Comparison of Effects of Laryngeal Mask Airway Supreme Cuff Inflation with Air, Air: Oxygen Mixture, and Oxygen: Nitrous Oxide Mixture in Adults: A Randomized Double-blind Study
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2019, Vol 6, Issue 11
Abstract
Introduction: Laryngeal mask airway (LMA) cuff pressure has been implicated as a prime reason for post-operative sore throat. LMA cuff pressure increases when the air is used for the cuff inflation during oxygen: Nitrous oxide (O2: N2O) anesthesia, which results in post-operative pharyngolaryngeal adverse events. We conducted this study to compare the effect of LMA supreme cuff inflation with air, air: Oxygen, and oxygen: Nitrous oxide mixture in adults. Aim: The aim of the study was to compare the changes in cuff pressure intraoperatively with different gas composition (air, air: Oxygen mixture, and oxygen: Nitrous oxide mixture) used to inflate the LMA supreme by a manometer and post-operative pharyngolaryngeal morbidity. Design: It was a potential randomized double-blind study which was conducted on 120 patients admitted for elective surgery under general anesthesia. Materials and Methods: A total of 120 patients were randomly allocated into three groups of 40 each according to the composition of gases used to inflate the supreme LMA cuff to achieve 40 cm H2O cuff pressure, air was used as cuff inflation medium in Group A, air: Oxygen mixture in Group AO, and oxygen: Nitrous oxide mixture in Group ON. Statistical Analysis: The cuff pressure, ventilatory parameters, and post-operative pharyngolaryngeal complications were noted. The analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: In Group A and Group OA cuff pressure significantly increased from initial cuff pressure of 40 cm H2O until the end of the surgery to 74.35 ± 7.41 cm H2O and 56.35 ± 3.63 cm H2O, respectively. An initial decrease in cuff pressure was observed at 15 min to a mean of 32.85 ± 1.42 cm H2O in Group ON which again gradually increased to near initial pressures to a mean of 40.10 ± 2.31 cm H2O toward the end of surgery. Cuff volume increased in Group A and Group AO; however, it decreased in Group ON (23.18 ± 4.45 ml, 18.73 ± 2.61 ml, and 11.50 ± 1.93 ml, respectively) from initial values. Ventilatory and hemodynamic parameters were comparable in all the three groups. A significant difference in pharyngolaryngeal morbidity was observed between Group A and Group ON. Conclusion: Cuff inflation with 50% O 2: N2O mixture provided more stable cuff pressure in comparison to air and O2: Air mixture during O2: N2O anesthesia. Ventilatory parameters and hemodynamic parameters did not change with variation in SLMA cuff pressure. Post-operative pharyngolaryngeal morbidity had a strong correlation with cuff pressure and was more in Group A and least in Group ON.
Authors and Affiliations
Ranjana Khetarpal, Veena Chatrath, Anu Sharma, Kirti Jangwal
Keywords
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