Clinical application of limiting laryngeal mask airway cuff pressures utilizing inflating syringe intrinsic recoil
David M. Corda1, Christopher B. Robards2, Mark J. Rice3, Timothy E. Morey1, Nikolaus Gravenstein1, Terrie Vasilopoulos1,4, Sorin J. Brull2
1 Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
2 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
3 Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
4 Department of Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
Background. Overinflation of the laryngeal mask airway (LMA) cuff may cause many of the
complications associated with the use of the LMA. There is no clinically acceptable (cost effective and practical) method to ensure cuff pressure is maintained below the manufacturer’s recommended maximum value of 60 cm H2O (44 mmHg). We studied the use of the intrinsic recoil of the LMA inflating syringe as an effective and practical way to limit cuff pressures at or below the manufacturer’s recommended values.
Methods. We enrolled 332 patients into three separate groups: LMAs inserted and inflated per standard practice at the institution with only manual palpation of the pilot balloon; LMA cuff pressures measured by a pressure transducer and reduced to < 60 cm H2O (44 mmHg); and LMA intra-cuff pressure managed by the intrinsic recoil of the syringe.
Results. There were no statistically significant differences between the pressure transducer group and the syringe recoil group for initial cuff pressure or cuff pressure 1 hour after surgery. Both the syringe recoil group and pressure transducer group were less likely than the standard practice group to have sore throat and dysphagia 1 hour after surgery. These differences remained 24 hours after surgery.
Conclusions. Syringe recoil provides an efficient and reproducible method similar to manometry in preventing overinflation of the LMA cuff and decreasing the incidence of postoperative laryngopharyngeal complications.
Keywords: laryngeal mask airway, sore throat, postoperative complications