Emergence characteristics and postoperative laryngopharyngeal morbidity with the laryngeal mask airway: a comparison of high versus low initial cuff volume

In this study we tested the hypothesis that the initial cuff volume of the laryngeal mask airway influences emergence characteristics and postoperativ e laryngopharyngeal morbidity. One hundred and sixty adult patients undergo ing minor surgery were randomly assigned for airway management with the lar yngeal mask airway with either a fully inflated cuff (LMA-High) or a semi-i nflated cuff (LMA-Low). Anaesthesia was with propofol, nitrous oxide, oxyge n and isoflurane. Following insertion, the cuff was inflated with either 15 or 30 ml for the size 4 (females) and 20 or 40 ml for the size 5 (males). At the end of surgery, a blinded observer documented the presence or absenc e of adverse airway events (hypoxia, hypercapnea, coughing, retching, regur gitation/vomiting, airway obstruction, hypoventilation, hiccupping, biting, body movement or shivering) during every 1 min epoch and cardiorespiratory variables (heart rate, mean blood pressure, arterial oxygen saturation, rn d-tidal carbon dioxide and respiratory rate) every 5 min until the patient was awake and the laryngeal mask airway removed. Patients were interviewed about pharyngolaryngeal morbidity (sore throat, dysphonia and dysphagia) im mediately before leaving the postanaesthesia care unit and 18-24 h followin g surgery Analysis by epoch showed more partial airway obstruction in the L MA-High group, but analysis by patient numbers revealed no difference. Hear t rate was slightly higher in the LMA-High group upon arrival in the postan aesthesia care unit, but otherwise there were no differences in cardiorespi ratory responses. Sore throat and dysphagia were more common in the LMA-Hig h group. We conclude that, in general, emergence characteristics with the l aryngeal mask airway are not influenced by the volume of air used to inflat e the cuff, but that postoperative sore throat and dysphagia are more likel y at high initial cuff volumes.