The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubation
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The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.Keywords:
Laryngeal Masks
Haemodynamic response
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In the past 25 years with the development of various supraglottic airway devices, the armamentarium for airway management has increased. In our study, the laryngeal mask airway (LMA)-ProSeal is compared with the LMA-Classic with respect to as follows: (a) Ease of insertion and number of insertion attempts, (b) Device positional stability and possible oropharyngeal leak, (c) Airway trauma, and (d) Hemodynamic changes; in children aged 3-15 years undergoing elective surgery under general anesthesia, hypothesizing that these would be different.Sixty consecutive American Society of Anesthesiologists Physical Status Classes I and II children aged 3-15 years and weighing 5-45 kg undergoing elective surgery in the supine position were randomized for airway management with the LMA-Classic or LMA-ProSeal.Size of the LMA used in both LMA-Classic and LMA-ProSeal was 1.5, 2, and 2.5 and was statistically nonsignificant. There was no difference between LMA-Classic and LMA-ProSeal with regard to ease of insertion, number of attempts for insertion, device positional stability, airway trauma and hemodynamic changes.The complications of usage of the LMA are minimal and similar in both the devices. The LMA-ProSeal has advantages over LMA-classic such as the placement of gastric tube, adequate ventilation, and oxygenation without any gastric distension.
Supine position
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Laryngeal Masks
Insertion time
Tracheal tube
Elective surgery
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Background The laryngeal mask airway LMA-Classic has been used widely in clinical practice. A new disposable supraglottic airway device, the Soft Seal LM, has been introduced recently. In a randomized study, the authors compared the LMA-Classic and the disposable Soft Seal LM in terms of their clinical performance, cuff pressures during nitrous oxide anesthesia, position of the laryngeal mask in situ by fiberoptic evaluation, and morbidity in a wide range of routine general surgery procedures. Methods A total of 200 adult patients were randomly assigned to a size 4 laryngeal mask in two equal-sized groups for airway management during surgery: (1) LMA-Classic (Intavent Orthofix Ltd., Maidenhead, Berkshire, United Kingdom); or (2) Soft Seal LM (Portex Ltd., Hythe, Kent, United Kingdom). Anesthesia was administered with fentanyl, propofol, nitrous oxide, oxygen, and sevoflurane. The variables studied were ease of insertion, fiberoptic view, time in situ, incidence of blood on the laryngeal mask at the time of removal, and the incidence of postoperative sore throat at 2 and 24 h. The laryngeal mask cuff pressures were measured continuously. Intracuff pressure limitation was not attempted. Results The LMA-Classic and the Soft Seal LM showed similar clinical performances, as shown by their insertion time (successful insertion at first attempt was achieved within 20 s in 97% with LMA-Classic trade mark vs. 95% with Soft Seal LM), fiberoptic evaluation of the anatomic position of the laryngeal mask, and satisfactory anesthesia conditions. Laryngeal mask cuff pressures increased from 45 to 100.3 mmHg in the LMA-Classic and from 45 to 46.8 mmHg in the Soft Seal LM (P < 0.001). Macroscopic blood was seen on only four occasions in the LMA-Classic group. The incidence of sore throat was significantly increased at 2 h postoperatively when using the LMA-Classic, although there was no difference at 24 h after surgery. Conclusions In spontaneously breathing adult patients requiring a size 4 laryngeal mask airway, the new disposable Soft Seal LM device is an acceptable alternative to the reusable LMA-Classic trade mark, resulting in a good laryngeal seal and offering similar clinical performance. Cuff pressures increase substantially when the LMA-Classic is used but not when using the Soft Seal LM. There was less trauma to patients using the Soft Seal LM, as assessed by the incidence of sore throat in the early postoperative period.
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Laryngeal Masks
Sore throat
Tracheal tube
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Laryngeal Masks
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Summary Many new supraglottic airway devices have been recently introduced, their development motivated by the need for a single‐use equivalent to the original re‐usable laryngeal mask airway. We performed a randomised cross‐over study in spontaneously breathing patients comparing the re‐usable Laryngeal Mask Airway‐Classic (LMA ™ ) and the disposable Soft Seal Laryngeal Mask in sizes 3, 4 and 5. Sixty patients had an LMA and a disposable laryngeal mask placed in random order. The primary outcome was first attempt insertion success rate. Ease of insertion was similar in both groups and there was no difference in first attempt success rates (96% with LMA and 92% with disposable laryngeal mask). The disposable laryngeal mask required significantly less air to inflate the cuff to produce a seal (10 [10–25] ml with disposable laryngeal mask and 15 [10–30] ml with laryngeal mask) and the cuff pressure produced was significantly lower (35 [20–80] cmH 2 O with disposable laryngeal mask and 75 [20–120] cmH 2 O with LMA). Data are median and range. We conclude that the disposable laryngeal mask is an acceptable alternative to the re‐usable LMA.
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Laryngeal Masks
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USable
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The laryngeal tube has been evaluated for brief periods of anaesthesia only [1, 2]. The device has been modified since its introduction. This evaluation compares the new laryngeal tube with the classic laryngeal mask airway throughout anaesthesia with controlled ventilation. Seventy-two ASA 1-2 patients were studied. Anaesthesia was with total intravenous anaesthesia using propofol, fentanyl and rocuronium. Patients were randomised to airway management with the laryngeal tube or laryngeal mask airway. Manufacturer's instructions were followed for all aspects of airway use. Insertion was successful with 36/36 laryngeal mask airways and 35/36 laryngeal tubes. Insertion of the laryngeal tube required more manipulations than the laryngeal mask airway (p < 0.05), although the time taken was identical. Complications were infrequent. Airway seal pressure was 28 cm H2O with the laryngeal tube and 20 cm H2O with the laryngeal mask airway (p < 0.05). The peak airway pressure to deliver 7 ml.kg−1 was 3 cm H2O higher with the laryngeal tube than the laryngeal mask airway (p < 0.05). Ventilation was perfect with the laryngeal tube in 32/35 cases and with the laryngeal mask airway in 29/32 (p > 0.05). Gas leak around the laryngeal mask airway occurred more frequently with the laryngeal mask airway than the laryngeal tube. There were more manipulations required in the laryngeal tube group during maintenance of anaesthesia. The airways were equally well tolerated during emergence and recovery and complications were equal in each group. Postoperative sequelae were similar in incidence, severity and number of patients affected with either device. The laryngeal tube allows an improved airway seal for lung ventilation compared to the laryngeal mask airway. However it requires a greater number of airway manipulations for insertion. Ventilation via the laryngeal tube requires a higher peak pressure than with the laryngeal mask airway.
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Epiglottis
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Objective To discuss the feasibility of painless laryngeal mask airway fiberoptic bronchoscopy and treatment in elderly patients.Methods 90 cases of painless fiberoptic bronchoscopy and treatment of elderly patients were randomly divided into three groups.Three groups fiberoptic bronchoscopy and treatment assisted by Dezocine plus Propofol anesthesia,using a nasal catheter to oxygen(nasal catheter group),endoscopic oxygen mask(mask group) and two pipe laryngeal mask airway control(laryngeal mask group) respectively.Three groups were compared in patients with SPO2 drop the number of cases and the times less than 85%,duration of anesthesia and inspection time,and postoperative evaluation by the surgery anesthesia satisfaction.Results Patients in incidence of SPO2 in mask group and laryngeal mask group was significantly lower than those in nasal catheter group(P0.05,P0.01).Patients in incidence of SPO2 in mask group and laryngeal mask group was different(P0.05).The number of SPO2 ≤ 85% in mask group and laryngeal mask group was lower than those in nasal catheter group(P0.05).Anesthesia time and inspection time in mask group and laryngeal mask group were significantly shorter than those in nasal catheter group(P0.05).Patients` satisfaction in mask group and laryngeal mask group was significantly higher than those in nasal catheter group(P0.05,P0.01).Conclusion Painless fiberoptic bronchoscopy using a tube laryngeal mask airway control,this method can improve the elderly patients tolerated and safety check,this method is also a worth promoting airway management means.
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Laryngeal Masks
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Supraglottic airway
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The haemodynamic response to the insertion of the laryngeal mask airway (LMA) was assessed and compared to that of laryngoscopy and tracheal intubation in a study of forty patients (ASA 1) randomly allocated into two groups and anaesthetised using a standard balanced anaesthetic technique. The results show that the changes in all cardiovascular parameters measured following LMA insertion were significantly less (P<0.05) when compared with those following laryngoscopy and tracheal intubation. We conclude that airway management with the LMA may be used to avoid the haemodynamic response to tracheal intubation where such a response is undersirable.
Laryngeal Masks
Haemodynamic response
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Summary Single‐use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic ™ laryngeal mask airway. We performed a randomised cross‐over study comparing the Ambu ® AuraOnce ™ Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84% with the LMA Classic; p = 0.22). The volumes of air required to inflate the cuff to produce a seal were similar, but the cuff pressure was lower for the Ambu Laryngeal Mask (median (IQR [range]) 18 (10–31 [0–100] cmH 2 O) than the LMA Classic 27 (17–50 [4–90] cmH 2 O; p = 0.007). Visual analogue scores for ease of insertion were 87 (73–93 [26–97]) mm for the Ambu and 84 (60–89 [18–96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic.
Supraglottic airway
Cuff
Laryngeal Masks
Insertion time
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