Use of the cuffed oropharyngeal airway as an alternative to the laryngeal mask airway with positive-pressure ventilation

• Published in: Anesthesiology (Philadelphia) Vol. 90; no. 5; pp. 1306 - 1310
• Main Authors: VAN VLYMEN, J. M, WEN FU, WHITE, P. F, KLEIN, K. W, GRIFFIN, J. D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-05-1999
• Subjects: Adult; Aged; Anesthesia; Anesthesia, General; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesia: equipment, devices; Biological and medical sciences; Female; Humans; Laryngeal Masks; Male; Medical sciences; Middle Aged; Oropharynx; Positive-Pressure Respiration; Propofol - pharmacology; Prospective Studies; Human; Cuff; Positive pressure; Oropharyngeal airway; Mask; General anesthesia; Larynx; Technique; Artificial ventilation; Comparative study; Technical equipment
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-199905000-00014

The cuffed oropharyngeal airway is a modified Guedel-type oral airway with a cuff at its distal end. The objectives of this study were to compare the ability of the cuffed oropharyngeal airway and the laryngeal mask airway to provide positive-pressure ventilation during general anesthesia, and to assess their relative ease of use and ability to reduce total fresh gas flow rates.
In this prospective, randomized study, a cuffed oropharyngeal airway (n = 25) or a laryngeal mask airway (n = 25) device was inserted after induction of anesthesia intravenously using 2 mg/kg propofol. While anesthesia was maintained with sevoflurane and nitrous oxide, the leak pressure, leak fraction (the fractional difference between the inspired and expired tidal volume), minimum fresh gas flow rate, and need for airway manipulations were determined. The anesthesia provider who inserted the device completed an evaluation form at the end of the 15-min study period.
Positive-pressure ventilation was established successfully on the first attempt in 92% of the patients when the cuffed oropharyngeal airway was used and in 88% of the patients when the laryngeal mask airway device was used. However, manipulations of the airway device were necessary more frequently (8 vs. 1 patient; P < 0.05) and the leak pressure was less (22 +/- 6 cm water vs. 26 +/- 5 cm water; P < 0.05) with the cuffed oropharyngeal airway than with the laryngeal mask airway. In addition, the leak fraction (0.19 +/- 0.18 vs. 0.31 +/- 0.22; P < 0.05) and the minimum fresh gas flow rate (1.3 +/- 1.5 vs. 2.4 +/- 2.5; P = 0.12) were less in the laryngeal mask airway group.
Positive-pressure ventilation is possible with the laryngeal mask airway and cuffed oropharyngeal airway devices. Although the cuffed oropharyngeal airway can be inserted easily by inexperienced users with a high first-attempt success rate (> 90%), manipulations of the device may be required to maintain a patent airway. The laryngeal mask airway device allows positive-pressure ventilation at slightly greater peak inspiratory pressures.