Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask
and laryngeal mask airway at high and low cuff volumes in males and females.
Author(s): Brimacombe J, Holyoake L, Keller C, Brimacombe N, Scully M, Barry J, Talbutt P,
Sartain J, McMahon P.
Affiliation(s): Department of Anaesthesia and Intensive Care Medicine, Cairns Base Hospital,
Australia. jbrimacombe@north.net.au
Publication date & source: 2000, Anesthesiology. , 93(1):26-31
BACKGROUND: There is controversy over (1) the relative incidence of sore throat
between the face mask (FM) and laryngeal mask airway (LMA), (2) the efficacy of
LMA intracuff pressure reduction as a mechanism for minimizing sore throat, and
(3) the relative incidence of sore throat with the LMA between males and females.
In a randomized double-blind study, the authors compared laryngopharyngeal, neck,
and jaw discomfort with the FM and LMA at high and low cuff volumes in males and
females.
METHODS: Three hundred adult patients were randomly assigned to three equal-sized
groups for airway management: (1) the FM, (2) the LMA with a fully inflated cuff
(LMA-High), or (3) the LMA with a semi-inflated cuff (LMA-Low). Anesthesia was
administered with propofol, nitrous oxide, oxygen, and isoflurane. In the FM
group, a Guedel-type oropharyngeal airway and jaw thrust were used only if
necessary. In the LMA groups, cuff inflation was achieved with either 15 or 30 ml
for the size 4 (females) and 20 or 40 ml for the size 5 (males). The LMA was
removed when the patient was awake. Patients were questioned 18-24 h
postoperatively about surgical pain, sore throat, sore neck, sore jaw, dysphonia,
and dysphagia, and about whether they were satisfied with their anesthetic.
RESULTS: The incidence of sore throat was lower in the FM (8%) than the LMA-High
(42%) and LMA-Low (20%) groups (both: P < or = 0.02). The incidence of sore neck
was higher for the FM (14%) than the LMA-High group (6%; P = 0.05) but similar to
the LMA-Low group (8%). The incidence of sore jaw was higher in the FM (11%) than
the LMA-High (3%) and LMA-Low (3%) groups (both: P = 0. 02). There were no
differences among groups for surgical pain or dysphonia. The incidence of
dysphagia was lower in the FM (1%) than the LMA-High group (11%; P = 0.003), but
similar to the LMA-Low group (1%). The incidence of sore throat and dysphagia was
lower in the LMA-Low group than the LMA-High group for both males and females
(all: P < or = 0.04). There were no differences in discomfort levels between
males and females in any group. Two patients from the FM group and one from the
LMA-High group were not satisfied with their anesthetic. These complaints were
unrelated to postoperative morbidity.
CONCLUSION: The LMA causes more sore throat and dysphagia but less jaw pain than
the FM. Sore throat and dysphagia are more common with the LMA if the initial
cuff volume is high. There are no differences in discomfort levels between males
and females. However, these discomforts do not influence patient satisfaction
after LMA or FM anesthesia.
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