A prospective evaluation of clinical tests for placement of laryngeal mask airways

Shailendra Joshi, Robert R. Sciacca, Daneshvari R. Solanki, William L. Young, Mali M. Mathru

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background: Reliable tests of correct anatomic placement of the laryngeal mask airway (LMA) may enhance safety during use and minimize the need for fiberoptic instrumentation during airway manipulation through the device. This study assessed the correlation between the outcomes of nine clinical tests to place the LMA and the anatomic position of the device as graded on a standard fiberoptic scale. Methods: During 150 anesthetics, the outcome of nine clinical tests of correct placement was individually scored as satisfactory (positive) or unsatisfactory (negative) for clinical use of the LMA. Anatomic placement was assessed (by fiberoptic evaluation) by an anesthesiologist, who was blinded to the placement of the device, as grade 1, vocal cords not seen; grade 2, cords plus the anterior epiglottis seen; grade 3, cords plus the posterior epiglottis seen; and grade 4, only vocal cords seen. The outcomes of clinical tests were correlated with fiberoptic grade. Results: Tests that correlated with the fiberoptic grade were the ability to generate an airway pressure of 20 cm water, the ability to ventilate manually, a black line on the LMA in midline, anterior movement of the larynx, outward movement of the LMA on inflation of the cuff, and movements of the reservoir bag with spontaneous breathing. Two tests, ability to generate airway pressure of 20 cm water and ability to ventilate manually, correlated with fiberoptic grades 4 and 3 combined (i.e., the epiglottis was supported by the LMA) and grade 2 (the epiglottis was not supported by the LMA). Tests with poor correlation with fiberoptic grade were the presence of resistance at the end of insertion, inability to advance LMA after inflation of the cuff, and presence of a capnographic trace. Conclusions: The outcome of clinical tests correlates with the anatomic placement of LMAs, as judged by fiberoptic examination. Two tests that best correlated with the fiberoptic grade were the ability to generate airway pressure of 20 cm water and the ability to ventilate manually.

Original languageEnglish (US)
Pages (from-to)1141-1146
Number of pages6
JournalAnesthesiology
Volume89
Issue number5
StatePublished - Nov 1998

Fingerprint

Laryngeal Masks
Epiglottis
Vocal Cords
Economic Inflation
Pressure
Equipment and Supplies
Water
Larynx
Anesthetics
Respiration
Safety

Keywords

  • Anesthetic equipment

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Joshi, S., Sciacca, R. R., Solanki, D. R., Young, W. L., & Mathru, M. M. (1998). A prospective evaluation of clinical tests for placement of laryngeal mask airways. Anesthesiology, 89(5), 1141-1146.

A prospective evaluation of clinical tests for placement of laryngeal mask airways. / Joshi, Shailendra; Sciacca, Robert R.; Solanki, Daneshvari R.; Young, William L.; Mathru, Mali M.

In: Anesthesiology, Vol. 89, No. 5, 11.1998, p. 1141-1146.

Research output: Contribution to journalArticle

Joshi, S, Sciacca, RR, Solanki, DR, Young, WL & Mathru, MM 1998, 'A prospective evaluation of clinical tests for placement of laryngeal mask airways', Anesthesiology, vol. 89, no. 5, pp. 1141-1146.
Joshi S, Sciacca RR, Solanki DR, Young WL, Mathru MM. A prospective evaluation of clinical tests for placement of laryngeal mask airways. Anesthesiology. 1998 Nov;89(5):1141-1146.
Joshi, Shailendra ; Sciacca, Robert R. ; Solanki, Daneshvari R. ; Young, William L. ; Mathru, Mali M. / A prospective evaluation of clinical tests for placement of laryngeal mask airways. In: Anesthesiology. 1998 ; Vol. 89, No. 5. pp. 1141-1146.
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