Oropharyngeal leak pressure with the laryngeal mask airway Supreme™ at different intracuff pressures: a randomized controlled trial

  • Lianfeng Zhang
  • Edwin Seet
  • Vanita Mehta
  • Rajeev Subramanyam
  • Saravanan P. Ankichetty
  • David T. Wong
  • Frances Chung
Reports of Original Investigations

Abstract

Background

A higher oropharyngeal leak pressure (OLP) is a marker of efficacy and safety when using laryngeal mask airway devices. The new disposable laryngeal mask airway (LMA™) Supreme™ has lower OLP compared with the LMA ProSeal™. Increased intracuff pressure of laryngeal mask airway devices may improve OLP but may result in more postoperative pharyngolaryngeal adverse events. This study was designed to compare the OLP of the LMA Supreme at varying intracuff pressures.

Methods

One hundred and twenty-three patients were divided randomly into three groups. General anesthesia was standardized using a propofol-fentanyl induction and desflurane in air-oxygen for maintenance. Intracuff pressures of the LMA Supreme were adjusted to 80 cm H2O, 60 cm H2O, and 40 cm H2O according to group allocation. The primary outcome was OLP. Secondary outcomes included postoperative pharyngolaryngeal adverse events and the satisfaction scores of patients and anesthesiologists. The OLP was compared amongst groups using analysis of variance with Bonferroni correction. All reported P values are two-sided.

Results

The OLP with an intracuff pressure of 80 cm H2O was significantly higher compared with 60 cm H2O and 40 cm H2O (26 [6] vs 20 [6] vs 18 [5] cm H2O, respectively; P < 0.001). The incidence of postoperative pharyngolaryngeal adverse events (P = 0.6), patient satisfaction scores (P = 0.2), and anesthesiologist satisfaction scores (P = 0.8) were comparable amongst the three groups.

Conclusion

An intracuff pressure of 80 cm H2O with the LMA Supreme is associated with a higher OLP compared with 60 cm H2O or 40 cm H2O without a greater incidence of postoperative pharyngolaryngeal adverse events. For a superior glottic seal when using the LMA Supreme, we recommend intracuff pressures up to 80 cm H2O.

Keywords

Sore Throat Laryngeal Mask Airway Desflurane Patient Satisfaction Score Intracuff Pressure 

La pression de fuite oropharyngienne avec le masque laryngé Supreme™ à différentes pressions intra-ballonnet: une étude randomisée contrôlée

Résumé

Contexte

Une pression de fuite oropharyngienne (PFO) élevée est un marqueur d’efficacité et de sécurité lors de l’utilisation de masques laryngés. Le nouveau masque laryngé (LMA™) jetable Supreme™ a une PFO plus basse que le LMA ProSeal™. Une pression intra-ballonnet accrue dans les masques laryngés pourrait améliorer la PFO mais pourrait également entraîner davantage de complications pharyngo-laryngées en période postopératoire. Cette étude a été conçue afin de comparer la PFO du LMA Supreme à différentes pressions intra-ballonnet.

Méthode

Cent vingt-trois patients ont été aléatoirement répartis en trois groupes. L’anesthésie générale était standardisée pour tous : induction au propofol et fentanyl, puis maintien à l’aide de desflurane dans un mélange air-oxygène. Les pressions intra-ballonnet du LMA Supreme ont été ajustées à 80 cm H2O, 60 cm H2O, et 40 cm H2O selon le groupe. Le critère d’évaluation principal était la PFO. Les critères secondaires comprenaient les complications pharyngo-laryngées postopératoires et les scores de satisfaction des patients et des anesthésiologistes. La PFO a été comparée entre les groupes à l’aide d’une analyse de variance avec correction de Bonferroni. Toutes les valeurs P rapportées sont bilatérales.

Résultats

La PFO avec une pression intra-ballonnet de 80 cm H2O était significativement plus élevée que celle avec 60 cm H2O et 40 cm H2O (26 [6] vs 20 [6] vs 18 [5] cm H2O, respectivement; P < 0,001). L’incidence de complications pharyngo-laryngées postopératoires (P = 0,6), les scores de satisfaction des patients (P = 0,2) et les scores de satisfaction des anesthésiologistes (P = 0,8) étaient comparables dans les trois groupes.

Conclusion

Une pression intra-ballonnet de 80 cm H2O avec le LMA Supreme est associée à une PFO plus élevée qu’une pression de 60 cm H2O ou 40 cm H2O sans être accompagnée d’une incidence plus élevée de complications pharyngo-laryngées postopératoires. Pour une étanchéité glottique supérieure lors de l’utilisation du LMA Supreme, nous recommandons des pressions intra-ballonnet allant jusqu’à 80 cm H2O.

Notes

Funding

Departmental funding supported the submitted works.

Funding

The laryngeal mask airway Supreme™ medical devices used in this study were supplied by Vitaid Canada Inc. Vitaid had no role in the design, analysis, or interpretation of the study.

Conflicts of interest

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2011

Authors and Affiliations

  • Lianfeng Zhang
    • 1
  • Edwin Seet
    • 2
  • Vanita Mehta
    • 1
  • Rajeev Subramanyam
    • 1
  • Saravanan P. Ankichetty
    • 1
  • David T. Wong
    • 1
  • Frances Chung
    • 1
  1. 1.Department of AnesthesiaUniversity Health Network, University of TorontoTorontoCanada
  2. 2.Department of AnesthesiaAlexandra Health Private Limited, Khoo Teck Puat HospitalSingaporeSingapore

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