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Routine use of the intubating laryngeal mask airway results in increased upper airway morbidity

[L'utilisation courante du masque laryngé d'intubation augmente la morbidité des voies aériennes supérieures]

Shinichi Kihara^*, Yuuichi Yaguchi^*, Joseph Brimacombe, Seiji Watanabe^* and Noriko Taguchi^*

^* From the Department of Anaesthesia, Pain Clinic, and Clinical Toxicology, Mito Saiseikai General Hospital, Ibaraki, Japan; and the
University of Queensland, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia.

Address correspondence to: Prof. J. Brimacombe, University of Queensland, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Phone: 61 7 40 506960; Fax: 61 7 40 311628; E-mail: jbrimacombe{at}austarnet.com.au

Purpose: The classic laryngeal mask airway (LMA) has a soft, silicone tube and the intubating laryngeal mask airway (ILM) has a rigid, silicone-coated steel tube. We compare postoperative pharyngolaryngeal morbidity in patients randomised to receive either device.

Methods: Sixty-five female patients (ASA physical status class I or II, aged 18–80 yr) undergoing balanced regional anesthesia for gynecological laparotomy expected to last one to two hours were randomly assigned for airway management with the LMA or ILM. Intracuff pressure was maintained at 60 cm H₂O. Postoperative pharyngolaryngeal morbidity (sore throat, difficulty swallowing, sore mouth, sore neck/jaw, hoarseness) was assessed at two, 24 and 48 hr by blinded investigators.

Results: The number of insertion attempts and duration of anesthesia was similar between groups. Sore throat was more common for the ILM at two hours (44 vs 15%, P=0.01), 24 hr (59 vs 21%, P=0.008) and 48 hr (34 vs 3%, P=0.005). Sore mouth was more common for the ILM at two hours (16 vs 0%, P=0.02) and 24 hr (12 vs 0%, P=0.04), but not at 48 hr (6 vs 3%). Difficulty swallowing was more common for the ILM at two hours (25 vs 0%, P=0.04), but not at 24 hr (31 vs 3%) and 48 hr (12 vs 9%). There were no differences in the incidence of sore jaw/neck (ILM, 3–12%; LMA, 0–3%) and hoarseness (ILM, 12–31%; LMA, 16–18%). There was no correlation between postoperative pharyngolaryngeal morbidity and duration of anesthesia.

Conclusion: Pharyngolaryngeal morbidity is more common with the ILM than the LMA following anesthesia lasting one to two hours.

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