Laryngeal Mask Airway Cuff Pressure and its Influence on the Incidence of Pharyngolaryngeal Adverse Effects: Need for Regular Monitoring

Laryngeal Mask Airway Cuff Pressure Adverse Effect.

Abstract

Background: During general anesthesia with laryngeal mask airway (LMA), cuff pressure needs to be maintained at an optimal level in order to prevent endothelial lesions and postoperative pharyngolaryngeal side effects, like cough, sore throat, hoarseness and even mucosal bleeding. This study evaluated the changes in the LMA cuff pressure after insertion with the passage of time and the effect of the increased pressure on the incidence of pharyngolaryngeal adverse effects.

Methodology: Sixty patients (18-60 y) belonging to American Society of Anesthesiologists (ASA) I or II, meeting the inclusion and exclusion criteria were included in the study and were randomly grouped into Groups A and B (n=30 each). They were evaluated and educated about LMA insertion, its advantages and side effects, following which written informed consent was obtained. Pre-anesthetic evaluation was carried out. For Group A, the cuff pressure was monitored every 10 min intra-operatively from the start of surgery and maintained at 60 cmH₂O throughout the surgery. In Group B the cuff was inflated to 60 cmH₂O initially and the cuff pressure was recorded at the end of surgery. The volume of air removed from the cuffs was measured and any postoperative complications immediately after removal of LMA and after 24 h were recorded and tabulated.

Result: The mean cuff pressure in Group A was 61.07 cmH₂O. The mean cuff pressure in Group B was 108.42 cmH₂O and was significantly higher than Group A (p < 0.001). The volume of air removed was also significantly higher in Group B than Group A (p < 0.001). No association of age, gender and ASA classification on the cuff pressures was observed. There were also significantly more postoperative complications in Group B than in Group A, both immediately after and 24 h after removal of LMA.

Conclusion: The results of our study show that while using a laryngeal mask airway during anesthesia, continual monitoring of cuff pressure and its maintenance within the allowable limits is essential in preventing postoperative complications and reducing pharyngolaryngeal morbidity.

Key words: Anesthesia, General; Insufflation; Laryngeal mask airway; Morbidity

Abbreviations: LMA – laryngeal mask airway; LMA-S – Laryngeal mask airway supreme; SAD – supraglottic airway devices; ETT – endotracheal tube; PVC – polyvinylchloride

Citation: Metange H, Kadam S. Laryngeal mask airway cuff pressure and its influence on the incidence of pharyngolaryngeal adverse effects:  need for regular monitoring. Anaesth. pain intensive care 2021;25(4):494–499.

DOI: 10.35975/apic.v25i4.1447

Received: February 01, 2021; Reviewed: April 2, 2021; Accepted:  April 27, 2021