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Large cuff volumes impede posterior pharyngeal mucosal perfusion with the laryngeal tube airway

[Un ballonnet de grand volume gêne la perfusion de la muqueuse pharyngienne postérieure réalisée avec le tube d’intubation laryngée]

Joseph Brimacombe, MB CHB FRCA MD^*, Christian Keller, MD, Winfried Roth, MD and Alex Loeckinger, MD

From the Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, 6020, Innsbruck, Austria and University of Queensland and James Cook University,
^* Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia.

Address correspondence to: Prof J. Brimacombe, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Fax: 61 7 40506854; E-mail: jbrimacombe{at}austarnet.com.au

Purpose: The laryngeal tube airway (LTA) is a new extraglottic airway device with a large proximal cuff that inflates in the laryngopharynx and a distal conical cuff that inflates in the hypopharynx. We determine the influence of the cuff volume and anatomic location on pharyngeal mucosal pressures for the LTA.

Methods: Fifteen fresh cadavers were studied. Microchip sensors were attached to the (anatomic location) anterior, lateral and posterior surface of the distal cuff (hypopharynx) and proximal cuff (laryngopharynx) of the size 4 LTA. Oropharyngeal leak pressure (OLP) and mucosal pressures were measured at 0–140 mL cuff volume in 20-mL increments. In addition, mucosal pressures for the proximal cuff were measured in three awake, topicalized volunteers.

Results: OLP and mucosal pressure at all locations increased with cuff volume (all: P < 0.01). Mucosal pressures were highest posteriorly. Mucosal pressures only exceeded 35 cm H₂O (pharyngeal mucosal perfusion pressure) in the anterior and posterior laryngopharynx and when the cuff volume was > 80–100 mL. Mucosal pressures were similar for cadavers and awake volunteers.

Conclusion: Mucosal pressures for the LTA increase with cuff volume, are highest posteriorly and potentially exceed mucosal perfusion pressure when cuff volume exceeds 80–100 mL.

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