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Abstract
To determine the incidence of pulmonary aspiration with the laryngeal mask airway
(LMA).
A meta-analysis of all published literature on the LMA to September 1993.
All 547 publications were reviewed and coded, and those observational studies in which
the LMA was the main form of airway management were analyzed. Pulmonary aspiration
was defined as either the presence of bilious secretions or particulate matter in
the tracheobronchial tree or, if bronchoscopy was not performed, a postoperative chest
radiograph with infiltrates present on preoperative chest radiograph of physical examination.
In the study population, there were 3 cases of aspiration in 12,901 patients, and
when combined with four independent reports excluded from the detailed analysis, this
gave a final incidence of 2 in 10,000. Ten confirmed pulmonary aspiration events from
published case reports showed that most cases had one or more predisposing factors.
No death of permanent disability occurred.
The evidence to date suggests that the pulmonary aspiration with the LMA is uncommon
and comparable to that for outpatient anesthesia with the face mask and tracheal tube.
Meticulous attention to selection of low-risk patients and appropriate operative procedures
and avoidance of light anesthesia should reduce the incidence even further.