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PubMed1999

Effects on vocal function and incidence of laryngeal disorder when using a laryngeal mask airway in comparison with an endotracheal tube.

A study of 56 patients was undertaken to determine whether there is a difference in the effect of the laryngeal mask airway and the endotracheal tube on the vocal tract after short-duration anaesthesia. All the patients were interviewed pre- and post-operatively. In 43 patients, it was possible to assess the larynx using videoendoscopy and videostrobolaryngoscopy both pre- and post-operatively. Selected acoustic characteristics were investigated in 51 patients pre- and 18-24 h post-operatively. Thirty-four patients that did not have anaesthesia were used as an age-matched control. The interview showed, that patients in the LMA group complained less frequently of having post-operative laryngeal discomfort. The videostrobolaryngoscopy demonstrated minor lesions of the vocal tract in six patients in the ETT group and in one patient in the LMA group. Of the 12 voice variables evaluated, there was no significant difference in any parameter between the two groups. Both groups had a higher fundamental frequency post-operatively.

Adolescent↗
PubMed1993

Resistance to constant air flow imposed by the standard laryngeal mask, the reinforced laryngeal mask and RAE tracheal tubes.

The reinforced laryngeal mask airway (RLMA) has been introduced recently for head and neck surgery. Its resistance to constant air flow has been measured and compared with that of the standard laryngeal mask airway (LMA). The RLMA resistance has also been compared with that imposed by the standard oral Ring-Adair-Elwyn (RAE) tube of a corresponding size for a given patient. The resistance to gas flow of the new RLMA was approximately three to five times that of the LMA at two flow rates (0.5 and 1.0 litre s-1). The resistance of the RLMA 4 was intermediate between that of RAE tubes sizes 8 and 9 mm, and that of RLMA 2 intermediate between that of RAE tubes sizes 5 and 6 mm.

Air Pressure↗
PubMed2000

Comparison of succinylcholine with two doses of rocuronium using a new method of monitoring neuromuscular block at the laryngeal muscles by surface laryngeal electromyography.

We compared the onset of neuromuscular block with succinylcholine (1 mg kg-1) and two doses of rocuronium (0.6 and 0.9 mg kg-1) at the adductor pollicis muscle using electromyography (EMG) and acceleromyography (AMG), and at the adductor laryngeal muscles with a new electromyographic method using a disposable surface electrode attached to the cuff of a tracheal tube. At the larynx, the mean (+/- SD) time to 90% block and the onset time of succinylcholine (38 +/- 15 and 47 +/- 19 s, respectively) were significantly shorter (P < 0.01) than for rocuronium 0.6 mg kg-1 (92 +/- 42 and 106 +/- 38 s) and rocuronium 0.9 mg kg-1 (52 +/- 31 and 64 +/- 30 s). We found that, with comparable degrees of neuromuscular block, the onset time of succinylcholine at the adductor pollicis was significantly shorter (P < 0.01) than for rocuronium 0.6 mg kg-1 and 0.9 mg kg-1 (EMG, 80 +/- 39 vs 145 +/- 48 s and 99 +/- 31 s; AMG, 90 +/- 39 vs 124 +/- 53 s and 106 +/- 38 s). Clinical duration at the adductor pollicis (AMG) was significantly longer (P < 0.01) for both rocuronium groups than for succinylcholine (T4:T1 = 0.7, 54 +/- 18 and 77 +/- 21 vs 8 +/- 6 min). The surface laryngeal electrode proved non-invasive, easy to use and reliable in measuring onset of the neuromuscular block at the larynx.

Adult↗
PubMed2002

Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques.

BACKGROUND: The efficacy of delivery of mechanical ventilation through different airway devices during fibreoptic intubation is not known. METHODS: We compared the laryngeal mask airway (LMA), intubating laryngeal mask (ILM) and endoscopy mask for positive pressure ventilation (PPV) during fibreoptic intubation. In 80 adult paralysed patients, fibreoptic intubation was performed during PPV using a combination of a size 3 or 4 LMA with a 6.0 mm nasal RAE tracheal tube (LMA3/4 group; n=22), a size 5 LMA with a 7.0 mm nasal RAE tube (LMA5 group; n=18), an ILM with an 8.0 mm special reinforced tracheal tube (ILM group; n=20) or an endoscopy mask (Patil mask) with a 7.5 mm standard tracheal tube (Patil group; n=20). The inspiratory and expiratory tidal volumes (VI and VE) with a ventilation pressure of 20 cm H2O were measured using a pneumotachograph. RESULTS: Mean VE values during fibreoptic intubation in the LMA5 [5.3 (SD 1.5) ml kg(-1)] and ILM [7.1 (2.3) ml kg(-1)] groups were greater than in the LMA3/4 group [2.6 (1.0) ml kg(-1), P<0.0001]. The mean VE was greater in the Patil group [20.6 (4.9) ml kg(-1)] than in the other three groups (P<0.0001). Gastric insufflation during intubation was more frequent in the Patil group (30%) than in the other three groups (4.5-5.6%) (P<0.05). CONCLUSION: PPV is possible with the LMA, ILM or endoscopy mask during fibreoptic intubation. With an airway pressure of 20 cm H2O, ventilation during intubation using a size 3 or 4 LMA was almost insufficient, while ventilation using a size 5 LMA or an ILM was almost acceptable. Ventilation during intubation with the endoscopy mask was greater than that with the LMA or ILM, but gastric insufflation was more frequent.

Adult↗
PubMed2003

Comparison of the standard laryngeal mask airway and the ProSeal laryngeal mask airway in obese patients.

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) may have advantages over the laryngeal mask airway (LMA) in obese patients. We tested this hypothesis in a clinical setting. METHODS: Sixty obese patients (BMI >30) were randomized to receive mechanical ventilation (tidal volume 7 ml kg(-1), PEEP 10 cm H(2)O), through either the PLMA or the LMA. A gastric tube was used in all patients. Cuff pressure was set at 60 cm H(2)O and increased progressively until excessive leak occurred. The incidence of sore throat was assessed at recovery and after 1 week. RESULTS: The mean leak fraction was 6.1 (SD 2.9)% with the LMA and 6.4 (3.5)% with the PLMA (P=0.721). With the PLMA, with no sign of ventilation problems, the drainage tube was not patent in three patients. The cuff pressure was >100 cm H(2)O in 38% of the LMA group and 7% of the PLMA group (P=0.05). The incidence of sore throat was similar in both groups and it was similarly scored in the recovery room and 1 week after surgery. CONCLUSIONS: Both the PLMA and the LMA can be used for mechanical ventilation of obese patients. The patency of the PLMA drainage tube needs to be checked constantly even when an optimal airtight seal is present. In obese patients the LMA requires a greater cuff pressure than the PLMA, but sore throat is not related to the cuff pressure. Sore throat assessment in the recovery room appears as reliable as assessment later.

Adult↗
PubMed2000

Comparison of laryngeal mask and intubating laryngeal mask insertion by the naïve intubator.

Seventy-five inexperienced participants were timed inserting the laryngeal mask airway (LMA) and the intubating laryngeal mask (ILM) in one of five cadavers. Adequacy of ventilation was assessed on a three-point scale depending on chest expansion and air leak. Participants were also asked to intubate the trachea via the ILM. The ILM was inserted faster than the LMA (P < 0.05) with a greater proportion achieving adequate ventilation after their first attempt (P < 0.05). Tracheal intubation via the ILM was completed successfully by 67% (52 of 75) of participants. In a questionnaire, participants stated that the ILM was easier to use and the preferred device in an emergency. The results suggest that inexperienced practitioners should use the ILM rather than the LMA for emergency ventilation.

Cadaver↗
PubMed2003

A comparison of the ProSeal laryngeal mask and the laryngeal tube in spontaneously breathing anesthetized patients.

In this multicenter, randomized study, we compared ease of insertion, postinsertion hemodynamic repercussion, quality of ventilation, and the capacity to achieve a "hands-free" anesthesia delivery between two new devices: the ProSeal laryngeal mask airway (PLMA) and the Laryngeal Tube (LT). The incidence of postoperative laryngopharyngeal discomfort was examined after short surgical interventions in spontaneously breathing patients. After induction with fentanyl and propofol, the respective airways were inserted into 70 adult ASA physical status I and II patients (35 patients in each group). First-attempt insertion success rates were more frequent for the PLMA (77% versus 51%; P < 0.05), but success rates were similar (100% versus 97%) after 3 attempts. The anesthesiologists considered that insertion of the PLMA was easier (P < 0.001). Expired tidal volume was larger with the PLMA (404.9 versus 328.4 mL; P < 0.005) and the ability to achieve hands-free ventilation was more frequent with the PLMA (32 versus 21 cases; P < 0.004). Positional maneuvers with the LT to correct ventilation deficiencies were not always completely effective (5 of 13). There were no differences in the incidence of intolerance, sore throat, dysphagia, and/or dysphonia between the two devices. We conclude that the PLMA showed greater ease of insertion and reliability than the LT for use in nonparalyzed anesthetized patients.

Adolescent↗
PubMed1999

Recovery of laryngeal sensation after superior laryngeal nerve anastomosis.

OBJECTIVES/HYPOTHESIS: Reliable motor reinnervation has been show in multiple laryngeal transplant studies; however, sensory reinnervation of the larynx after nerve anastomosis has yet to be demonstrated. The role of sensory nerve anastomosis in the transplanted larynx in unknown, but is thought to be necessary to provide airway protection. A canine model was developed to examine the possibility of reformation of sensory pathways in the larynx after nerve section and anastomosis. STUDY DESIGN: Randomized controlled experiment. METHODS: Ten canines were randomly assigned to two groups. Hydrochloric acid-induced laryngospasm was demonstrated in every dog. All dogs then had their necks explored, and the internal branch of the superior laryngeal nerve was identified and transected bilaterally. Following nerve section all dogs were retested for an acid-induced laryngospasm reflex. The control group had their wounds closed and were then awakened from anesthesia. The study group underwent microscopic anastomosis of their sensory nerves. Following a 6-month period the two groups of dogs were compared for the presence of the laryngospasm reflex. RESULTS: No dog in the control group had a response to the acid. All dogs in the study group had some response to the acid, although none of them had return of true laryngospasm. CONCLUSION: We concluded that sensory reinnervation does occur after nerve anastomosis, but the recovery of sensation may be incomplete or altered.

Anastomosis, Surgical↗
PubMed2005

Comparison of the intubating laryngeal mask airway and laryngeal tube placement during manual in-line stabilisation of the neck.

We compared the placement of the laryngeal tube (LT) with the intubating laryngeal mask airway (ILMA) in 51 patients whose necks were stabilised by manual in-line traction. Following induction of anaesthesia and neuromuscular blockade, the LT and ILMA were inserted consecutively in a randomised, crossover design. Using pressure-controlled ventilation (20 cmH(2)O inspiratory pressure), we measured insertion attempts, time to establish positive-pressure ventilation, tidal volume, gastric insufflation, and minimum airway pressure at which gas leaked around the cuff. Data were compared using Wilcoxon signed-rank tests; p < 0.05 was considered significant. Insertion was found to be more difficult with the LT (successful at first attempt in 16 patients) than with the ILMA (successful at first attempt in 42 patients, p < 0.0001). Time required for insertion was longer for the LT (28 [23-35] s, median [interquartile range]) than for the ILMA (20 [15-25] s, p = 0.0009). Tidal volume was less for the LT (440 [290-670] ml) than for the ILMA (630 [440-750] ml, p = 0.013). Minimum airway pressure at which gas leak occurred and incidence of gastric insufflation were similar with two devices. In patients whose necks were stabilised with manual in-line traction, insertion of the ILMA was easier and quicker than insertion of the LT and tidal volume was greater with the ILMA than the LT.

Adult↗
PubMed2005

Airway rescue in acute upper airway obstruction using a ProSeal Laryngeal mask airway and an Aintree catheter: a review of the ProSeal Laryngeal mask airway in the management of the difficult airway.

We report the successful use of a ProSeal Laryngeal mask airway (PLMA) to rescue the airway when emergency tracheal intubation and ventilation of the lungs were impossible after haemorrhage into the neck following carotid endarterectomy, despite evacuation of the clot. The airway was re-established after placement of a PLMA. Fibreoptic examination of the airway revealed severe supraglottic swelling compromising airway patency. An Aintree catheter was placed in the trachea under fibreoptic guidance and a tracheal tube railroaded over this. The use of the PLMA in seven cases of difficult airway management and 11 cases of airway rescue is reviewed. Use of the PLMA was associated with high levels of success, often rescuing the airway when other techniques had failed. No complications of use of the PLMA were reported in these cases. The PLMA appears to be a useful device to assist in management of the difficult airway and for airway rescue. Potential advantages over the classic laryngeal mask airway include improved airway seal and reduced risk of aspiration. The gum elastic bougie-guided insertion technique is recommended when the PLMA is used for airway rescue.

Acute Disease↗
PubMed2006

Haemodynamic and catecholamine stress responses to the Laryngeal Tube-Suction Airway and the Proseal Laryngeal Mask Airway.

Supraglottic airway devices such as the ProSeal Laryngeal Mask Airway (PLMA) and Laryngeal Tube-Suction Airway (LTS) that provoke the least stress responses could be beneficial in many situations, especially in patients with cardiovascular disease. We compared the haemodynamic and catecholamine stress response of the LTS and PLMA in a randomised study of 36 patients. Mean arterial pressure, heart rate, epinephrine and norepinephrine levels were all reduced following induction of anaesthesia with no significant differences between the two groups. Following insertion of LTS, mean arterial pressure, heart rate, epinephrine and norepinephrine levels increased to pre-induction levels. However, following the insertion of the PLMA, mean arterial pressure, heart rate, epinephrine and norepinephrine levels remained significantly lower than pre-induction values. Mean arterial pressure, heart rate and epinephrine were significantly greater in the LTS group than in the PLMA group. We conclude that the LTS produces a greater and more sustained haemodynamic and catecholamine stress response than does the PLMA.

Adolescent↗
PubMed2006

Comparison of airway management with the intubating laryngeal mask, laryngeal tube and CobraPLA by paramedical students in anaesthetized patients.

BACKGROUND: Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). METHODS: We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. RESULTS: Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB (P<0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB (P=not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. CONCLUSION: Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff.

Anesthesia, General↗
PubMed2006

Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients.

BACKGROUND: The laryngeal tube (LT) is a supraglottic ventilatory device used in adults. However, there is limited information about LT use in pediatric patients. This randomized controlled study compares LT with laryngeal mask (LMA) for airway management during spontaneous or assisted ventilation and during fiberoptic laryngoscopy in children. METHODS: Thirty children under 10-years old, ASA I-II, scheduled for minor general surgery, Mallampati score I-II, fasted and premedicated were included. Patients with upper respiratory infection, craniofacial malformation, intracranial hypertension, emergency surgery were excluded. The primary outcome measure was the proportion of patients in whom effective spontaneous or assisted ventilation [Vt > or = 4 ml.kg(-1), SpO2 > or = 95% with FiO2 0.4, P(E)CO2 < or = 7.2 kPa (55 mmHg)] was achieved after 3 min of LT or LMA cuff inflation. The secondary endpoint was the proportion of patients in whom fiberoptic laryngoscopy resulted in identification of the vocal cords. RESULTS: Eleven children with LMA and two children in LT group had adequate spontaneous or assisted ventilation after initial positioning (P < 0.01). After head extension or device repositioning 15 of 15 patients in LMA group had adequate ventilation compared with 11 of 15 patients in LT group (P < 0.05). The vocal cords could be observed with fiberoptic laryngoscopy in 11 LMA group patients compared with no patients in the LT group (P < 0.001). CONCLUSIONS: The LT is less effective than the LMA to allow adequate spontaneous or assisted ventilation and for fiberoptic evaluation of the airway in children under 10 years old.

Anesthesia, General↗
PubMed2006

Prospective, randomized comparison of laryngeal tube and laryngeal mask airway in pediatric patients.

BACKGROUND: While reports of the use of laryngeal mask airway (LMA)-Classic in great patient numbers are available, data on the use of the laryngeal tube (LT) in this age group is limited. The two devices are compared in a prospective randomized trial to evaluate success rates and quality of airway seal. METHODS: Sixty children, aged 2-8 years, scheduled for elective surgical interventions were randomized to be ventilated with LMA or LT. Standardized anesthesia was induced with fentanyl and propofol. Number of insertion attempts, time until first tidal volume and intraoperative tidal volumes, and peak pressures were recorded. Airway leak pressure was measured with cuff pressure adjusted to 60 cmH(2)O. RESULTS: Demographic data were comparable, average age in the LMA/LT group was 5.2 +/- 1.9/5.3 +/- 1.9 years. Insertion was successful in 29 of 30 patients in the LMA group (second attempt 8) and in all patients in the LT group (second attempt 3). Time until first tidal volume for LMA/LT was 23.1 +/- 7.3/19.2 +/- 8.6 s (P < 0.05). Peak airway pressures for LMA and LT were 15.3 +/- 3.4 and 17.1 +/- 4.0 cmH(2)O (P < 0.05) with tidal volumes of 10.2 +/- 2.2 and 10.2 +/- 1.9 ml.kg(-1), airway leak pressure was 19.2 +/- 8.6 cmH(2)O for LMA and 26.3 +/- 7.3 cmH(2)O for LT (P < 0.001). CONCLUSION: Insertion success rate is high with both LMA and LT in the age group studied. The airway leak pressure, serving as an estimate to judge quality of airway seal, is higher with the LT.

Air Pressure↗
PubMed2001

Effect of recurrent laryngeal nerve paralysis on superior laryngeal nerve afferents during evoked vocalization.

We tested the hypothesis that vocal fold paresis leads to a substantial reduction in activity from the internal branch of the superior laryngeal nerve (iSLN) during respiration and evoked vocalization. The iSLN afferent activity was measured before and after recurrent laryngeal nerve paresis by cold block in decerebrate cats during spontaneous respiration and electrically evoked vocalization. Response rate patterns of 33 iSLN single units from 11 cats were categorized into 5 groups based on responses to vocalization. Only 24% of single units during spontaneous respiration and 18% during evoked phonation displayed activity pattern changes as a result of paresis. Those fibers affected were heterogeneous in discharge pattern, but none of the units that followed voice frequency lost this characteristic when the motor nerve was cooled. The relative insensitivity of iSLN activity to motor paralysis suggests that the receptors studied are coupled to tissue such that passive interaction rather than active muscular contraction is the major stimulus.

Animals↗
PubMedDate not supplied

Laryngeal phonatory reflex. The effect of anesthetization of the internal branch of the superior laryngeal nerve: Acoustic aspects.

Summary--The laryngeal phonatory reflex through the internal branch of the superior laryngeal nerve (SLN) was investigated by means of anesthetization of the nerve, after which acoustic signals were subjected to computer analysis to determine how anesthesia affected basic vocal parameters. Results showed that the anesthetization did not affect the abrupt cycle-to-cycle frequency changes and also did not influence the gross control of the fundamental frequency. But slower fluctuation of the fundamental frequency increased following anesthesia. From these results, it is suggested that the anesthetization of the internal branch of the SLN may derange the fine control mechanism of the larynx without affecting overall or gross performance of the phonatory apparatus.

Humans↗