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Canadian Journal of Anesthesia 50:967 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

Protection of the airway with the LMA during upper airway surgery

Stuart Dolling, MB BS FRCA, Nicola R.K. Anders, MB CHB FRCA and Sian E. Rolfe, MB CHB FRCA

Stockport, UK

To the Editor:

We read with interest the recent publication by Ahmed and Vohra1 and we agree with their conclusions that the laryngeal mask airway (LMA) provides a safe and reliable airway, although our findings of LMA contamination were rather different.

Following a personal communication with one of the authors (Vohra) we incorporated their scoring system into a study that we were conducting involving the use of laryngeal masks in outpatient pediatric dental surgery.

We recruited 71 patients (ASA I or II, age range 2–15 yr) who were undergoing routine extractions for carious teeth under general anesthesia. The patients were anesthetized with propofol (3–4 mg•kg-1), or via an inhalational induction (O2/N2O/sevoflurane) depending on the ease of venous access and patient preference/compliance. Anesthesia was maintained by spontaneous ventilation with O2/N2O/sevoflurane. Following the extraction of teeth by experienced dental surgeons the LMA was removed when the patients were fully awake. The LMA was immediately examined by one of the authors (Dolling) and scored accordingly.1

Our results are markedly different (TableGo). Short-lived desaturations below 94% were seen in ten of our patients during recovery [three with score 1, four with score 2, three with score 3 (no statistical significance)]. All patients uneventfully met our discharge criteria.


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  		TABLE Comparison of LMA soiling scores in our study with Ahmed/Vohra’s
 
Several articles2,3 have shown that the LMA protects the larynx from fluids above but this may not always be the case. We used standard, rather than reinforced LMAs, which may be associated with increased movement of the LMA during surgery and subsequent reduction in the integrity of the protective seal. Also, our surgeons used only dental packs to stem the flow of blood. This is likely to result in more blood in the airway than in nasal or septal surgery, with subsequently increased pooling above the cuff. An alternative explanation, of the differing results, could simply be that the LMAs were contaminated by intra-oral blood on removal (unlike the Ahmed/Vohra study, no intra-oral suction was performed prior to removal to minimize stimulation).

It would be interesting to clarify the reasons for our different results using reinforced LMAs or a fibreoptic scope to examine the underside of the LMA prior to its removal.

References

1 Ahmed MZ, Vohra A. The reinforced laryngeal mask airway (RLMA) protects the airway in patients undergoing nasal surgery – an observational study of 200 patients. Can J Anesth 2002; 49: 863–6.[Abstract/Free Full Text]

2 John RE, Hill S, Hughes TJ. Airway protection by the laryngeal mask. A barrier to dye placed in the pharynx. Anaesthesia 1991; 46: 366–7.[Medline]

3 Samarkandi AH, Ali MS, Elgammal M, Bakhamees HS. Airway protection by the laryngeal mask airway in children. Middle East J Anaesthesiol 1995; 13: 107–13.[Medline]


Related articles in CJA:

REPLY
M. Zubair Ahmed and Akbar Vohra
CJA 2003 50: 967-968. [Full Text]  




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