Teleflex | LMA - Better by Design

Authors

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”