The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme® on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study

• Published in: BMC anesthesiology 2014-01, Vol.14 (1), p.2-2, Article 2
• Main Authors: Bergmann, Ingo, Crozier, Thomas Allen, Roessler, Markus, Schotola, Hanna, Mansur, Ashham, Büttner, Benedikt, Hinz, José Maria, Bauer, Martin
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia, General - instrumentation; Anesthesia, General - methods; Blood pressure; Entropy; Equipment Design - instrumentation; Equipment Design - standards; Female; Glottis - anatomy & histology; Glottis - physiology; Humans; Laryngeal Masks - standards; Laryngoscopes - standards; Laryngoscopy - instrumentation; Laryngoscopy - methods; Male; Middle Aged; Morbidity; Prospective Studies; Pulmonary Ventilation - physiology; Ventilation
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/1471-2253-14-2

The conventional sequence when using supraglottic airway devices is insertion, cuff inflation and fixation. Our hypothesis was that a tighter fit of the cuff and tip could be achieved with a consequently lower incidence of air leak, better separation of gastrointestinal and respiratory tracts and less airway morbidity if the device were first affixed and the cuff then inflated. Our clinical review board approved the study (public registry number DRKS00003174). An LMA Supreme® was inserted into 184 patients undergoing lower limb arthroscopy in propofol-remifentanil anaesthesia who were randomly assigned to either the control (inflation then fixation; n = 92) or study group (fixation then inflation; n = 92). The cuff was inflated to 60 cmH2O. The patients' lungs were ventilated in pressure-controlled mode with 5 cmH2O PEEP, Pmax to give 6 ml kg-1 tidal volume, and respiratory rate adjusted to end-tidal CO2 of 4.8 and 5.6 kPa. Correct cuff and tip position were determined by leak detection, capnometry trace, oropharyngeal leak pressure, suprasternal notch test, and lube-tube test. Bowl and cuff position and the presence of glottic narrowing were assessed by fiberscopic examination. Postoperative dysphagia, hoarseness and sore throat were assessed with a questionnaire. Ventilatory impairment was defined as a tidal volume