CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Related articles in CJA
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brimacombe, J.
Right arrow Articles by Keller, C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Brimacombe, J.
Right arrow Articles by Keller, C.
Canadian Journal of Anesthesia 50:526 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

REPLY

Joseph Brimacombe, MD1 and Christian Keller, MD2

1 Cairns, Australia
2 Innsbruck, Austria

We thank Drs. Matioc and Arndt for their interest in our paper. We agree that intracuff pressure limitation is seldom performed, but should be a standard of practice with any cuffed extraglottic airway device to reduce mucosal pressure. The target intracuff pressure should be the minimum required to form an effective seal with the respiratory tract (all devices) and gastrointestinal tract (those devices with distal cuffs in the hypopharynx or esophagus). Determining the seal with the respiratory tract is easy since intracuff pressure can be titrated against ventilation; however, determining the seal with the gastrointestinal tract is difficult since air usually leaks out the mouth rather than into the esophagus.1 We suggest that cuff volume is adjusted so that there is a slight oropharyngeal leak at the required ventilatory setting and then adding air until this leak just disappears. This intracuff pressure should be the target pressure for subsequent adjustments. It is important to appreciate that for most extraglottic devices, including the laryngeal tube airway, intracuff pressure is much higher than mucosal pressure due to the elastic properties of the cuff.2 An easy way to determine mucosal pressure is to subtract in vivo from in vitro intracuff pressure for a given cuff volume. Finally, another clinical test that is seldom performed, but should be a standard of practice, and which is perhaps more important than intracuff pressure limitation, is epigastric auscultation. Epigastric auscultation can detect gastric insufflation of 4 mL air after one breath with 95% confidence.3

References

1 Brimacombe JR. Positive pressure ventilation with the size 5 laryngeal mask. J Clin Anesth 1997; 9: 113–7.[Medline]

2 Brimacombe J, Keller C, Roth W, Loeckinger A. Large cuff volumes impede posterior pharyngeal mucosal perfusion with the laryngeal tube airway. Can J Anesth 2002; 49: 1084–7.[Abstract/Free Full Text]

3 Brimacombe J, Keller C, Kurian S, Myles J. Reliability of epigastric auscultation to detect gastric insufflation. Br J Anaesth 2002; 88: 127–9.[Abstract/Free Full Text]


Related articles in CJA:

The laryngeal tube and pharyngeal mucosal pressure
Adrian A. Matioc and George Arndt
CJA 2003 50: 525-526. [Full Text]  




This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Related articles in CJA
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Brimacombe, J.
Right arrow Articles by Keller, C.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Brimacombe, J.
Right arrow Articles by Keller, C.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS