Anesthetic Management for Language Area Mapping with Laryngeal Mask Airway: A case report / 대한마취과학회지

Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.

Anesthetic Management for Language Area Mapping with Laryngeal Mask Airway: A case report / 대한마취과학회지

Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp.

The Clinical Assessment of the Efficacy and Safety of the Intubating Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: The intubating laryngeal mask airway (ILMA) was introduced recently as an effective ventilatory device and intubation guide. The following study was designed to assess not only efficacy but also safety of the ILMA. METHODS: Sixty adult patients who were randomly assigned in 3 groups (Group 1, 2, 3), ASA class 1 or 2, undergoing elective surgery were induced with intravenous injection of fentanyl, thiopental sodium, vecuronium, lidocaine and inhalation of O2, N2O, enflurane. In Group 1 (n=20), the patients were intubated with Macintosh curved blade and endotracheal tube. In Group 2 (n=20), blind tracheal intubation using an ILMA was attempted. In Group 3 (n=20), we applicated the ILMA to a fiberoptic bronchoscope-aided tracheal intubation. Then we decided success rates for blind and fiberoptic-guided passage of an endotracheal tube via the ILMA. We measured systolic, diastolic arterial pressure and heart rate before administration of induction agent, 1 and 5 minutes after induction, just after intubation, 1, 2, 3 and 5 minutes after endotracheal intubation. RESULTS: The success rates for blind (Group 2) and fiberoptic-guided (Group 3) passage of an endotracheal tube via the ILMA were 70% and 100% respectively. There were no statistically significance in the systolic, diastolic arterial pressure and heart rate when compared to value of any other groups at any time but higher in all groups when compared to preinduction value of each group just after intubation. CONCLUSIONS: Though the ILMA may be an effective intubation guide, it doesn't blunt hemodynamic changes effectively than standard laryngoscopic intubation.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.

Complications Associated with Removal of the Laryngeal Mask Airway: Deep Anesthesia Versus Waking State / 대한마취과학회지

BACKGROUND: The optimal time to remove the laryngeal mask airway (LMA) at the end of surgery is still a matter of controversy. The purpose of this study was to compare the incidence of complications associated with the removal of the LMA from the deeply anesthetized and from the awake patient. METHODS: The LMA was used in 120 adults undergoing general elective lower abdominal or extremity surgery. The patients were randomly assigned to two groups. In 60 patients the LMA was removed by the anesthetist with the patient deeply anesthetized in the operating room. In the other 60 patients it was removed by the anesthetist when the patient responded to verbal commands in the operating room. Any airway complications occurring within 15 minutes of LMA removal were recorded. These complications included coughing, biting, retching, vomiting, excessive salivation, airway obstruction and laryngospasm. RESULTS: Groups were similar in age, weight, and duration of surgery. Airway complications associated with LMA removal were noted in fourteen patients. Airway complications occurred in six patients who had their LMA removed during deep anesthesia, and in eight patients who under went removal of their LMA on awakening. In the anesthetized group, there were four kinds of airway complications in six patients (retching, excessive salivation, airway obstruction and laryngospasm). In the awake group, eight patients experienced six kinds of airway complications (coughing, biting, vomiting, excessive salivation, airway obstruction and laryngospasm). There was no significant difference between the two groups in the incidence of complications after removal of the LMA. CONCLUSIONS: Removal of the LMA under deep anesthesia had no advantage compared to removal from awakening patients in terms of complications in adult.

The Suitable Time for the Removal of Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway (LMA), but the results of those studies were much different from one another. This conflicting results may be due to the time of the removal of LMA, which has been usually after the arousal (when the patient can open the mouth on command). So, the authors investigated the incidence of the gastroesophageal reflux and the regurgitation of gastric contents above the upper esophageal sphincter associated with the difference of the time of the removal of LMA. METHODS: Sixty three patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were allocated randomly to Group A (n=34, LMA was removed when the rejection signs such as struggle, restlessness, swallowing and cough came out.) or Group B (n=29, LMA was removed after arousal). For the detection of reflux and regurgitation episodes during anesthesia, a pH monitoring probe was positioned in the lower esophagus and a methylene blue (50 mg) gelatine capsule was swallowed just before induction. At the end of anesthesia, the episodes of reflux and regurgitation of gastric contents were analyzed according to the pharyngeal blue staining or pH< or = 4. RESULTS: The incidence of reflux (pH< or = 4) from the time of the rejection signs to the removal of LMA and the total incidence of reflux in Group B were significantly higher than that of Group A. No patient in both group showed pharyngeal staining of methylene blue. There was no clinical evidence of aspiration of gastric contents in either group. CONCLUSION: Maintenance of LMA until the patient can open the mouth on command seems to increase the incidence of the gastroesophageal reflux.

Anesthetic Management using Laryngeal Mask Airway during Reconstructive Surgery of Trachea Cancer: A case report / 대한마취과학회지

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.

Clinical Investigation of Laryngeal Mask Airway Use in Geriatric Patients / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) has many advantages including easy insertion, less trauma, minimal cardiovascular changes. And the elderly have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes, so endotracheal intubation in geriatric patient is sometimes difficult and harzardous. This clinical study was designed to investigate availability and problems of LMA insertion in geriatric patients. METHODS: 60 geriatric patients undergoing elective surgery were induced with intravenous injection of pentothal sodium or propofol, vecuronium or atracurium and inhalation of O2, N2O, enflurane or isoflurane. After deep anethesia and full muscle relaxation LMA was inserted and cuff was inflated. When blind insertion was failed, laryngoscope was used. Anesthesia was maintained with inhalation of O2, N2O, enflurane or isoflurane under positive pressure ventilation. Thereafter, we observed peak inspiratory pressure and any incident including gas leakage, stomach distension, regurgitation of stomach content intraoperatively and then any complication postoperatively. RESULTS: LMA placement was successful in 98.8%, but LMA insertion in geriatric patient had some difficulty because patient's tongue slided down with LMA due to oropharyngeal dryness, teeth loss. Intraoperatively LMA was well maintained under positive pressure ventilation. There was no critical incident associated with LMA use. CONCLUSIONS: LMA is safe and may have a useful role in the anesthetic management of geriatric patients who have many problems such as poor dentition, limited cervical extension and age related cardiovascular changes.

Differences of Incidence and Severity of Sore Throat and Hoarseness between the Methods of Airway Security / 대한구급학회지

Introduction: The sore throat and hoarseness are common complications during the postoperative period. We investigated differences of incidence and severity of sore throat and hoarseness according to methods of airway security. METHODS: One hundred twelve patients, in ASA physical status class 1~2, were included in this study (58 males and 54 females). They were divided into three groups: group 1 (n=42), intubated with endotracheal tube lubricated with normal saline; group 2 (n=40), intubated with endotracheal tube lubricated with 5% lidocaine ointment; group 3 (n=30), inserted with laryngeal mask airway (LMA) for airway security. RESULTS: The incidence of sore throat and hoarseness were 78.6% and 54.8% in group 1, 35% and 30% in group 2, and 33.3% and 20.0% in group 3. CONCLUSIONS: Both 5% lidocaine-lubricated endotracheal tube and laryngeal mask airway showed tendency of decreased incidence of postoperative sore throat and hoarseness but there are no statistical significance.

Fiberoptic Laryngoscopic View of the Laryngeal Mask Airway Placed in the Hypopharynx / 대한마취과학회지

BACKGROUND: The laryngeal mask airway (LMA) should be correctly placed into the hypopharynx for adequate ventilation. The purpose of this study was to evaluate a LMA position relation to the laryngeal skeleton and narrowing degree of a LMA lumen by the epiglottis. METHODS: The LMA (# 3 or # 4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberoptic laryngoscopic findings through the lumen of LMA were recorded at ten minutes after LMA placements. The position of the LMA was estimated in relation to its distal aperture to the laryngeal skeleton as central, posterior, right and left lateral position. The narrowing degree of the LMA by the epiglottis was estimated as 0%, 1~25%, 26~50%, 51~75%, or 76~100%. RESULTS: The fiberoptic laryngoscope showed central positions in 70.1%, lateral deviations to the left or right in 21.2% and posterior positions in 9%. The most frequent incidence (84/231, 36.4%) of narrowing by the epiglottis is 76~100% but ventilating problems were not developed. However, ventilation was impossible immediately after LMA placement in one patient, so the LMA was removed and the trachea was intubated. Esophageal enterance was visible in one patient without regurgitation of the stomach content. CONCLUSIONS: These findings show that LMA provides a reliable and safe airway management technique, although inadequate positioning and narrowing of LMA lumen by the epiglottis may frequently occur.