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 studyReportar como inadecuado




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 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Anesthesiology

, 14:2

Airway and respiratory management

Abstract

BackgroundThe 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.

MethodsOur 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 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 with Pmax at oropharyngeal leak pressure, glottic narrowing was defined as an angle between the vocal cords under 16 degrees.

ResultsThe 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.

ConclusionsAltering 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.

KeywordsSupraglottic airway Insertion sequence Malposition Endoscopic evaluation Glottic narrowing Ventilatory impairment Airway morbidity Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-2 contains supplementary material, which is available to authorized users.

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