Page 42 - CASA Bulletin of Anesthesiology 2022; 9(2) (5)

CASA Bulletin of Anesthesiology

minor peripheral surgery with a ProSeal LMA™ vs. ETT and found ventilation was adequate
27
in both groups while postoperative pulmonary complications were decreased in the LMA group
27 . Keller et al. showed that the ProSeal™ LMA was temporarily effective in ventilating obese
28
patients with a BMI >35 prior to intubation . Although second-generation LMAs have been
used in obese patients, further studies should be done to investigate the safety of LMA use in
obese patients.

Summary

LMA design has evolved and clinical use has expanded significantly in recent decades.
Evidence suggests that LMA use is safe with mechanical ventilation in appropriately fasted
patients while minimizing the inspiratory pressures applied. Second-generation devices may
minimize leak and limit gastric insufflation compared to first-generation LMAs. Muscle relaxant
may be considered and has been shown to facilitate LMA insertion and mechanical ventilation.
Application of LMA in obese patient remains controversial. Studies have proved successful
ventilation of obese patients with a BMI below 30. However, in patients with higher BMIs,
ventilation may be impaired due to physiologic changes in obesity. The LMA should always be
considered as a rescue device for difficult ventilation or intubation, regardless of patient size.
Appropriate LMA indications continue to be debated. It is important to recognize the potential
complications and relative contraindications to the LMA and adjust a clinical algorithm, which
would optimize the use of the LMA in airway management.

Dr. Schwartz is a Cardiothoracic Anesthesia Fellow at the Department of Anesthesiology at the University Of
Florida College Of Medicine, Gainesville, FL.
Dr. Peng is a Professor of Anesthesiology and Chief of the Cardiothoracic Anesthesia Division in the Department of
Anesthesiology and Associate Professor of Surgery, University of Florida College of Medicine, Gainesville, FL.

References

1. Sharma B, Sahai C, Sood J. Extraglottic airway devices: technology update [published correction appears in
Med Devices (Auckl). 2018;11:27]. Med Devices (Auckl). 2017;10:189–205.
2. Brimacombe J. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth.
1995;42:1017–1023.
3. 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.
4. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth. 2002;88:582–
584.
5. 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.
6. Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal
tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis. Medicine
(Baltimore). 2016;95:e4598.
7. Updated by the Committee on Standards and Practice Parameters, Apfelbaum JL, Hagberg, CA Caplan RA, et.
al. The previous update was developed by the American Society of Anesthesiologists Task Force on Difficult
Airway Management, Caplan RA, Benumof JL, Berry FA, et al; Practice guidelines for management of the
difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of
the Difficult Airway. Anesthesiology 2013;118:251–270.

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