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      Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways.

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          Abstract

          Because of the many advantages of supraglottic airways (SGA) compared to mask ventilation and endotracheal intubation, their areas of application are constantly expanding. The development of second-generation SGAs in particular has led to a widening of the indications for use thanks to the improved oropharyngeal leak pressure and the possibility of inserting a gastric tube. The identification of possible malpositions and any increased ventilation requirements using simple clinical tests must be given particular emphasis. The question of patient safety for expanded indications has to be evaluated.

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          Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review.

          Seung Yu, O Beirne (2010)
          The purpose of the present study was to determine whether, in patients undergoing general anesthesia, those provided with a laryngeal mask airway (LMA) have a lower risk of airway-related complications than those undergoing endotracheal intubation. A systematic review of randomized prospective controlled trials was done to compare the risk of airway complications with an LMA versus an endotracheal tube (ETT) in patients receiving general anesthesia. Two independent reviewers identified 29 randomized prospective controlled trials that met the predetermined inclusion and exclusion criteria. The data for each individual outcome measure were combined to analyze the relative risk ratios (RRs). The Cochrane RevMan software was used for statistical analysis. When an ETT was used to protect the airway, a statistically significant greater incidence of hoarse voice (RR 2.59, 95% confidence interval [CI] 1.55 to 4.34), a greater incidence of laryngospasm during emergence (RR 3.16, 95% CI 1.38 to 7.21), a greater incidence of coughing (RR 7.12, 95% CI 4.28 to 11.84), and a greater incidence of sore throat (RR 1.67, 95% CI 1.33 to 2.11) was found compared with when an LMA was used to protect the airway. The differences in the risk of regurgitation (RR 0.84, 95% CI 0.27 to 2.59), vomiting (RR 1.56, 95% CI 0.74 to 3.26), nausea (RR 1.59, 95% CI 0.91 to 2.78), and the success of insertion on the first attempt (RR 1.08, 95% CI 0.99 to 1.18) were not statistically significant between the 2 groups. For the patients receiving general anesthesia, the use of the LMA resulted in a statistically and clinically significant lower incidence of laryngospasm during emergence, postoperative hoarse voice, and coughing than when using an ETT. The risk of aspiration could not be determined because only 1 study reported a single case of aspiration, which was in the group using the ETT. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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            Comparison of the LMA Supreme vs the i-gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation.

            Peter M L Teo, T. Suhitharan, Kwang Youl Lee … (2010)
            We compared the efficacy of the inflatable cuff of the LMA Supreme against the non-inflatable i-gel cuff in providing an adequate seal for laparoscopic surgery in the Trendelenburg position in 100 female patients. There was no difference in our primary outcome, oropharyngeal leak pressure, between the LMA Supreme and the i-gel (mean (SD) 26.4 (5.1) vs 25.0 (5.7) cmH(2) O, respectively; p = 0.18). Forty-seven (94%) LMA Supremes and 48 (96%) i-gels were successfully inserted on the first attempt, with similar ease, and comparable times to the first capnograph trace (mean (SD) 14.3 (4.7) s for the LMA Supreme vs 15.4 (8.2) s for the i-gel; p = 0.4). Gastric tube insertion was easier and achieved more quickly with the LMA Supreme vs the i-gel (9.0 (2.5) s vs 15.1 (7.3) s, respectively; p < 0.001). After creation of the pneumoperitoneum, there was a smaller difference between expired and inspired tidal volumes with the LMA Supreme (21.5 (15.2) ml) than with the i-gel (31.2 (23.5) ml; p = 0.009). There was blood on removal of two LMA Supremes and one i-gel. Four patients in the LMA Supreme group and one patient in the i-gel group experienced mild postoperative sore throat.
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              Time to abandon the 'vintage' laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice.

              T M Cook, F Kelly (2015)
              Article 0 comments Cited 34 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Curr Opin Anaesthesiol
                Title: Current opinion in anaesthesiology
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Electronic): 1473-6500
                ISSN (Print): 0952-7907
                Publication date (Electronic): Dec 2015
                Volume: 28
                Issue: 6
                Affiliations
                [1 ] aDepartment of Anesthesiology, Pain Therapy, Intensive Care and Emergency Medicine, Red Cross Hospitals Berlin Westend and Mitte, Berlin, Germany bDepartment of Anaesthesia and Intensive Care Medicine, Spital Männedorf AG, Männedorf, Switzerland cDepartment of Anesthesiology, Universitätsmedizin Göttingen, Gottingen, Germany.
                Article
                Publisher Item ID: 00001503-201512000-00018
                DOI: 10.1097/ACO.0000000000000262
                PubMed ID: 26539790
                SO-VID: 4ae2d117-5bda-4b7a-9022-cdbc5ca9d2d0
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