Standard Laryngeal Mask Airway Research Articles

Clinical Outcomes of a Modified Laryngeal Mask Airway (LMA® Gastro™ Airway) During Esophagogastroduodenoscopy in Children and Adolescents: A Randomized Study.

IntroductionDuring esophagogastroduodenoscopy (EGD), general anesthesia (GA) may be provided using a laryngeal mask airway (LMA) with the endoscope inserted behind the cuff of the LMA into the esophagus. Passage of the endoscope may increase the intracuff of the LMA. We evaluated a newly designed LMA (LMA® Gastro™ Airway) which has an internal channel exiting from its distal end to facilitate EGD. The current study compared the change of LMA cuff pressure between this new LMA and a standard clinical LMA (Ambu® AuraOnce™) during EGD.MethodsPatients less than 21 years of age and weighing more than 30 kg were randomized to receive airway management with one of the two LMAs during EGD. After anesthetic induction and successful LMA placement, the intracuff pressure of the LMAs was continuously monitored during the procedure. The primary outcome was the change of intracuff pressure of the LMAs.ResultsThe study cohort included 200 patients (mean age 13.6 years and weight 56.6 kg) who were randomized to the LMA® Gastro™ Airway (n=100) or the Ambu® AuraOnce™ LMA (n=100). Average intracuff pressures during the study period (before and after endoscope insertion) were not different between the two LMAs. Ease of the procedure was slightly improved with the LMA® Gastro™ Airway (p<0.001).DiscussionThe LMA® Gastro™ Airway blunted, but did not prevent an increase in intracuff pressure during EGD when compared to the Ambu® AuraOnce™ LMA. Throat soreness was generally low, and complications were infrequent in both groups. The ease of the procedure was slightly improved with the LMA® Gastro™ Airway compared to the Ambu® AuraOnce™ LMA.

“A Comparison of General Anaesthesia Techinques Using Proseal Laryngeal Mask Airway Or Endotracheal Tube, In Patients Undergoing Laproscopic Surgery”.

Introduction: Traditional open surgeries are now being done by minimally invasive keyhole laparoscopic techniques. Simultaneously, airway management of patients has also progressed from ventilation through endotracheal tube to lesser invasive Laryngeal Mask Airway. The Proseal Laryngeal Mask Airway, the latest in the family of Laryngeal Mask Airway, differs from the standard Laryngeal Mask Airway in having a drain tube in addition to a reinforced airway tube. It is a highly satisfactory device in securing an airway, it's lacunae with positive pressure ventilation (PPV), especially in patients with decreased pulmonary compliance prompted him further to find a better airway device.It also offered protection against regurgitation and gastric insufflation. AIMS And Objective: The present study aims to compare safety and efficacy of giving general anesthesia using proseal laryngeal mask airway in patients undergoing laproscopic surgery. The above will be reached by observing vital parameters – heart rate, blood pressure , oxygen saturation , end tidal carbon di-oxide level & any other complications as observed . Material And Methods: The proposed study was carried out in S.R.N. Hospital associated with M.L.N. Medical College , Allahabad. After randomization & blinding, patients will be allocated in one of the following groups. each group containing 30 patients. Group A: Undergoing general anaesthesia using Proseal laryngeal mask Airway(PLMA). Group B: Undergoing general anaesthesia using Endotracheal tube(ETT). Results:Compared to PLMA group , patient that were intubated with E.T. tube showed significantly increase in Pulse rate, SBP, DBP & MAP which was statistically significant till 5 th min of induction(p value <0.0001) & immediate postoperative period.Postoperative there was significant increase in incidence of sorethroat in ETT group. Conclusion: The comparative study showed PLMA has good hemodynamic stability, adequate ventilation and less post-operative airway complication. Hence, it is concluded PLMA is suiFigure and a safe alternative to cuffed ETT for airway management in elective non obese patients undergoing laparoscopic surgeries under general anaesthesia

The effect of preoperative intravenous dexketoprofen trometamol on postoperative pain in minor outpatient urologic surgery.

The aim of this prospective double-blind randomized study was to compare the effectiveness of preoperative dexketoprofen trometamol for acute postoperative pain in patients undergoing minor outpatient urologic surgery. Sixty male patients (ASA I and II) undergoing varicocelectomy and testicular sperm extraction (TESE) with standard laryngeal mask airway (LMA) anesthesia were randomly divided into two groups. Patients in Group I (n=30) received 50 mg of dexketoprofen trometamol iv before induction, whereas patients in Group II (n=30) received saline. All patients received standard LMA anesthesia (propofol, sevoflurane and N2O/O2). Analgesic efficacy was evaluated by self-assessment of pain intensity (VAS) at regular intervals. Vital signs, side effects and time to reach a postanesthesia discharge score (PADS) of ≥9 were also recorded. Paracetamol 1 gr iv and tramadol 100 mg iv were used for rescue analgesia. Demographic data and duration of surgery were similar in both groups. There was no significant difference between groups with respect to postoperative pain scores and side effects. Although more patients in Group II (60%) required rescue analgesia compared to Group I (33.3%), the difference did not reach statistical significance. Preoperative IV use of dexketoprofen trometamol iv did not decrease the need for rescue analgesia in patients undergoing minor outpatient urological surgery.

Difficult Laryngeal Mask Airway Placement.

To the Editor; Laryngeal mask airway (LMA), which consists of a silicone tube connected to a miniature silicone mask appropriate for the shape of hypopharynx and covers the larynx as a gasket, was developed in 1980s in the United Kingdom. It is frequently used both to avoid negative effects of endotracheal intubation by establishing direct connection with the airway of patient and to easily provide a more reliable airway as compared to the facial mask. It has particular importance in difficult airway management and cardiopulmonary resuscitation since it can be successfully placed even by inexperienced users. Gel is applied to the posterior surface of the mask and it is placed blindly into the airway by pushing towards hypopharynx while the head of the patient is in extension position. Herein, we present a case, in which LMA could not be placed despite several attempts and a mass tissue was detected in the hypopharynx during laryngoscopy performed subsequently. An 81-year-old, 70 kg male patient was scheduled for cystoscopy in the urology clinic. Preanaesthetic evaluation revealed no pathology or concomitant disease except for advanced age. He had previously undergone prostate surgery under spinal anaesthesia. His Mallampati score was 3 and he had a large tongue (Figure 1). As the procedure was anticipated to take a short time and the patient, who had a high Mallampati score, did not want to be awake during the procedure, LMA was preferred for airway management. Figure 1 Examination image for Mallampati score Induction of anaesthesia was made with propofol, fentanyl and rocuronium, the patient was easily ventilated with a face mask, and an attempt was made to place a size 5 standard LMA; but as the mask, which was pushed forward, came back, it was thought that the mask was large for the patient and the attempt was repeated using a size 4 mask. However, as this attempt was also unsuccessful, it was thought that silicone tip of the balloon was folded; thus, I-Gel (size 4), which is a supraglottic airway device without a cuff and stands more stable, was tried to be placed. However as size 4 I-Gel LMA was pushed forward and ventilation was initiated, a significant air leakage occurred, and considering that size 4 was small, we again tried using size 5. However, observing substantial amount of air leak at the end of all these attempts, LMA was planned to be placed under laryngoscopic guidance. Airway examination, which was performed by a Macintosh laryngoscope, revealed a 2×2 cm mass located at the base of the hypopharynx, covered by normal mucosa, and appeared to be neither cystic nor ulcerated (Figure 2). It was thought that the mass, which was located at the same place where LMA device was placed, caused the tip of standard LMAs to be folded or remain between the mass and pharyngeal tissue, and hindered I-Gel LMA to closely fit after being placed and caused leakage from the back of the device, and consequently the attempts were unsuccessful. The patient, of whom Cormack-Lehane score was 2, was then intubated by size 8 endotracheal tube. We encountered no problem during intraoperative period and the patient was extubated without problem at the end of the procedure that lasted for 45 minutes; he was recommended to refer to the ENT outpatient clinic. Meanwhile, consent of the patient was obtained for presenting his case as a case report. Figure 2 The appearance of the mass through the laryngoscope Unforeseen dangers might have been in question because of blindly placed LMA, in this patient who had a deeply localized asymptomatic lesion that could not be detected by routine airway examination. If this mass located in the hypopharynx, had been cystic, it would have been perforated during the attempts to place the LMA and would have led to serious consequences by the spread of cyst content into the lungs. Again, if it had been a vascular mass like a haemangioma, it would have been difficult to control the unexpected bleeding. Lingual tonsil hyperplasia, which is more common in paediatric cases, may lead to similar problems (1, 2). Although blind placement of LMA without using a laryngoscope is an advantage, it may turn into a disadvantage in complicated cases and may lead to various problems. In case of recurrent failure while placing a supraglottic device, an airway disorder, as well as common problems such as incompatibility between device and patient anatomy and folded balloon, should be considered and attempts should aim at performing non-traumatic interventions as much as possible without insisting on blind replacement.

Intubating condition, hemodynamic parameters and upper airway morbidity: A comparison of intubating laryngeal mask airway with standard direct laryngoscopy.

Background:Intubating Laryngeal Mask Airway (ILMA) is a relatively new device designed to have better intubating characteristics than the standard Laryngeal Mask Airway. This study was designed to compare Intubating Laryngeal Mask with standard Direct Laryngoscopy (DLS), taking into account ease of intubation, time taken for intubation, success rate of intubation, hemodynamic responses and upper airway morbidity.Materials and Methods:Sixty patients, ASA I or II, of age between 20 and 60 years, were enrolled in this prospective and randomized study. They were randomly allocated to one of the two groups: group ILMA, Intubating Laryngeal Mask Airway; group DLS, Direct Laryngoscopy. The patients were intubated orally using either equipment after induction of general anesthesia.Results and Conclusions:DLS is comparatively a faster method to secure tracheal intubation than Intubating Laryngeal Mask. ILMA offers no advantage in attenuating the hemodynamic responses compared to direct laryngoscope. The success rate of intubation through Intubating Laryngeal Mask is comparable with that of DLS. The upper airway morbidity and mean oxygen saturation are comparable in both the groups.

Survey of Elective Laryngeal Mask Airway Use in the Presence of Gastroesophageal Reflux Disease

Concern exists about the potential risks of pulmonary aspiration with the laryngeal mask airway (LMA) due to its inability to provide a tight seal at the larynx. The safety of LMA use in the presence of gastroesophageal reflux disease (GERD) is unclear, as GERD is presumed to increase the risk of aspiration under anesthesia. VA Anesthesiolo- gists were surveyed regarding their practices in the setting of mild, moderately severe and severe symptoms of GERD. Approximately half responded that they would use a standard LMA in a patient with GERD as long as symptoms are mild. Nineteen percent would not use the LMA in any patient with a history of GERD.

Abstract 59: The Incidence Of Pulmonary Aspiration With Laryngeal Mask Airway Use During Cardiopulmonary Resuscitation And Positive Pressure Ventilation In Swine.

Objective: Pulmonary aspiration of gastric contents occurs 20 –30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest. This is due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Even though the American Heart Association (AHA) has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by EMS personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain. We sought to determine the incidence of aspiration after LMA placement, CPR and PPV. Methods: We conducted a prospective study on 16 consecutive post-experimental mixed-breed domestic swine of either sex (mean mass 25.7 ±1.4 kgs). A standard size-4 LMA was modified so that a vacuum catheter could be advanced into and past the LMA diaphragm. The LMA was placed into the hypopharynx and its position confirmed using End-tidal CO 2 and direct visualization of lung expansion. Fifteen milliliters of heparinized blood were instilled into the pharynx. After 5 PPVs with a mechanical ventilator, chest compressions were performed for 60s with asynchronous ventilations continuing at a rate of 12 per minute. After chest compressions, a suction catheter was inserted through the cuff and suction applied for approximately 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated and the LMA removed. The intima of the LMA diaphragm was inspected for signs of blood. In a validation cohort of 4 animals, the LMA was reinserted, a cricothyrotomy performed and 5 mL of blood instilled directly into the trachea. Results: There were 0/16 (95% CI=0 –17%) with a positive tests for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm. In the validation cohort, all four were positive for blood in both the vacuum catheter and the intima of the LMA diaphragm. Conclusions: In this simple model of regurgitation of after LMA placement, there was no sign of pulmonary aspiration, and no evidence that blood had passed beyond the seal created by the LMA cuff. Concerns over aspiration with LMA use may be unfounded. Future studies should determine the frequency of pulmonary aspiration after LMA placement in the clinical setting.

Size 2 ProSeal™ laryngeal mask airway: a randomized, crossover investigation with the standard laryngeal mask airway in paediatric patients

One of the main concerns with the use of the standard laryngeal mask airway (SLMA) in small infants is that its low-pressure seal might be inadequate for positive pressure ventilation so that there is a risk of gas leakage into the stomach with the subsequent risk of regurgitation. The new ProSeal LMA (PLMA) has been shown to form a more effective seal than the SLMA and to facilitate gastric tube placement in adults. The first paediatric size PLMA became available recently. Thirty anaesthetized, non-paralysed children aged 46 (19) months, weighing 16 (10-21) kg, were studied. The SLMA and PLMA were inserted in random order into each patient. Airway leak pressure and maximum tidal volume were measured. Ease of insertion, quality of initial airway and fibreoptic position were also determined. Gastric tube placement was assessed for the PLMA. The airway leak pressure and maximum tidal volume were significantly higher for the PLMA (P=0.001). Ease of insertion and quality of initial airway were similar for both devices. Air entry into the stomach occurred more frequently with the SLMA (P=0.005). Gastric tube placement was possible in all patients. The size 2 PLMA offered some advantages over the same size of SLMA in this crossover investigation. The high reliability of gastric tube placement and the significantly increased airway leak pressure might have important implications for use of this device for positive pressure ventilation in infants.

An Audit of the Single Use Portex Laryngeal Mask

We performed an audit of the insertion of the Single Use Portex Laryngeal Mask in 400 patients. Insertion was successful at first attempt in 335 out of 400 patients (83.8%). However in 15 patients (3.8%), the Portex laryngeal mask could not be placed despite repeated attempts. In 12 of these 15 patients (80%), a standard Laryngeal Mask Airway (LMA) was successfully placed. After the completion of the audit, 22 out of 29 anaesthetists (75.9%), who had inserted > or = 5 Portex laryngeal masks, considered it inferior to the standard LMA. It would appear to us that the Portex laryngeal mask might need some design modifications to be a real alternative to the standard LMA.

Comparison of Disposable and Reusable Laryngeal Mask Airways in Spontaneously Ventilating Adult Patients

Recent studies have indicated that despite stringent sterilization processes, the reusable silicone laryngeal mask airway (LMA) has the potential for disease transmission through residual biological debris. As a result, a polyvinyl chloride (PVC) disposable LMA has been introduced. This randomized trial involved 138 spontaneously ventilating adult patients who underwent elective surgery requiring airway management with an LMA to determine whether there is a clinical difference between the disposable Portex LMA (PLMA) and the standard reusable LMA in terms of ease of insertion, intra-operative cuff pressures and postoperative incidence of sore throat. There was no significant difference in first attempt insertion success rates (79% vs 84%) or difference in the incidence of postoperative sore throat observed between the two groups. Cuff pressure increases with nitrous oxide anaesthesia were significantly larger with the reusable LMA. The disposable PLMA provided a suitable airway in spontaneously ventilating patients without the risk of disease transmission inherent in a reusable device.

Laryngeal Mask Airway

The laryngeal mask airway (LMA), invented by Dr. Brain in 1981, is a new airway device filling the gap between tracheal intubation and the use of a facial mask. The LMA is reusable, simple to use, atraumatic to in-sert, and helpful in overcoming an obstructed airway. The LMA is inserted blindly into the hypopharynx and forms a low pressure seal around the laryngeal inlet. It is minimally stimulating to the airway, thus avoiding the unwanted sympathetic stimulation associated with laryngoscopy and intubation. Besides the use as a routine airway for elective surgery, the LMA has a role in management of difficult airway and traumatic patients. The standard LMA, the LMA-Classic(R), is still being used for majority of cases in and out of hospital, but newer variant LMAs have been developed for the last decade. The LMA with a reinforced airway tube, the LMA-Flexible(R), has been used for head and neck and intraoral surgery. The intubating LMA, the LMA-Fastrach(R), was developed for an aid to intubation in difficult airway as well as a ventilating device. The disposable LMA, the LMA-Unique(R), was introduced into the practice for an emergency airway. Furthermore, the recently developed LMA, the LMA-ProSeal(R), with a dual cuff and an additional drain tube, offers better seal and less risk of aspiration than the standard LMA. Perhaps, the LMA-ProSeal(R) may replace the LMA-Classic(R) in most of anesthesia practice in near future.

Use of the ProSeal Laryngeal Mask to protect the airway from methylene blue dye

In the trauma patient tracheal soiling is usually from the upper airway [1]. Although the ProSeal Laryngeal Mask Airway (LMA) gives a better seal pressure than the standard LMA [2] and is designed to prevent inadvertent gastric insufflation, and thus should reduce aspiration of gastric contents, its ability to protect the airway from material already in the mouth has not been formally assessed.

Ease of Placing LMAs During Manual In-Line Stabilization

The laryngeal mask airway (LMA) is increasingly being used in the emergency department. In this prospective, randomized, crossover study, the authors compared the ease of placement and the seal of the standard LMA and the ProSeal LMA in 20 generally healthy, elective-surgery …

Does the ILMA make sense in HEMS?

As first reported by Brain 1 by the early 1980s, the laryngeal mask airway (LMA) represented a new approach to airway management. The LMA has been used to facilitate tracheal intubation by a variety of methods. In fact, the LMA has been used to intubate the patient with difficult tracheal access. A recent addition to this technique, the intubating laryngeal mask airway (ILMA), shown in Figure 1, first was proposed by Brain and coworkers in 1995. 1,2 [Display omitted] The ILMA incorporates the standard LMA cuff in sizes 3, 4, or 5, along with a metal airway tube and handle. The handle allows users to manipulate the device within the patient's airway. The airway tube component has a wider internal diameter and is shorter than the standard LMA tube. A silicone rubber bite block surrounds the upper portion of the stem.

Intubating LMA vs. Standard LMA: Equally Easy to Learn and Use for Inexperienced Operators

The lack of airway protection with the standard laryngeal mask airway (LMA) has limited its utility as a rescue device in the ED or EMS setting.

The Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the Flexible and the Standard Laryngeal Mask Airway

Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria, and University of Queensland and Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Australia

The Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the Flexible and the Standard Laryngeal Mask Airway

We conducted a randomized, cross-over study of 20 paralyzed anesthetized adult patients to test the hypothesis that oropharyngeal leak pressure and cuff position (assessed fiberoptically) vary with head and neck position for the flexible (FLMA) and standard laryngeal mask airway (LMA). Both devices were inserted into each patient in random order. Oropharyngeal leak pressure and fiberoptic position (including degree of rotation) were documented in four head and neck positions (neutral first, then flexion, then extension and rotation in random order) for each device. The size 5 was used for all patients, and the intracuff pressure was set at 60 cm H2 O in the neutral position. All airway devices were inserted at the first attempt. Oropharyngeal leak pressure was similar for the FLMA and LMA in the neutral (22 vs 21 cm H2 O), flexed (26 vs 26 cm H2 O), and extended positions (19 vs 18 cm H2 O) but was slightly higher for the LMA when the head was rotated (19 vs 22 cm H2 O; P = 0.04). Compared with the neutral position, oropharyngeal leak pressure for the LMA was higher with flexion (26 vs 21 cm H2 O; P = 0.0004) and lower with extension (18 vs 21 cm H2 O; P = 0.03) but similar with rotation. Compared with the neutral position, oropharyngeal leak pressure for the FLMA was higher with flexion (26 vs 22 cm H2 O; P = 0.0001) and lower with extension (19 vs 22 cm H2 O; P = 0.03) and rotation (19 vs 22 cm H2 O; P = 0.03). The difference in oropharyngeal leak pressure between flexion and extension was 7 and 8 cm H2 O for the FLMA and LMA, respectively. Fiberoptic position was similar between devices and was unchanged by head and neck position. Rotation was not detected fiberoptically. We conclude that there are small changes in oropharyngeal leak pressure but no changes in cuff position in different head and neck positions for the FLMA and LMA. Oropharyngeal leak pressure may be improved by head and neck flexion and by avoiding extension. Implications: There are small changes in oropharyngeal leak pressure but no changes in cuff position in different head and neck positions for the flexible and standard laryngeal mask airways. Oropharyngeal leak pressure may be improved by head and neck flexion and by avoiding extension. (Anesth Analg 1999;88:913-6)

Liability of laryngeal mask airway devices to thermal damage from KTP and Nd:YAG lasers

We have compared the liability of four laryngeal mask airway (LMA) devices (standard, flexible, intubating and reusable) and a tracheal tube to thermal damage from KTP and Nd:YAG lasers at two power densities used commonly in airway surgery: 570 W cm-2 and 1140 W cm-2. Eighty-five airway devices were tested: 24 standard LMA (silicone-based), 12 flexible LMA (silicone-based, metal wires), 24 disposable LMA (PVC-based), one intubating LMA (silicone and steel-based) and 24 PVC-based tracheal tubes. Comparisons were made during laser strike to eight different targets: the unmarked and marked part of the airway device tube; the unmarked part of the airway device tube after application of blood; the cuff filled with air or methylene blue dye; the unmarked flexible LMA tube on or between the metal wires; and the epiglottic elevator bar of the intubating LMA. The laser strike was continued for 30 s and each target was tested three times. Three different, but identical, impact sites were used for each target. There was no ignition of any airway device with either power density or laser type. The silicone-based LMA were generally more resistant to flaring and penetration than the PVC-based LMA and tracheal tube, but the intubating LMA tube flared more rapidly with the KTP laser, and the disposable LMA cuff was more resistant to penetration. Print markings, blood and the metal wires of the flexible LMA reduced the thermal resistance of the tube. Filling the cuff with methylene blue dye increased the thermal resistance of all airway devices. We conclude that the silicone-based LMA devices were more thermal resistant to KTP and Nd:YAG laser strike than PVC-based devices with the exception of the disposable LMA cuff and the intubating LMA tube.

The modified laryngeal mask airway: four head and neck procedures in two children with mild subglottic stenosis

The laryngeal mask airway (LMA) was first described in 1983, and has since been used for administration of general anesthesia, resuscitation and as an aid to bronchoscopy or intubation. When used for anesthesia, the LMA has the advantage of lessening potential subglottic injury as compared to an endotracheal tube. Children with mild subglottic stenosis often have minimal symptoms of airway compromise at baseline. However, a minor degree of subglottic irritation may result in dyspnea (as in upper airway infection or following laryngeal intubation). We have begun using the LMA in such patients undergoing a general anesthetic for head and neck procedures unrelated to the airway. The present report describes two such children who underwent rhinologic and ophthalmologic surgery using the LMA. No perioperative stridor or respiratory distress was noted, and the LMA did not interfere with the procedure. In addition, we describe a modification of the standard LMA to further facilitate surgical access to the head and neck.

Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation

To investigate the incidence and severity of laryngo-pharyngeal complaints following anesthesia with the use of a laryngeal mask airway (LMA) compared with endotracheal intubation in adults. Prospective study with randomized patient selection. University medical center. 202 adult ASA physical status I, II, and III patients scheduled for elective surgery of either an extremity or breast, or a transurethral resection. Following intravenous induction of anesthesia, a standard LMA size #3, #4, or #5 corresponding to the patient's body weight, was inserted in 103 patients; 99 patients were intubated with a polyvinylchloride endotracheal tube [7.5 mm inner diameter (ID) in women and 8.0 mm ID in men]. Cuff pressures in the LMA group were initially reduced to a minimum pressure at which an air-tight seal between the LMA and the laryngeal inlet was provided at a positive pressure of 20 cm H2O during manual bag ventilation. Cuffs of endotracheal tubes were inflated and controlled to a volume needed to prevent gas leak at 35 cm H2O pressure. Cuff pressures were continuously monitored in both groups. Patients assessed their laryngo-pharyngeal complaints on a 101-point numerical rating scale on the evening after surgery and the following two days. No difference was found in the incidence and severity of sore throat on the evening following surgery or on the two following days. Dysphonia was more frequent following intubation than following LMA insertion on the day of surgery (46.8% vs. 25.3%) and on the first postoperative day (28.1% vs. 11.6%) (p < 0.05). However, the incidence of dysphonia increased with the duration of anesthesia in LMA patients but not in intubated patients. The incidence of dysphagia was significantly higher following LMA insertion compared with endotracheal intubation on the day of surgery (23.8% vs. 12.5%), and on the first postoperative day (22.3% vs. 10.4%). The severity of the individual complaints of minor laryngo-pharyngeal morbidity was comparable between groups. The type of airway management during anesthesia did not affect patient satisfaction with the anesthesia received. There is a distinct pattern of laryngo-pharyngeal complaints following the use of the LMA and endotracheal intubation. With regard to minor laryngo-pharyngeal morbidity, the advantage of the LMA to endotracheal intubation is questionable.