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The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases

[Le masque laryngé est efficace et, probablement, sans risque pour une césarienne non urgente chez des parturientes en bonne santé : une étude prospective de 1 067 cas]

Tae-Hyung Han, MD PhD FAAFP^*, Joseph Brimacombe, MB CHB FRCA MD, Eun-Ju Lee, MD and Hong-Seuk Yang, MD PhD³

^* From the Department of Anesthesiology Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea;
the Department Of Anaesthesia and Intensive Care, Cairns Base Hospital, University of Queensland, Cairns, Australia; and
the Department Of Anesthesiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

Dr. Hong-Seuk Yang, Department of Anesthesiology, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 PungNap-Dong, SongPa-Ku, Seoul, Korea 138-736. Phone: +82-2-2224-3868; Fax: +82-2-470-1363 E-mail: hsyang@www.amc.seoul.kr

Purpose: To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I–II patients preferring general anesthesia.

Methods: Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N₂O and 50% O₂ and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO₂ <94%, or end-tidal CO₂ >45 mmHg. Postdelivery, vecuronium and fentanyl were administered.

Results: An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO₂ <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were 7 after five minutes.

Conclusion: We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.

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