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INFLUENCE OF NEUROMUSCULAR BLOCK DURING POSITIVE PRESSURE VENTILATION USING A LARYNGEAL MASK AIRWAY ON POSTOPERATIVE LARYNGO-PHARYNGEAL DISCOMFORT.

¹ Université de Montréal, Department of Anesthesiology, Hôtel-Dieu, 3840 Rue St-Urbain, Montréal, PQ, H2Y 1T8, Canada,
² University Friedrich-Alexander, Erlangen, Krankenhausstr. 12, Erlangen, 91054, Germany

INTRODUCTION

The purpose of this study was to evaluate the influence of neuromuscular block (NMB) during positive pressure ventilation (PPV) using a laryngeal mask airway (LMA) on the incidence of postoperative laryngo-pharyngeal discomfort.

METHODS

After approval of the local Ethics Committee and informed consent, 130 patients undergoing general surgery in LMA were included in the study. Anesthesia was induced by remifentanil/propofol and maintained using remifentanil/ sevoflurane (oxygen/air 30 %, PPV). Patients were randomly assigned to receive no neuromuscular blocking agent (Group A) or boli of cisatracurium titrated to establish and maintain no visual response of the corrugator supercilii muscle after TOF stimulation (Group B). Prior to the end of surgery, morphine 3 - 5 mg IV was injected. The ease of insertion of the LMA, cuff- and inspiratory pressures were recorded. Patients were asked immediately postop. (S1), 2 hours postop. (S2) and 24 h after surgery (S3) to rate sore throat, dysphonia or dysphagia as not existent, minimal, moderate or severe. Continuous data were compared using t-test, categorical variables using Chi-squared test (P<0.05).

RESULTS

LMA insertion was possible in all patients, age, sex, weight distribution was not different between the groups (A, N= 68, B, N= 62). Results are presented in Table 1 (no patient had any complaints of scores higher than moderate) and did not differ between the groups.

Despite high cuff pressures, the incidence of laryngopharyngeal discomfort was lower than previously recorded (1). Our findings cannot support the theory that positive pressure ventilation using a LMA without NMB increases the incidence of sore throat or dysphonia (1).

REFERENCES

1 Can J Anaesth 1999; 46: 220–5[Abstract/Free Full Text]

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