The effect of cuff pressure on postoperative sore throat after Cobra perilaryngeal airway

Han Bum Joe, Dae Hee Kim, Yun Jeong Chae, Jong Yeop Kim, Min Kang, Kwan Sik Park, Han Bum Joe, Dae Hee Kim, Yun Jeong Chae, Jong Yeop Kim, Min Kang, Kwan Sik Park

Abstract

Purpose: The cuff volume of the Cobra perilaryngeal airway (CobraPLA) is larger than that of other alternative airway devices and makes it difficult to predict the effect of cuff pressure on the perilaryngeal mucosa. We tested the hypothesis that adjustment of the cuff pressure of the CobraPLA could reduce the incidence of postoperative sore throat (POST).

Methods: After induction of general anesthesia and insertion of the CobraPLA by standardized method, the cuff pressure was set to 60 cmH(2)O (group C, n = 87) or adjusted to minimal seal-up pressure +5 cmH(2)O (group A, n = 87). The frequency and severity (0, none; 1, mild; 2, moderate; 3, severe) of throat soreness, pain, discomfort, and adverse effects were evaluated 1 and 24 h after removal of the CobraPLA.

Results: Incidence of moderate POST in group C was higher than that in group A (11% vs. 2%, P = 0.021) whereas the overall POST incidence was not different between the two groups (31% vs. 20%, P = 0.092). The inflated air volume of group A was different from that of group C (41 vs. 50 ml, P = 0.009).

Conclusions: Adjustment of cuff pressure reduces the incidence of moderate POST after use of the CobraPLA.

Figures

Fig. 1
Fig. 1
Cobra perilaryngeal airway (CobraPLA) has three components: head (1) (which looks like a cobra snake); cuff (2) with large volume; ventilation tube (3); and inflating valve (4). Lateral view of CobraPLA (a) and anterior view (b) of the head with anterior grill (5)

References

    1. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia. 1999;54(5):444–453. doi: 10.1046/j.1365-2044.1999.00780.x.
    1. Reier CE. Bleeding, dysphagia, dysphonia, dysarthria, severe sore throat, and possible recurrent laryngeal, hypoglossal, and lingual nerve injury associated with routine laryngeal mask airway management: where is the vigilance? Anesthesiology 2004;101(5):1241–2; author reply 1242–4.
    1. Galvin EM, van Doorn M, Blazquez J, Ubben JF, Zijlstra FJ, Klein J, Verbrugge SJ. A randomized prospective study comparing the Cobra perilaryngeal airway and Laryngeal Mask Airway-Classic during controlled ventilation for gynecological laparoscopy. Anesth Analg. 2007;104(1):102–105. doi: 10.1213/01.ane.0000246812.21391.d1.
    1. Turan A, Kaya G, Koyuncu O, Karamanlioglu B, Pamukcu Z. Comparison of the laryngeal mask (LMA) and laryngeal tube (LT) with the new perilaryngeal airway (CobraPLA) in short surgical procedures. Eur J Anaesthesiol. 2006;23(3):234–238. doi: 10.1017/S0265021505002243.
    1. Cook TM, Lowe JM. An evaluation of the Cobra perilaryngeal airway: study halted after two cases of pulmonary aspiration. Anaesthesia. 2005;60(8):791–796. doi: 10.1111/j.1365-2044.2005.04261.x.
    1. Jolliffe L, Jackson I. Airway management in the outpatient setting: new devices and techniques. Curr Opin Anaesthesiol. 2008;21(6):719–722. doi: 10.1097/ACO.0b013e328316bb57.
    1. Lee JJ, Kim JA, Gwak MS, Kim MH. Evaluation of the Cobra perilaryngeal airway (CPLA) as an airway conduit. Eur J Anaesthesiol. 2007;24(10):852–855. doi: 10.1017/S0265021507000877.
    1. Khan RM, Maroof M, Johri A, Ashraf M, Jain D. Cobra PLA can overcome LMA failure in patients with face and neck contractures. Can J Anaesth. 2005;52(3):340. doi: 10.1007/BF03016081.
    1. Mezzetti M, Lindenberg P, Rizzi F, Alfery D, Szmuk P. Airway rescue using an “undersized” CobraPLA during cardiopulmonary resuscitation. J Clin Anesth. 2008;20(5):404–405. doi: 10.1016/j.jclinane.2008.03.009.
    1. Jensen PJ, Hommelgaard P, Sondergaard P, Eriksen S. Sore throat after operation: influence of tracheal intubation, intracuff pressure and type of cuff. Br J Anaesth. 1982;54(4):453–457. doi: 10.1093/bja/54.4.453.
    1. Brimacombe J, Holyoake L, Keller C, Brimacombe N, Scully M, Barry J, Talbutt P, Sartain J, McMahon P. Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females. Anesthesiology. 2000;93(1):26–31. doi: 10.1097/00000542-200007000-00009.
    1. Burgard G, Mollhoff T, Prien T. The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anesth. 1996;8(3):198–201. doi: 10.1016/0952-8180(95)00229-4.
    1. Wong JG, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS. Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Paediatr Anaesth. 2009;19(5):464–469. doi: 10.1111/j.1460-9592.2009.02968.x.
    1. Brimacombe J, Keller C, Puhringer F. Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway. Anesthesiology. 1999;91(6):1661–1665. doi: 10.1097/00000542-199912000-00018.
    1. Gaitini L, Carmi N, Yanovski B, Tome R, Resnikov I, Gankin I, Somri M, Alfery D. Comparison of the CobraPLA (Cobra Perilaryngeal Airway) and the Laryngeal Mask Airway Unique in children under pressure controlled ventilation. Paediatr Anaesth. 2008;18(4):313–319. doi: 10.1111/j.1460-9592.2008.02449.x.
    1. van Zundert A, Al-Shaikh B, Brimacombe J, Koster J, Koning D, Mortier EP. Comparison of three disposable extraglottic airway devices in spontaneously breathing adults: the LMA-Unique, the Soft Seal laryngeal mask, and the Cobra perilaryngeal airway. Anesthesiology. 2006;104(6):1165–1169. doi: 10.1097/00000542-200606000-00010.
    1. Park SH, Han SH, Do SH, Kim JW, Kim JH. The influence of head and neck position on the oropharyngeal leak pressure and cuff position of three supraglottic airway devices. Anesth Analg. 2009;108(1):112–117. doi: 10.1213/ane.0b013e318192376f.
    1. van Zundert A, Brimacombe J, Kamphuis R, Haanschoten M. The anatomical position of three extraglottic airway devices in patients with clear airways. Anaesthesia. 2006;61(9):891–895. doi: 10.1111/j.1365-2044.2006.04745.x.
    1. Nam SB, Chang CH, Lee YW, Lee JS, Yang HG, Jang DJ. Hypoglossal nerve injury following the use of the CobraPLA. Eur J Anaesthesiol. 2007;24(6):556–557. doi: 10.1017/S026502150600216X.
    1. Twigg S, Brown JM, Williams R. Swelling and cyanosis of the tongue associated with use of a laryngeal mask airway. Anaesth Intensive Care. 2000;28(4):449–450.
    1. Colbert SA, O’Hanlon DM, Flanagan F, Page R, Moriarty DC. The laryngeal mask airway reduces blood flow in the common carotid artery bulb. Can J Anaesth. 1998;45(1):23–27. doi: 10.1007/BF03011987.

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