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GENERAL ARTICLES

Resting Esophageal Sphincter Pressures and Deglutition Frequency in Awake Subjects After Oropharyngeal Topical Anesthesia and Laryngeal Mask Device Insertion

Christian Keller, MD^*, and Joseph Brimacombe, MB, ChB, FRCA, MD

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

Address correspondence to Prof. J. Brimacombe, Department of Anaesthesia and Intensive Care Medicine, University of Queensland, Cairns Base Hospital, Cairns 4870, Australia. Address e-mail to jbrimacombe{at}austarnet.com.au

We investigated the effects of oropharyngeal topical anesthesia and placement of the standard (LMA) and the ProSeal (PLMA) laryngeal mask airway on resting gastroesophageal barrier pressure (GEBP), upper esophageal sphincter pressure (UESP), and deglutition frequency in awake subjects. Each subject was studied on 2 consecutive days: 1 day with the LMA and the other with the PLMA, in random order. GEBP and UESP were measured between deglutitions by using a pull-through technique in five sequential conditions: 1) after acclimatization to the manometer, 2) after topical anesthesia, 3) after the LMA or PLMA was self-inserted and the cuff inflated with either 10 or 30 mL of air in random order, 4) after the cuff volume was adjusted to the other randomized volume, and 5) after LMA or PLMA removal. Deglutition frequency was determined between pressure measurements by using a neck microphone. UESP was always larger than GEBP (P < 0.001 for all). Topical anesthesia had no influence on GEBP, UESP, or deglutition frequency. LMA and PLMA placement did not influence GEBP or UESP, but deglutition frequency was higher (P < 0.02 for all). GEBP and UESP did not vary between devices for any condition. Cuff volume did not influence GEBP or UESP. Deglutition frequency was more frequent for the LMA than the PLMA at a 30-mL cuff volume (P = 0.008). We conclude that resting GEBP and UESP are unaffected by oropharyngeal topical anesthesia and the LMA or PLMA in awake subjects, but that deglutition frequency is increased by the LMA or PLMA. This may have implications for the incidence of regurgitation in these situations.

Implications: Resting gastroesophageal barrier pressure and upper esophageal sphincterpressure are unaffected by oropharyngeal topical anesthesia and laryngeal maskdevices in awake subjects, but deglutition frequency is increased by laryngealmask devices. This may have implications for the incidence of regurgitation inthese situations.

This article has been cited by other articles:

				T. M. Cook, G. Lee, and J. P. Nolan The ProSealTM laryngeal mask airway: a review of the literature: [Le masque larynge ProSealTM : un examen des publications] Can J Anesth, August 1, 2005; 52(7): 739 - 760. [Abstract] [Full Text] [PDF]

				J. Brimacombe, C. Keller, and T. Asai Who is at increased risk of aspiration? Br. J. Anaesth., February 1, 2005; 94(2): 251 - 252. [Full Text] [PDF]

				H. G. Wagner-Berger, V. Wenzel, W. G. Voelckel, K. Rheinberger, K. H. Stadlbauer, T. Muller, S. Augenstein, A. von Goedecke, K. H. Lindner, and C. Keller A Pilot Study to Evaluate the SMART BAG(R): A New Pressure-Responsive, Gas-Flow Limiting Bag-Valve-Mask Device Anesth. Analg., December 1, 2003; 97(6): 1686 - 1689. [Abstract] [Full Text] [PDF]

				N. R. Evans, R. L. Llewellyn, S. V. Gardner, and M. F.M. James Aspiration prevented by the ProSealTM laryngeal mask airway: a case report: [Prevention de l'aspiration par le masque larynge ProSealTM : une etude de cas] Can J Anesth, April 1, 2002; 49(4): 413 - 416. [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