Comparing the insertion and ventilation of laryngeal mask airway according to the patient’s head position and muscle relaxation use. A prospective clinical trial

Guanghui An, Bin Fang, Zhaomin Wang

Abstract


Objectives: To assess the insertion and ventilation of the laryngeal mask airway (LMA) classic while using different head positions with or without muscle relaxant.

Methods: This is a double-blind randomized clinical trial. Patients scheduled for ureteral calculus surgery at Shanghai General Hospital, Shanghai, China were recruited between November 2017 and November 2018. A total of 132 adults were consecutively selected. Patients were randomly divided into 4 groups according to head positioning and muscle relaxant use. An 8-cm-high pillow was used to achieve the sniffing position. The insertion time, initial peak pressure (Ppeak), mean pressure (Pmean) of the airway during intermittent positive pressure ventilation (primary endpoint) and fiberoptic score of the LMA position (secondary endpoint) were evaluated via electronic bronchoscopy through the mask bar. All adverse events were recorded.

 

Results: Data were analyzed by ANOVA, 2-way ANOVA, Chi-squared, Cochran-Mantel-Haenszel, and Kruskal-Wallis tests. The insertion time required for the first attempt, fiberoptic score, Ppeak and Pmean did not differ among the groups. However, the incidence of adverse events in groups not using muscle relaxant was higher than in those using muscle relaxant.

 

Conclusion: Use of a sniffing position and muscle relaxant slightly eased the insertion of the LMA but did not affect the fiberoptic score or ventilation parameters. Using a muscle relaxant, but not the sniffing position, reduced the incidence of adverse effects.

 

 

Saudi Med J 2019; Vol. 40 (7): 687-693
doi: 10.15537/smj.2019.7.24299



How to cite this article:

An G, Fang B, Wang Z. Comparing the inseertion and ventilation of laryngeal mask airway according to the patient's head position and muscle relaxation use. Saudi Med J 2019; 40 (7): 687-693. doi: 10.15537/smj.2019.7.24299.


Keywords


LMA; muscle relaxation; sniffing position; neutral position; LMA ventilation

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References


Jannu A, Shekar A, Balakrishna R, Sudarshan H, Veena GC, Bhuvaneshwari S. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask. Arch Craniofac Surg 2017; 18: 223-229.

Hagberg CA, Ghouse AA, Iannucci DG. The Development of techniques for airway management. In: Eger Ii EI, Saidman LJ, Westhorpe RN, editors. The wondrous story of anesthesia. New York (NY): Springer New York; 2014. p. 723-44.

Singh A, Bhalotra AR, Anand R. A comparative evaluation of ProSeal laryngeal mask airway, i-gel and supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial. Indian J Anaesth 2018; 62: 858-864.

Tulgar S, Boga I, Cakiroglu B, Thomas DT. Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway. J Pediatr Surg 2017; 52: 1705-1710.

Banerjee G, Jain D, Bala I, Gandhi K, Samujh R. Comparison of the ProSeal laryngeal mask airway with the i-gel™ in the different head-and-neck positions in anaesthetised paralysed children: A randomised controlled trial. Indian J Anaesth 2018; 62: 103-108.

Mishra SK, Nawaz M, Satyapraksh MVS, Parida S, Bidkar PU, Hemavathy B, et al. Influence of head and neck position on oropharyngeal leak pressure and cuff position with the proseal laryngeal mask airway and the i-gel: a randomized clinical trial. Anesthesiol Res Pract 2015; 2015: 705869.

Somri M, Vaida S, Garcia Fornari G, Mendoza GR, Charco-Mora P, Hawash N, et al. A randomized prospective controlled trial comparing the laryngeal tube suction disposable and the supreme laryngeal mask airway: the influence of head and neck position on oropharyngeal seal pressure. BMC anesthesiology 2016; 16: 87.

Jun JH, Baik HJ, Kim JH, Kim YJ, Chang RN. Comparison of the ease of laryngeal mask airway ProSeal placementand the fiberoptic scoring according to the head position and the presence of a difficult airway. Korean J Anesthesiol 2011; 60: 244-249.

Aleksandrowicz D, Gaszynski T. Intubation through 2 supraglottic airway device in cervical spine immobilization: a randomized trial of residents’ use of the intubating laryngeal mask airway and the intubating laryngeal tube in manikins. Emergencias 2018; 30: 186-189.

Fujiwara A, Komasawa N, Nishihara I, Miyazaki S, Tatsumi S, Nishimura W, et al. Muscle relaxant effects on placementefficacy of the laryngeal mask ProSeal® in anesthetized patients: a prospective randomized controlled trial. J Anesth 2015; 29: 580-584.

Kong M, Li B, Tian Y. Laryngeal mask airway without muscle relaxant in femoral head replacement in elderly patients. Exp Ther Med 2016; 11: 65-68.

Brimacombe J, Berry A. A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg 1993; 76: 457.

Keller C, Brimacombe J, Puhringer F. A fibreoptic scoring system to assess the position of laryngeal mask airway devices. Interobserver variability and a comparison between the standard, flexible and intubating laryngeal mask airways. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie. AINS 2000; 35: 692-694.

Kulnig J, Fureder L, Harrison N, Frass M, Robak O. Performance and skill retention of five supraglottic airway devices for the pediatric difficult airway in a manikin. Eur J Pediatr 2018: 177; 871-878.

Kim H, Chang JE, Min SW, Lee JM, Ji S, Hwang JY. A comparison of direct laryngoscopic views in different head and neck positions in edentulous patients. Am J Emerg Med 2016; 34: 1855-1858.

Akhtar M, Ali Z, Hassan N, Mehdi S, Wani G, Mir A. A randomized study comparing the sniffing position with simple head extension for glottis visualization and difficulty in intubation during direct laryngoscopy. Anesth Essays Res 2017; 11: 762-766.

Akihisa Y, Hoshijima H, Maruyama K, Koyama Y, Andoh T. Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials. Am J Emerg Med 2015; 33: 1606-16011.

Kuna ST. Respiratory-related activation and mechanical effects of the pharyngeal constrictor muscles. Respir Physiol 2000;119:155-161.

Grady DM, McHardy F, Wong J, Jin F, Tong D, Chung F. Pharyngolaryngeal morbidity with the laryngeal mask airway in spontaneously breathing patients: does size matter? Anesthesiology 2001; 94: 760-766.

Porhomayon J, Farid SD, El-Solh AA, Adlparvar G, Nader ND. The impact of endotracheal tube vs. Laryngeal Mask Airway on the incidence of postoperative nausea and vomiting:a systemic review and meta-analysis. Middle East J Anaesthesiol 2015; 23: 9-16.

Kim MS, Lee JS, Nam SB, Kang HJ, Kim JE. Randomized Comparison of Actual and Ideal Body Weight for Size Selection of the Laryngeal Mask Airway Classic in Overweight Patients. J Korean Med Sci 2015;30: 1197-1202.


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