The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme® on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study

BMC Anesthesiology

Ingo Bergmann¹  Thomas Allen Crozier¹  Markus Roessler¹  Hanna Schotola¹  Ashham Mansur¹  Benedikt Büttner¹  José Maria Hinz¹  Martin Bauer¹ 

[1] Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany

关键词: Airway morbidity;    Ventilatory impairment;    Glottic narrowing;    Endoscopic evaluation;    Malposition;    Insertion sequence;    Supraglottic airway;   

Others  :  816626
DOI  :  10.1186/1471-2253-14-2

 received in 2013-09-18, accepted in 2013-12-29,  发布年份 2014

【 摘 要 】

Background

The conventional sequence when using supraglottic airway devices is insertion, cuff inflation and fixation. Our hypothesis was that a tighter fit of the cuff and tip could be achieved with a consequently lower incidence of air leak, better separation of gastrointestinal and respiratory tracts and less airway morbidity if the device were first affixed and the cuff then inflated.

Methods

Our clinical review board approved the study (public registry number DRKS00003174). An LMA Supreme® was inserted into 184 patients undergoing lower limb arthroscopy in propofol-remifentanil anaesthesia who were randomly assigned to either the control (inflation then fixation; n = 92) or study group (fixation then inflation; n = 92). The cuff was inflated to 60 cmH₂O. The patients’ lungs were ventilated in pressure-controlled mode with 5 cmH₂O PEEP, Pmax to give 6 ml kg^-1 tidal volume, and respiratory rate adjusted to end-tidal CO₂ of 4.8 and 5.6 kPa. Correct cuff and tip position were determined by leak detection, capnometry trace, oropharyngeal leak pressure, suprasternal notch test, and lube-tube test. Bowl and cuff position and the presence of glottic narrowing were assessed by fiberscopic examination. Postoperative dysphagia, hoarseness and sore throat were assessed with a questionnaire. Ventilatory impairment was defined as a tidal volume < 6 ml kg^-1 with Pmax at oropharyngeal leak pressure, glottic narrowing was defined as an angle between the vocal cords under 16 degrees.

Results

The incidence of incorrect device position (18% vs. 21%), failed ventilation (10% vs. 9%), leak pressure (24.8 vs. 25.2 cmH₂O, p = 0.63), failed lube-tube test (16.3% vs. 17.6%) and glottic narrowing (19.3% vs. 14.1%, p = 0.35) was similar in both groups (control vs. study, resp.). When glottic narrowing occurred, it was more frequently associated with ventilatory impairment in the control group (77% vs. 39%; p = 0.04). Airway morbidity was more common in the control group (33% vs. 19%; p < 0.05).

Conclusions

Altering the sequence of cuff inflation and device fixation does not affect device position, oropharyngeal leak pressures or separation of gastrointestinal and respiratory tracts. It reduces the incidence of glottic narrowing with impaired ventilation and also perioperative airway morbidity.

【 授权许可】

   
2014 Bergmann et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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