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Ruananukun N, Watcharotayangul J, Jeeranukosol S, Komonhirun R. Correlation and variation of cuff inflating volumes and pressures in different adult models of laryngeal mask: a prospective randomized trial. BMC Anesthesiol 2020; 20:108. [PMID: 32380954 PMCID: PMC7206679 DOI: 10.1186/s12871-020-01028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH2O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH2O in the adult laryngeal masks from different manufacturers. METHODS Two groups of 80 patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnce™ (Ambu®), LMA-Classic™ (Teleflex®) and LMA-ProSeal™ (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH2O was recorded. RESULTS Mean (SD) volume of air required to achieve the intracuff pressure of 60 cmH2O in Soft Seal®, AuraOnce™, LMA-Classic™, LMA-ProSeal™ laryngeal mask size 3 were 11.80(1.88), 9.20(1.88), 8.95(1.50) and 13.50(2.48) ml, respectively, and these volumes in laryngeal mask size 4 were 14.45(4.12), 12.55(1.85), 11.30(1.95) and 18.20(3.47) ml, respectively. The maximum recommended volume resulted in high intracuff pressures (> 60 cmH2O) in all laryngeal mask types and sizes studied. CONCLUSION Pressure-volume curves of adult laryngeal masks are all in sigmoidal shape. Cuff designs and materials can effect pressure and volume correlation. Approximately half of the maximum recommended volume is required to achieve the intracuff pressure of 60 cmH2O except LMA-ProSeal™ which required two-thirds of the maximum recommended volume. TRIAL REGISTRATION Thai Clinical Trials Registry, TCTR20150602001, May 28, 2015.
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Affiliation(s)
- Narut Ruananukun
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Jittiya Watcharotayangul
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Suchaya Jeeranukosol
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Rojnarin Komonhirun
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
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Corda DM, Robards CB, Rice MJ, Morey TE, Gravenstein N, Vasilopoulos T, Brull SJ. Clinical application of limiting laryngeal mask airway cuff pressures utilizing inflating syringe intrinsic recoil. Rom J Anaesth Intensive Care 2018; 25:11-18. [PMID: 29756057 PMCID: PMC5931177 DOI: 10.21454/rjaic.7518.251.cuf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/09/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Overinflation of the laryngeal mask airway (LMA) cuff may cause many of the complications associated with the use of the LMA. There is no clinically acceptable (cost effective and practical) method to ensure cuff pressure is maintained below the manufacturer's recommended maximum value of 60 cm H2O (44 mmHg). We studied the use of the intrinsic recoil of the LMA inflating syringe as an effective and practical way to limit cuff pressures at or below the manufacturer's recommended values. METHODS We enrolled 332 patients into three separate groups: LMAs inserted and inflated per standard practice at the institution with only manual palpation of the pilot balloon; LMA cuff pressures measured by a pressure transducer and reduced to < 60 cm H2O (44 mmHg); and LMA intra-cuff pressure managed by the intrinsic recoil of the syringe. RESULTS There were no statistically significant differences between the pressure transducer group and the syringe recoil group for initial cuff pressure or cuff pressure 1 hour after surgery. Both the syringe recoil group and pressure transducer group were less likely than the standard practice group to have sore throat and dysphagia 1 hour after surgery. These differences remained 24 hours after surgery. CONCLUSIONS Syringe recoil provides an efficient and reproducible method similar to manometry in preventing overinflation of the LMA cuff and decreasing the incidence of postoperative laryngopharyngeal complications.
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Affiliation(s)
- David M. Corda
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Christopher B. Robards
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Mark J. Rice
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy E. Morey
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nikolaus Gravenstein
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
| | - Sorin J. Brull
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
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Takeshita J, Nishiyama K, Fujii M, Tanaka H, Beppu S, Sasahashi N, Shime N. Repetitive postoperative extubation failure and cardiac arrest due to laryngomalacia after general anesthesia in an elderly patient: a case report. J Anesth 2017; 31:779-781. [PMID: 28508288 DOI: 10.1007/s00540-017-2373-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation.
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Affiliation(s)
- Jun Takeshita
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masashi Fujii
- Department of Anesthesiology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Hiroyuki Tanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Sim YH, Choi JH, Kim MK. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report. Korean J Anesthesiol 2016; 69:382-5. [PMID: 27482316 PMCID: PMC4967634 DOI: 10.4097/kjae.2016.69.4.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/11/2015] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.
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Affiliation(s)
- Yeo Hae Sim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
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Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine. BIOMED RESEARCH INTERNATIONAL 2015; 2015:746560. [PMID: 26783527 PMCID: PMC4691459 DOI: 10.1155/2015/746560] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.
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Affiliation(s)
- Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
- University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - William Donaldson
- Department of Anaesthetics, Antrim Area Hospital, Bush Road, Antrim BT41 4RD, UK
| | - Eliska Vobrubova
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
| | - Marek Hakl
- Department of Anaesthesia and Intensive Medicine, St. Anne University Hospital, Pekarska 53, 656 91 Brno, Czech Republic
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Rosen CA, Mau T, Remacle M, Hess M, Eckel HE, Young VN, Hantzakos A, Yung KC, Dikkers FG. Nomenclature proposal to describe vocal fold motion impairment. Eur Arch Otorhinolaryngol 2015; 273:1995-9. [PMID: 26036851 PMCID: PMC4930794 DOI: 10.1007/s00405-015-3663-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.
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Affiliation(s)
- Clark A Rosen
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marc Remacle
- Department of ORL-Head and Neck Surgery, Louvain University Hospital of Mont-Godinne, Yvoir, Belgium
| | - Markus Hess
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans E Eckel
- Abteilung Hals-, Nasen- u Ohrenkrankheiten, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - VyVy N Young
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anastasios Hantzakos
- First Department of ORL-HNS of University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Katherine C Yung
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA, USA
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Breen PH. An Alternative Way to Remove the Laryngeal Mask Airway "Guide" After Intubation. Anesth Analg 1997. [DOI: 10.1213/00000539-199710000-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Brimacombe JR. Arytenoid Dislocation and the Laryngeal Mask Airway. Anesth Analg 1997. [DOI: 10.1213/00000539-199708000-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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