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GENERAL ARTICLES

Do Laryngeal Mask Airway Devices Attenuate Liquid Flow Between the Esophagus and Pharynx? A Randomized, Controlled Cadaver Study

C. Keller, MD^*, J. Brimacombe, MB, ChB, FRCA, MD, C. Rädler^*, and F. Pühringer, MD^*

*Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria; and University of Queensland, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia

Address correspondence and reprint requests to Dr. J. Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to 100236,2343{at}compuserve.com

In this randomized, controlled cadaver study, we tested the hypothesis that the standard laryngeal mask airway (LMA) and flexible laryngeal mask airway (FLMA) attenuate liquid flow between the esophagus and pharynx. Fifty fresh cadavers were studied in four LMA groups. Ten female cadavers had a size 4 LMA and 10 had a size 4 FLMA; 10 male cadavers had a size 5 LMA and 10 had a size 5 FLMA; 5 male and 5 female cadavers functioned as controls. The chest was opened, and the infusion set of a pressure-controlled, continuous flow pump was inserted into the esophagus and ligated into place. Esophageal pressure was increased in 2-cm H₂O increments. Regurgitation pressure was the esophageal pressure at which fluid was first seen with a fiberoptic scope in the hypopharynx (control group) and above the cuff or within the bowl (LMA groups). This was performed in the LMA groups at 0–40 mL cuff volume in 10-mL increments. Mean (95% confidence interval) regurgitation pressure for the control group was 7 (6–8) cm H₂O and for the LMA groups combined was 19 (17–20) cm H₂O at 0 mL cuff volume, 47 (41–52) cm H₂O at 10 mL, 51 (44–55) cm H₂O at 20 mL, 52 (45–56) cm H₂O at 30 mL, and 52 (45–55) cm H₂O at 40 mL. The increase in regurgitation pressure with increasing cuff volume from 0 to 10 mL was statistically significant (P < 0.0001). Regurgitation pressure was higher for the LMA groups at all cuff volumes compared with the control group (P < 0.0001). There were no differences in regurgitation pressure among the LMA groups. We conclude that the correctly placed LMA and FLMA attenuate liquid flow between the esophagus and pharynx.

Implications: We have shown, in cadavers, that the correctly placed standard and flexible laryngeal mask airways attenuate liquid flow between the pharynx and esophagus.

This article has been cited by other articles:

				W. Schmidbauer, S. Bercker, T. Volk, G. Bogusch, G. Mager, and T. Kerner Oesophageal seal of the novel supralaryngeal airway device I-GelTM in comparison with the laryngeal mask airways ClassicTM and ProSealTM using a cadaver model Br. J. Anaesth., January 1, 2009; 102(1): 135 - 139. [Abstract] [Full Text] [PDF]

				S. Bercker, W. Schmidbauer, T. Volk, G. Bogusch, H. P. Bubser, M. Hensel, and T. Kerner A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure Anesth. Analg., February 1, 2008; 106(2): 445 - 448. [Abstract] [Full Text] [PDF]

				R. S. Vaughan, I. T. Campbell, S. Patel, G. Turner, J. Brimacombe, and C. Keller Aspiration and the laryngeal mask airway Br. J. Anaesth., April 1, 2005; 94(4): 545 - 547. [Full Text] [PDF]

				C. Keller, J. Brimacombe, J. Bittersohl, P. Lirk, and A. von Goedecke Aspiration and the laryngeal mask airway: three cases and a review of the literature Br. J. Anaesth., October 1, 2004; 93(4): 579 - 582. [Abstract] [Full Text] [PDF]

				A. Ng and G. Smith Gastroesophageal Reflux and Aspiration of Gastric Contents in Anesthetic Practice Anesth. Analg., August 1, 2001; 93(2): 494 - 513. [Abstract] [Full Text] [PDF]

				C. Keller and J. Brimacombe Resting Esophageal Sphincter Pressures and Deglutition Frequency in Awake Subjects After Oropharyngeal Topical Anesthesia and Laryngeal Mask Device Insertion Anesth. Analg., July 1, 2001; 93(1): 226 - 229. [Abstract] [Full Text] [PDF]

				C. Keller, J. Brimacombe, A. Kleinsasser, and A. Loeckinger Does the ProSeal Laryngeal Mask Airway Prevent Aspiration of Regurgitated Fluid? Anesth. Analg., October 1, 2000; 91(4): 1017 - 1020. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999