Laryngeal mask airway protector™: Advanced uses for laparoscopic cholecystectomies

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Abstract

The laryngeal mask airway (LMA) Protector™ is a second-generation perilaryngeal sealer type supraglottic airway device recently introduced into clinical practice. We describe our initial experiences with the use of the LMA Protector™ in three patients undergoing laparoscopic cholecystectomies. In all patients, we found the LMA Protector™ to have acceptable placements on the first attempt, adequate oropharyngeal leak pressures and ventilation adequacy.

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Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial.

Tai-Tong Wong, Edwin Seet, Farhanah Yousaf … (2010)

Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (<44 mmHg) with patients under routine care. Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 +/- 6 vs. 114 +/- 57 mmHg, P < 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P < 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.

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Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomized controlled trial.

Edwin Seet, Subramanyam Rajeev, Tamal Firoz … (2010)

The Supreme laryngeal mask airway (LMA) is a new single-use polyvinyl chloride supraglottic device that combines the functionality of the ProSeal and Fastrach airways. High oropharyngeal leak pressures are important as they indicate airway protection, feasibility of positive pressure ventilation and likelihood of successful LMA placement. The oropharyngeal leak pressure of the LMA Supreme is not well established versus the LMA ProSeal. This study was designed to compare the safety and efficacy of the LMA Supreme versus the LMA ProSeal in elective ambulatory procedures.

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The LMA-ProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy.

Michael T Beriault, P. Maltby, R. Fick … (2002)

To compare LMA-ProSeal (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during laparoscopic cholecystectomy. We randomized 109 ASA I-III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg x m-2). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT (women 7 mm, men 8 mm) was inserted and the cuff inflated. A #14 gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Ventilation was set at 10 mL x kg-1 and 10 breaths x min-1. The surgeon, blinded to the airway device, scored stomach size on an ordinal scale of 0-10 at insertion of the laparoscope and upon decompression of the pneumoperitoneum. There were no statistically significant differences in SpO2 or P(ET)CO2 between the two groups before or during peritoneal insufflation in either non-obese or obese patients. Median (range) airway pressure at which oropharyngeal leak occurred during a leak test with LMA-PS was 34 (18-45) cm water. Change in gastric distension during surgery was similar in both groups. Four of 16 obese LMA-PS patients crossed over to ETT because of respiratory obstruction or airway leak. A correctly seated LMA-PS or ETT provided equally effective pulmonary ventilation without clinically significant gastric distension in all non-obese patients. Further studies are required to determine the acceptability of the LMA-PS for laparoscopic cholecystectomy in obese patients.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Anaesth

Journal ID (iso-abbrev): Indian J Anaesth

Journal ID (publisher-id): IJA

Title: Indian Journal of Anaesthesia

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0019-5049

ISSN (Electronic): 0976-2817

Publication date (Print): August 2017

Volume: 61

Issue: 8

Pages: 673-675

Affiliations

[1]Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore

[1 ]MD Programme, Duke-NUS Medical School, Singapore

Author notes

Address for correspondence: Dr. Leng Zoo Tan, Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828. E-mail: tan.leng.zoo@ 123456alexandrahealth.com.sg

Article

Publisher ID: IJA-61-673

DOI: 10.4103/ija.IJA_240_17

PMC ID: 5579859

PubMed ID: 28890564

SO-VID: 87b061a2-c38c-4547-9fcf-d1438caba3b7

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Laryngeal mask airway protector™: Advanced uses for laparoscopic cholecystectomies

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Most cited references 7

Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial.

Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomized controlled trial.

The LMA-ProSeal is an effective alternative to tracheal intubation for laparoscopic cholecystectomy.

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