Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the facemast and laryngeal mask airway at high and low cuff volumes in males and females

Background: There is controversy over (1) the relative incidence of sore th roat between the face mask (FM) and laryngeal mask airway (LMA), (2) the ef ficacy of LMA intracuff pressure reduction as a mechanism for minimizing so re throat, and (3) the relative incidence of sore throat with the LMA betwe en males and females. In a randomized double-blind study, the authors compa red 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 i nflated cuff (LMA-High), or (3) the LMA with a semi-inflated cuff (LMA-Low) . Anesthesia was administered with propofol, nitrous oxide, oxygen, and iso flurane. In the FM group, a Guedel-type oropharyngeal airway and jaw thrust were used only if necessary. In the LMA groups, cuff inflation was achieve d 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 we re questioned 18-24 h postoperatively about surgical pain, sore throat, sor e neck, sore jaw, dysphonia, and dysphagia, and about whether they were sat isfied 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 less than or equal to 0.02). The incidence of sore neck was higher for the FM (14%) than the LMA-High gr oup (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 surgic al pain or dysphonia. The incidence of dysphagia was lower in the FM (1%) t han 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 gr oup than the LMA-High group for both males and females (all: P less than or equal to 0.04). There were no differences in discomfort levels between mal es and females in any group. Two patients from the FM group and one from th e LMA-High group were not satisfied with their anesthetic. These complaints were unrelated to post-operative 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 pat ient satisfaction after LMA or FM anesthesia.