the risk of gastric insufflation

Anesthesia and Analgesia
F LatorreW Heinrichs

Abstract

A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage. The objective of the present study was to assess the incidence of LMA malpositions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyngeal air leakage. One hundred eight patients were studied after the induction of anesthesia, before any surgical manipulations. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 40 cm H2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using a flexible bronchoscope. The overall incidence of LMA malpositions was 40% (43 of 108). Gastric air insufflation occurred in 19% (21 of 108), and in 90% (19 of 21) of these patients, the LMA was malpositioned. Oropharyngeal air leakage occurred in 42%, and was independent of LMA position. We conclude that clinically unrecognized LMA malposition is a significant risk factor for gastric air insufflation. Routine placement of laryngeal mask airways does not require laryngoscopy. In our study, fibero...Continue Reading

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Citations

Feb 18, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·J Oyston
May 8, 2001·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·C ParkK H Lee
Aug 10, 2000·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·J R MaltbyG H Fick
Nov 7, 2001·Paediatric Anaesthesia·P DevavaramC W Lillehei
Jul 13, 1999·The Laryngoscope·B E Duff
Apr 11, 2008·The Journal of Trauma·Ronald PauldineDavid W Kaczka
Sep 24, 2009·BMC Emergency Medicine·Johannes BickenbachRolf Rossaint
Mar 5, 2005·BMJ : British Medical Journal·Jerry P NolanCharles D Deakin
Oct 27, 2004·Anesthesia and Analgesia·Daniel d'HulstBrian Matthews
Apr 16, 1998·Anesthesia and Analgesia·J R BrimacombeD Ferson
Feb 10, 2011·Anesthesia and Analgesia·Bih-Chern LinYi-Ying Chiang
Oct 4, 2006·Current Opinion in Anaesthesiology·W F Dick, W Mauritz

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