THE REINFORCED LARYNGEAL MASK AIRWAY FOR DENTOALVEOLAR SURGERY

We have evaluated the reinforced laryngeal mask airway (LMA) for use d uring dento-alveolar surgery in 100 ASA I and II day-case patients all ocated randomly to receive either a nasotracheal tube or reinforced LM A. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In add ition, a fibreoptic assessment was made of laryngotracheal soiling, an d the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway position ing or perioperative oxygen desaturation. Nineteen patients in the nas otracheal tube group had epistaxis (P = 0.001) and laryngotracheal soi ling occurred in three of these patients. Two reinforced LMA were disl odged on moving into the operating theatre and in a further five patie nts in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by do wnward pressure on the mandible by the surgeon. There were no differen ces in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.