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Canadian Journal of Anaesthesia

, Volume 45, Issue 3, pp 206–211 | Cite as

Gas leak and gastric insufflation during controlled ventilation: face maskversus laryngeal mask airway

  • Lily M. Ho-Tai
  • J. Hugh Devitt
  • Alva G. Noel
  • Michael P. O’Donnell
Reports of Investigation

Abstract

Purpose

To compare two airway management techniques, face mask (FM) with oropharyngeal airway and laryngeal mask airway (LMA), with respect to the effectiveness of positive pressure ventilation and airway maintenance.

Methods

After induction of anaesthesia, two airway management techniques (FM or LMA) and three peak pressures (20, 25 and 30 cm H2O) were randomly applied during controlled ventilation in 60 patients. Data collected included inspiratory and expiratory volumes and presence of gastro-oesophageal insufflation. Leak was calculated by subtracting the expiratory from the inspiratory volume, expressed as a fraction of the inspiratory volume.

Results

Expiratory volumes (mean ± SD) at 20, 25 and 30 cm H2O for LMA ventilation were 893 ± 260, 986 ± 276 and 1006 ± 262 respectively, and for FM ventilation 964 ± 264, 1100 ± 268 and 1116 ± 261. Leak fractions at 20, 25 and 30 cm H2O for LMA ventilation were 0.21 ± 0.15, 0.24 ± 0.18 and 0.26 ± 0.18 respectively, and for FM ventilation 0.14 ± 0.09, 0.14 ± 0.09 and 0.12 ± 0.08. The frequency of gastro-oesophageal insufflation was 1.6%, 5% and 5% for the LMA and 5%, 15% and 26.6% for the FM for ventilation pressures of 20, 25 and 30 cm H2O respectively which was greater with LMA use.

Conclusion

Ventilation was adequate in all patients using both techniques. Leak was pressure dependent and greater with LMA use. Most of the leak was vented to the atmosphere via the pharynx. Gastro-oesophageal insufflation was more frequent with ventilation using the face mask. LMA use with positive pressure ventilation would appear to be a better airway management method than the face mask.

Keywords

Neuromuscular Blockade Airway Management Face Mask Rapid Sequence Induction Mask Technique 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Comparer deux techniques de maintien des voies aériennes, le masque facial (MF) avec canule oropharyngée et le masque laryngé (ML) quant à l’efficacité de la ventilation à pression positive et du maintien des voies aériennes.

Méthodes

Après induction de l’anesthésie, on a utilisé de façon aléatoire chez 60 patients 2 méthodes de contrôle des voies aériennes (MF ou ML) et 3 pressions de pointe (20, 25 et 30 cm H2O) durant la ventilation contrôlée. Comme données on a colligé les volumes inspiratoires et expiratoires et la présence d’insufflation gastro-oesophagienne. La fuite a été calculée en soustrayant le volume expiré du volume inspiré et a été exprimée comme une fraction du volume inspiré.

Résultats

Pour la ventilation avec ML, les volumes expirés (moyenne ± Écart type) mesurés à 20, 25 et 30 cm H2O étaient respectivement de 893 ± 260, 986 ± 276 et 1006 ± 262, alors que pour la ventilation avec MF les volumes étaient respectivement de 964 ± 264, 1100 ± 268 et 1116 ± 261. La fraction de fuite à 20, 25 et 30 cm H2O a été pour la ventilation avec ML respectivement de 0,21 ± 0,15, 0,24 ± 0,18 et 0,25 ± 1,18, alors qu’avec le MF elle atteignait 0,14 ± 0,09, 0,14 ± 0,09 et 0,12 ± 0,08. La fréquence de l’insufflation gastro-oesophagienne se situait respectivement à 1,6%, 5% et 5% pour le ML et à 5%, 15% et 26,6% pour le MF pour des pressions de ventilation de 20,25 et 30 cm H2O.

Conclusion

La ventilation a été adéquate chez tous les patients en utilisant l’une ou l’autre technique. La fuite était plus grande avec le ML, dépendait de la pression et était en grande partie évacuée dans l’atmosphère par le pharynx. Linsufflation gastro-oesophagienne était plus fréquente avec l’utilisation du MF Lutilisation du ML lors de ventilation à pression positive semble une meilleure méthode de maintien des voies aériennes que l’utilisation du masque facial.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Lily M. Ho-Tai
    • 1
  • J. Hugh Devitt
    • 1
  • Alva G. Noel
    • 1
  • Michael P. O’Donnell
    • 1
  1. 1.Department of Anaesthesia, Sunnybrook Health Science CentreUniversity of TorontoToronto

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