Prospective Evaluation of Complications Related to the Use of Laryngeal Mask Airway

Abstract

The use of ‘laryngeal mask airway' (LMA) can lead to pharyngolaryngeal complications. We aimed to prospectively analyze complications in patients who had LMA as an airway device under general anesthesia. American Society of Anesthesiologists score (ASA) I-III class patients, who were over 18 years and administered LMA between October 2015 and May 2016 were enrolled into the study. Patients’ demographic characteristics, duration of operation, operation history, intraoperative hemodynamic parameters, oxygen saturation, cuff pressure of LMA, experience level and situation of healthcare personnel and the number of attempts were recorded. Additionally, we noted intraoperative complications and complications during insertion and removal of LMA and presence of blood stain on LMA after removal. The incidence of LMA-associated complications increased with age (p=0.009). The rate of complications was lower in ASA I class patients (p=0.001). The rate of complications was higher when LMA was placed by a physician (p=0.003). Complications was higher in unexperienced medical staff to over 4 years experienced ones (p=0.010). Majority of complications occurred while inserting LMA (p=0.001). Furthermore, the rate of complications was higher among the patients, who were intubated (p=0.002) or intervened with LMA (p=0.024) for general anesthesia in the last one week. We observed more complications in patients, whose LMA was bloody after removal (p=0.001). Additionally, the rate of complications was higher among patients whose operation duration was between 30-60 minutes (p=0.04), it was lower in patients who were under operation for less than ≤15 minutes (p=0.01). As a result, complications related to LMA use, which we know to have many advantages in favor of the patient and the practitioner in appropriate operations under 3 hours and in the company of experienced practitioners; we concluded that it can be minimized by increasing the experience and keeping the number of initiatives low.

Keywords

• LMA
• Complications
• General Anesthesia

Laringeal Mask Airway Kullanımı ile İlgili Komplikasyonların Prospektif Olarak Değerlendirilmesi

Abstract

'Laringeal maske airway' (LMA) uygulamasına bağlı faringolaringeal komplikasyonlar gelişebilmektedir. Çalışmamızda genel anestezi altında LMA kullanılan hastalarda, LMA uygulmasına bağlı komplikasyonları prospektif olarak incelemeyi amaçladık. Ekim 2015-Mayıs 2016 tarihleri arasında opere olacak ve LMA kullanılacak 'American Society of Anesthesiologists' skoru (ASA) I-III olan 18 yaş ve üzeri hastalar çalışmaya dahil edildi. Hastaların demografik özellikleri, operasyon süresi, operasyon öyküleri, intraoperatif hemodinamik parametreleri, oksijen saturasyonu, LMA’nın kaf basıncı, LMA’yı yerleştiren sağlık personelinin görevi ve deneyimi, deneme sayısı kaydedildi. LMA uygulamasına bağlı gelişen ventilasyon problemi, hıçkırma, hava yolu reaksiyonu gibi komplikasyonlar; mukoza hasarı, kanama gibi intraoperatif komplikasyonlar ve regürjitasyon, bronkolarengeal spazm, ses kısıklığı, yutma güçlüğü gibi postoperatif komplikasyonlar ile LMA çıkartıldıktan sonra üzerindeki kan varlığı da not edildi. Komplikasyon olan ve olmayan grup arasında, yaş arttıkça komplikasyon görülme sıklığı artmış (p=0.009), ASA I hastalarda daha az komplikasyon görülmüştür (p=0.001). Bir yıldan az deneyimi olan sağlık personelinde, 4 yıldan fazla deneyimi olanlara göre daha fazla komplikasyon saptanmıştır (p=0.003). Doktorlar tarafından LMA yerleştirildiğinde daha fazla komplikasyon görülmüştür (p=0.003). Komplikasyonların çoğunluğu LMA yerleştirilirken meydana gelmiştir (p=0.001). Son bir hafta içerisinde genel anestezi altında entübe edilmiş (p=0.002) veya LMA yerleştirilmiş hastalarda (p=0.024) veya ekstübasyon sonrası LMA üzerinde kan görülenlerde komplikasyon oranı daha fazla bulunmuştur (p=0.001). Komplikasyonlar operasyon süresi 30-60 dk arasında olanlarda daha fazla (p=0.04), 15 dk.dan az olanlarda daha az görülmüştür (p=0.01). Sonuç olarak, 3 saatin altında uygun operasyonlarda ve deneyimli uygulayıcı eşliğinde hasta ve uygulayıcı lehine birçok avantaja sahip olduğunu bildiğimiz LMA kullanımına bağlı komplikasyonların; deneyimin artırılması ve girişim sayısının az tutulması ile en aza indirilebileceği kanısına vardık.

Keywords

• laringeal mask airway
• genel anestezi
• komplikasyon

References

1. 1) Geoffrey B. Rushman, N. J. H. Davies, Jeremy N. Cashman, John Alfred. Havayolu kontrolü. Lee Davies NJH. Cashman JN (eds.). Lee‟s synopsis of anaesthesia. Özkoçak Turan I. Çeviri editörü. 13. baskı. Ankara: Güneş Tıp Kitabevi; 2008.201-229.
2. 2) Taheri A, Hajimohamadi F, Soltanghoraee H, Moin A. Complications of Using Laryngeal Mask Airway During Anesthesia in Patients Undergoing Major Ear Surgery. Acta Otorhinolaryngol Ital; 2009;29(3):151-5
3. 3) Verghese C, Brimacombe JR. Survey of laryngeal mask airway usage in 11910 patients: safety and efficacy for conventional and nonconventional usage. Anesth Analg 1996;82:129-33
4. 4) Souvik M, Puneet K, Kumar B. Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients: systematic review with meta-analysis. Eur J Anaesthesiol 2014;31:266-73.
5. 5) Goldmann K, Hechtfischer C, Malik A, et al. Use of ProSeal laryngeal mask airway in 2114 adult patients: a prospective study. Anesth Analg 2008;107:1856–61.
6. 6) Kim M, Hwang J, Kim E. Comparison of the size 3 and size 4 ProSeal laryngeal mask airway in anesthetized, non-paralyzed women: a randomized controlled trial. J Anesth 2014;29:256–262
7. 7) Kihara S, Brimacombe JR. Sex-based ProSeal laryngeal mask airway size selection: a randomized crossover study of anesthetized,paralyzed male and female adult patients. Anesth Analg 2003;97:280–4
8. 8) Kong M, Li B, Tian Y. Laryngeal mask airway without muscle relaxant in femoral head replacement in elderly patients. ExpTher Med 2006;11:65-68

9. 9) Yurtlu BS, Hanci V, Köksal B, et al. Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate. Braz J Anesthesiol 2015;65:455-46
10. 10) Von Ungern-Sternberg BS, Erb TO, Chambers NA, et al. Laryngeal mask airways – to inflate or to deflate after insertion? Paediatr Anaesth 2009;19:837–43
11. 11) 7) Cook TM, Gibbison B. Analysis of 1000 consecutive uses of the ProSeal laryngeal mask airway by one anaesthetist at a district general hospital. Br J Anaesth 2007; 99:436– 9
12. 12) Brimacombe JR. Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing outine anaesthesia. Anaesthesia 1996;51: 76–80
13. 13) Brimacombe JR, Keller C, Fullekrug B, et al. A Multicenter Study Comparing the ProSeal and Classic Laryngeal Mask Airway in Anesthetized, Nonparalyzed Patients. Anesthesiology 2002;96.2:289-295
14. 14) Seet E, Rajeev S, Firoz T, et al. Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomised controlled trial. Eur J Anaesthesiol 2010;27:602–607
15. 15) Kuppusamy A, Azhar N. Comparison of bougie-guided insertion of Proseal laryngeal mask airway with digital technique in adults. Indian J Anaesth 2010;54:35–9
16. 16) Hwang J, Park H, Lim Y, et al. Comparison of two insertion techniques of ProSealTM Laryngeal Mask Airway.Anesthesiology 2009;110:905–7
17. 17) Venkatesan T, Wijk V, Elhalawani I, et al. Lingual nerve neuropraxia following use of the Laryngeal Mask Airway Supreme. J Clin Anaesth 2014;26.1:65-68
18. 18) Foley, E, Shanahan E, Phelon D, et al. Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature. Ir J Med Sci 2010;179.2:297-300
19. 19) Cook TM, Seller C, Gupta K, et al. Non-conventional uses of the Aintree Intubating catheter in management of the difficult airway: fourteen reports. Anaesthesia 2007;62:169–74