JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Brimacombe, J. R. Articles by Pühringer, F. Search for Related Content PubMed PubMed Citation Articles by Brimacombe, J. R. Articles by Pühringer, F.

---

GENERAL ARTICLES

The Influence of the Tonsillar Gag on Efficacy of Seal, Anatomic Position, Airway Patency, and Airway Protection with the Flexible Laryngeal Mask Airway: A Randomized, Cross-Over Study of Fresh Adult Cadavers

J. R. Brimacombe, MB, ChB, FRCA MD^*, C. Keller, MD, A. R. Gunkel, MD, and F. Pühringer, MD

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

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

We conducted a randomized, controlled, cross-over cadaver study to test the hypothesis that the efficacy of seal for ventilation and airway protection, anatomic position, and airway patency with the flexible laryngeal mask airway (FLMA) are altered by the application of a Boyle Davis (B-D) gag. We also determined the airway sealing pressure (ASP) at which the FLMA prevents aspiration when large volumes of fluid are placed above the cuff. We studied 20 adult cadavers (6–24 h postmortem). Efficacy of seal for ventilation and airway protection, anatomic position, and airway patency were determined with and without a B-D gag (two blade sizes: 8 and 10 cm) for the size 3, 4, and 5 FLMA in random order. Efficacy of seal for ventilation was determined by measuring the ASP at an intracuff pressure of 60 cm H₂O. Efficacy of seal for airway protection was determined by flooding the mouth with 55–135 mL of water, reducing intracuff pressure until aspiration was detected fiberoptically and measuring ASP at this intracuff pressure. Anatomic position and airway patency were determined with a fiberoptic scope at an intracuff pressure of 60 cm H₂O. In addition, in vivo compliance and ASP for the FLMA were measured in 10 cadavers and 10 paralyzed, anesthetized patients. Efficacy of seal for ventilation and airway protection, anatomic position, and airway patency did not change with the application of a gag for any mask size. The mean (range) ASP at which aspiration occurred when large volumes of fluid were placed above the cuff was 11 (7–15) cm H₂O. The ASP for ventilation was always higher than the ASP for airway protection (P < 0.0001). The FLMA had similar in vivo compliance and ASP in cadavers and anesthetized patients. We conclude that efficacy of seal for ventilation and airway protection, anatomic position and airway patency for the FLMA are unaffected by the application of a B-D gag in adults. ASP should be >15 cm H₂O if there is a maximal risk of aspiration from above the cuff.

Implications: The flexible laryngeal mask airway forms an effective seal for ventilation and protection of the airway that is unaffected by the application of a mouth gag that provides surgical access to the oropharynx. The efficacy of the seal should be >15 cm H₂O if there is a maximal risk of aspiration from above the cuff.

This article has been cited by other articles:

				J. Brimacombe, C. Keller, W. Roth, and A. Loeckinger Large cuff volumes impede posterior pharyngeal mucosal perfusion with the laryngeal tube airway: [Un ballonnet de grand volume gene la perfusion de la muqueuse pharyngienne posterieure realisee avec le tube d'intubation laryngee] Can J Anesth, December 1, 2002; 49(10): 1084 - 1087. [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]

				C. Keller, J. Brimacombe, and K. Keller Pressures Exerted Against the Cervical Vertebrae by the Standard and Intubating Laryngeal Mask Airways: A Randomized, Controlled, Cross-Over Study in Fresh Cadavers Anesth. Analg., November 1, 1999; 89(5): 1296 - 1296. [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