The randomized crossover comparison of airway sealing with the laryngeal mask airway Supreme(™) at three different intracuff pressures in children.

Abstract

An intracuff pressure of 80cm H2 O in the adult-sized laryngeal mask airway Supreme has been recommended to obtain a higher oropharyngeal leak pressure (OLP). However, the intracuff pressure for the higher OLP in the pediatric laryngeal mask airway Supreme could be different from that in the adult-sized laryngeal mask airway Supreme. Thus, we measured and compared OLP at three intracuff pressures of 40, 60, and 80cm H2 O in the pediatric laryngeal mask airway Supreme. This study was designed as a randomized crossover study and enrolled 36 children, aged 0-108months and 5-30kg in weight. After insertion of the laryngeal mask airway Supreme, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 40, 60, and 80cm H2 O according to one of six sequences produced on the basis of 3×6 Williams crossover design. During the intraoperative period, the laryngeal mask airway Supreme was maintained using the last intracuff pressure of the allocated sequence. The intraoperative and postoperative complications were compared among three maintenance intracuff pressures. OLP at the intracuff pressure of 60cm H2 O was significantly higher than that of 40cm H2 O (17.9±3.9 vs 16.9±4.2cm H2 O, P=0.004) and was comparable with that of 80cm H2 O (17.9±3.9 vs 17.8±4.6cm H2 O, P=0.938). There were no significant differences of intraoperative and postoperative complications among the three maintenance intracuff pressures. Our results suggest that the use of an intracuff pressure of 60cm H2 O in pediatric laryngeal mask airway Supreme provides a higher OLP compared with 40cm H2 O.