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October 14, 2007
9:00 AM - 11:00 AM
Room Hall D, Area D,
The Effectivness of the LMA Supreme™ in Patients with Normal and Difficult-to-Manage Airways
David Z. Ferson, M.D., Linda Chi, M.D., Sonal Zambare, M.D., David Brown, M.D.
Anesthesiology and Pain Medicine, The University of Texas – M. D. Anderson Cancer Center, Houston, Texas
Introduction: The Laryngeal Mask Airway Supreme (LMA-S) is a new disposable airway device that combines desirable features of the LMA Fastrach (curved shaft to ease insertion) and the LMA ProSeal (gastric access tube to minimize the risk of aspiration). We studied the success rates for insertion of and ventilation through the LMA-S and the incidence of any complications associated with the use of the device in 50 patients with normal or difficult airways. Methods: After obtaining approval from the institutional review board, we reviewed the anesthesia and medical records of 50 consecutive patients in whom the LMA-S was used for airway management during surgical procedures from October 2006 through March 2007. Data collected included the success rates for insertion and ventilation, and the incidence of any complications associated with the use of the device. Results: The LMA-S was successfully inserted in all 50 patients. The first-attempt success rate was 96%; one patient (2%) required two attempts, and one patient (2%) required three attempts to insert the LMA-S. Controlled ventilation was achieved in all patients. In one patient, ventilation through the LMA-S was difficult. Fiberoptic evaluation through the LMA-S in this patient revealed that the cuff was folded backwards, and this malpositioning of the device was causing partial airway obstruction. Removing the device and reinserting it corrected the cuff position and provided a clear airway. Ten patients in our study had difficult airways. In four of these patients, the LMA-S was used emergently to ventilate and, with the aid of a fiberoptic scope, to intubate patients after rigid laryngoscopy revealed a grade 4 view and tracheal intubation failed. In five other patients with a known history of difficult laryngoscopy, the LMA-S was used electively. In four patients in this group, the LMA-S was used as a primary airway device, and in one patient, tracheal intubation was performed using a fiberoptic scope. In one other patient who was undergoing a computed tomography-guided biopsy of an unstable C1-C2 pathological fracture, the LMA-S was used as the primary airway device. A minor sore throat (less than 4 on a scale of 10) was reported by 6 patients (12%). There were no other complications. Conclusions: The LMA-S provided a clear airway in 98% of our patients after the first attempt at insertion and 100% after two attempts. When used in patients with difficult airways, the device provided excellent ventilation and allowed for fiberoptically guided tracheal intubation. There were no serious complications associated with the use of the LMA-S. Success rates for insertion of the LMA ProSeal reported in the literature by experienced users range from 82% to 85%. Thus, on the basis of our reported success rate, the new LMA-S is easier to insert. This is significant, considering the fact that in our study the LMA-S was inserted by novice users of the device. Our report indicates that the LMA-S is a valuable addition to airway devices for patients with normal and difficult-to-manage airways and warrants further clinical studies.

Anesthesiology 2007; 107: A592