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Pharyngolaryngeal Morbidity With the Laryngeal Mask Airway SupremeTM at Different Fiberoptic Bronchoscopy Grades: An Observational Study

      Summary

      Objective

      To assess whether the different fiberoptic bronchoscopy (FOB) grades of laryngeal mask airway (LMA) Supreme™ affects pharyngolaryngeal morbidity (PLM, including sore throat, dysphonia, pharyngoxerosis, and dysphagia) after general anesthesia.

      Methods

      A total of 235 adult patients scheduled for elective laser lithotripsy undergoing general anesthesia with the placement of LMA Supreme™ were enrolled. The position of LMA Supreme™ was assessed by FOB and categorized into five grades. Meanwhile, patients were divided into four groups (grades A–D); none was assessed as grade E. We collected blinded data on PLM at 2 (H+2), 6 (H+6), and 24 hours (H+24) postoperatively. The incidence and severity of PLM as the primary outcome and incidence of PLM at three time points as a secondary outcome were compared.

      Results

      The incidence of PLM was higher at 2 and 6 hours than at 24 hours; however, no significant difference was found between the incidence of PLM in the FOB groups. Furthermore, the severity of sore throat and dysphonia between groups were obviously differed at H+6 and H+24, but similar at H+2. The severity of postoperative pharyngoxerosis and dysphagia were similar between groups at three time points.

      Conclusions

      A positive association was found between the severity of postoperative sore throat and dysphonia and FOB grade after LMA Supreme™ placement. PLM secondary to placement of the LMA Supreme™ was short lasting.

      Key Words

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      REFERENCES

        • Woodall NM
        • Cook TM
        National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists.
        Br J Anaesth. 2011; 106: 266-271
        • Tong D
        • Chung F
        • Wong D
        Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients.
        Anesthesiology. 1997; 87: 856-864
        • Hu LQ
        • Leavitt OS
        • Malwitz C
        • et al.
        Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: a randomised clinical trial.
        Eur J Anaesthesiol. 2017; 34: 448-455
        • Mizutamari E
        • Yano T
        • Ushijima K
        • et al.
        A comparison of postoperative sore throat after use of laryngeal mask airway and tracheal tube.
        J Anesth. 2004; 18: 151-157
        • Rieger A
        • Brunne B
        • Hass I
        • et al.
        Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation.
        J Clin Anesth. 1997; 9: 42-47
        • Marsh HM
        Optimal use of LMA SupremeTM for laparoscopy.
        J Invest Surg. 2020; : 1-2
        • Abdi W
        • Amathieu R
        • Adhoum A
        • et al.
        Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme and the ETT.
        Acta Anaesthesiol Scand. 2010; 54: 141-146
        • van Esch BF
        • Stegeman I
        • Smit AL
        Comparison of laryngeal mask airway vs. tracheal intubation: a systematic review on airway complications.
        J Clin Anesth. 2017; 36: 142-150
        • Chantzara G
        • Stroumpoulis K
        • Alexandrou N
        • et al.
        Influence of LMA cuff pressure on the incidence of pharyngolaryngeal adverse effects and evaluation of the use of manometry during different ventilation modes: a randomized clinical trial.
        Minerva Anestesiol. 2014; 80: 547-555
        • Brimacombe J
        • Holyoake L
        • Keller C
        • et al.
        Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females.
        Anesthesiology. 2000; 93: 26-31
        • McHardy FE
        • Chung F
        Postoperative sore throat: cause, prevention and treatment.
        Anaesthesia. 1999; 54: 444-453
        • Figueredo E
        • Vivar-Diago M
        • Muñoz-Blanco F
        Laryngo-pharyngeal complaints after use of the laryngeal mask airway.
        Can J Anaesth. 1999; 46: 220-225
        • Grady DM
        • McHardy F
        • Wong J
        • et al.
        Pharyngolaryngeal morbidity with the laryngeal mask airway in spontaneously breathing patients: does size matter?.
        Anesthesiology. 2001; 94: 760-766
        • Hwang JW
        • Park HP
        • Lim YJ
        • et al.
        Comparison of two insertion techniques of ProSeal laryngeal mask airway: standard versus 90-degree rotation.
        Anesthesiology. 2009; 110: 905-907
        • Vasanth Karthik R
        • Ranganathan P
        • Kulkarni AP
        • et al.
        Does cuff pressure monitoring reduce postoperative pharyngolaryngeal adverse events after LMA-ProSeal insertion? A parallel group randomised trial.
        J Anesth. 2014; 28: 662-667
        • Natalini G
        • Facchetti P
        • Dicembrini MA
        • et al.
        Pressure controlled versus volume controlled ventilation with laryngeal mask airway.
        J Clin Anesth. 2001; 13: 436-439
        • Campbell RL
        • Biddle C
        • Assudmi N
        • et al.
        Fiberoptic assessment of laryngeal mask airway placement: blind insertion versus direct visual epiglottoscopy.
        J Oral Maxillofac Surg. 2004; 62: 1108-1113
        • Chandan SN
        • Sharma SM
        • Raveendra US
        • et al.
        Fiberoptic assessment of laryngeal mask airway placement: a comparison of blind insertion and insertion with the use of a laryngoscope.
        J Maxillofac Oral Surg. 2009; 8: 95-98
        • Timmermann A
        • Cremer S
        • Eich C
        • et al.
        Prospective clinical and fiberoptic evaluation of the Supreme laryngeal mask airway.
        Anesthesiology. 2009; 110: 262-265
        • Von Ungern-Sternberg BS
        • Wallace CJ
        • Sticks S
        • et al.
        Fibreoptic assessment of paediatric sized laryngeal mask airways.
        Anaesth Intensive Care. 2010; 38: 50-54
        • Rollert MK
        The case against the laryngeal mask airway for anesthesia in oral and maxillofacial surgery.
        J Oral Maxillofac Surg. 2004; 62: 739-741
        • Tang MY
        • Tang IP
        • Wang CY
        Optimal size AMBU® laryngeal mask airway among Asian adult population.
        Med J Malaysia. 2014; 69: 151-155
        • Tan SM
        • Sim YY
        • Koay CK
        The ProSeal laryngeal mask airway size selection in male and female patients in an Asian population.
        Anaesth Intensive Care. 2005; 33: 239-242
        • Kim MH
        • Hwang JW
        • Kim ES
        • et al.
        Comparison of the size 3 and size 4 ProSeal™ laryngeal mask airway in anesthetized, non-paralyzed women: a randomized controlled trial.
        J Anesth. 2015; 29: 256-262
        • Li X
        • Wang X
        • Zhao Y
        • et al.
        Incidence of postoperative sore throat after using a new technique of insertion of a second generation laryngeal mask airway: a randomised controlled trial.
        Eur J Anaesthesiol. 2021; 38: 285-293
        • Tazeh-Kand NF
        • Eslami B
        • Mohammadian K
        Inhaled fluticasone propionate reduces postoperative sore throat, cough, and hoarseness.
        Anesth Analg. 2010; 111: 895-898
        • Park SY
        • Kim SH
        • Lee AR
        • et al.
        Prophylactic effect of dexamethasone in reducing postoperative sore throat.
        Korean J Anesthesiol. 2010; 58: 15-19
        • Ruetzler K
        • Guzzella SE
        • Tscholl DW
        • et al.
        Blind intubation through self-pressurized, disposable supraglottic airway laryngeal intubation masks: an international, multicenter, prospective cohort study.
        Anesthesiology. 2017; 127: 307-316
        • Füllekrug B
        • Pothmann W
        • Werner C
        • et al.
        The laryngeal mask airway: anesthetic gas leakage and fiberoptic control of positioning.
        J Clin Anesth. 1993; 5: 357-363
        • Brimacombe J
        • Keller C
        Stability of the LMA-ProSeal and standard laryngeal mask airway in different head and neck positions: a randomized crossover study.
        Eur J Anaesthesiol. 2003; 20: 65-69
        • Xue FS
        • Mao P
        • Liu HP
        • et al.
        The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway.
        Anaesthesia. 2008; 63: 979-985
        • Song K
        • Yi J
        • Liu W
        • et al.
        Confirmation of laryngeal mask airway placement by ultrasound examination: a pilot study.
        J Clin Anesth. 2016; 34: 638-646
        • Chang E
        • Wu L
        • Ruan X
        • et al.
        Laryngeal mask position evaluated by ultrasonography and fiberoptic bronchoscopy along with 3D-CTR constructive images: a prospective observational study.
        J Clin Anesth. 2020; 67109974
        • Joshi S
        • Sciacca RR
        • Solanki DR
        • et al.
        A prospective evaluation of clinical tests for placement of laryngeal mask airways.
        Anesthesiology. 1998; 89: 1141-1146
        • Kim J
        • Kim JY
        • Kim WO
        • et al.
        An ultrasound evaluation of laryngeal mask airway position in pediatric patients: an observational study.
        Anesth Analg. 2015; 120: 427-432
        • Kim GW
        • Kim JY
        • Kim SJ
        • et al.
        Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion.
        BMC Anesthesiol. 2019; 19: 4
        • Pothmann W
        • Füllekrug B
        • Schulte am Esch J
        Fiberoptische Befunde zum Sitz der Kehlkopfmaske [Fiberoptic determination of the position of the laryngeal mask].
        Anaesthesist. 1992; 41 (German): 779-784
        • Thiruvenkatarajan V
        • Van Wijk RM
        • Rajbhoj A
        Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series.
        Anaesthesia. 2015; 70: 344-359
        • Hell J
        • Pohl H
        • Spaeth J
        • et al.
        Incidence of gastric insufflation at high compared with low laryngeal mask cuff pressure: a randomised controlled cross-over trial.
        Eur J Anaesthesiol. 2021; 38: 146-156
        • L'Hermite J
        • Dubout E
        • Bouvet S
        • et al.
        Sore throat following three adult supraglottic airway devices: a randomised controlled trial.
        Eur J Anaesthesiol. 2017; 34: 417-424