Prospective audit on the use of the LMA Supreme™ for airway management of adult patients undergoing elective orthopaedic surgery in prone position
Authors
Sharma V. et al.
Publication
Br J Anaesth 2010; 105 (2): 228-232.
Summary
- A study to describe airway management during the use of the LMA Supreme™ in adult patients undergoing elective orthopaedic surgery on the spine whilst in the prone position
- Successful insertion of the LMA Supreme™ in the prone position was achieved in all of the study participants
- The LMA Supreme™ was a useful alternative to tracheal intubation in patients undergoing spinal surgery in the prone position
Objectives:
- To describe airway management during the use of the LMA Supreme™ in adult patients undergoing elective orthopaedic surgery on the spine whilst in the prone position
Method:
- This was a prospective audit undertaken in consecutive patients
- Patients were adequately fasted and were American Society of Anesthesiologists physical status 1-3
- Patients were able to choose whether they were induced in the prone position or in the supine position (with subsequent repositioning to the prone position)
- Endpoints of interest included
- Number of attempts required to achieve a successful insertion
- Manipulations required to achieve an acceptable airway
- Reinsertions
- Complications
Results:
- Overall, 94 male and 111 female patients were audited
- The median age was 51-57 years and the median body mass index (BMI) was 27-28 kg/m2
- In total, 79 patients were classified as obese (BMI >30 kg/m2)
- The LMA Supreme™ was successfully inserted in the prone position in all of the study participants
- Insertion of the device on the first attempt was achieved in 90% of patients
- Establishing and maintaining positive pressure ventilation was successful in all of the 199 patients in whom this was undertaken
- Although repositioning of the LMA Supreme™ was necessary in 13 patients, this was achieved in a single attempt and did not require that the device be removed
- Regurgitation of gastric contents through the drainage tube was observed in four patients, with no evidence of clinically relevant aspiration
- It was necessary to replace the initial LMA Supreme™ in five patients
- A different sized LMA Supreme™ was suitable in four such patients, while in one patient it was necessary to use an LMA ProSeal™ due to the unavailability of a suitably sized replacement LMA Supreme™
- There was no need to reposition any patients into the supine position because of complications during airway management
- The incidence of problems during insertion and airway management in obese patients was similar to that in the overall population
Conclusions:
- The LMA Supreme™ can be successfully used as an airway management device in patients undergoing elective orthopaedic surgery of the spine whilst in the prone position
- Minor airway problems were easily resolved and did not require that patients be changed to the supine position
- The results of this study suggest that the LMA Supreme™ is “a useful alternative to tracheal intubation for surgery in fasted patient[s] in the prone position”