USE OF THE LARYNGEAL MASK AIRWAY IN THE AMBULATORY SETTING

Study Objective: To determine the utility of the laryngeal mask airway (LMA) in an ambulatory surgery practice. Design: Prospective, longitu dinal device (survival) study. Setting: University-based ambulatory su rgery center. Patients: 1,831 ASA physical status I, II, and III outpa tients undergoing superficial ambulatory surgery procedures. Intervent ions: Twenty LMA devices were entered into sen,ice over a 2-year perio d and the number of uses, as well as the structural integrity, were as sessed at the end of this study period. The serial number on, each LMA device was used to track the number of times it runs autoclaved, as w ell as the date that the device failed any of the standardized pre-use tests or was lost. Measurements and Main Results: During the 2-year s urvey, 6,430 general anesthetics were administered at the ambulatory s urgery center, with 1,831 (28%) using an LMA device for airway managem ent. At the end of the study period, nine devices were still in use, t hree had been withdrawn for structural analysis by the manufacturer (a fter > 100 uses), three failed the pre-use test (after 35-82 uses), an d five devices were lost (after 21-162 uses). The structural examinati on revealed that the tubes were 50% weaker; however, the cuffs, pilot balloons, and values were functioning normally. The median (range) num ber of uses was 92 (21-195). Thus, the 20 LMA devices evaluated tolera ted an average of 92 autoclave cycles each over the 2-year observation period. Conclusions: To optimize the use of the LMA device in the amb ulatory setting it is necessary to increase awareness that it is a non disposable piece of equipment and to adhere to the manufacturer's inst ructions for cleaning sterilization, and insertion.