Association of Mallampati scoring on airway outcomes in women undergoing general anesthesia with Supreme™ laryngeal mask airway in cesarean section

Hon Sen Tan, Shi Yang Li, Wei Yu Yao, Yong Jing Yuan, Rehena Sultana, Nian-Lin R Han, Alex Tiong Heng Sia, Ban Leong Sng, Hon Sen Tan, Shi Yang Li, Wei Yu Yao, Yong Jing Yuan, Rehena Sultana, Nian-Lin R Han, Alex Tiong Heng Sia, Ban Leong Sng

Abstract

Background: Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics.

Methods: This prospective cohort study was performed at a single-center: Quanzhou Women's and Children's Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes.

Results: The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p < 0.0001). There was no difference in maternal age, ASA status and gestational age. There was similar time to effective ventilation (mean (SD) High MP: 14.9 (4.5) vs Low MP: 15.7 (4.4) seconds, p = 0.2172), and first attempt success rate, seal pressure, and peak airway pressure. No clinical aspiration was noted. The incidence of blood on SLMA was higher in the High MP group than in Low MP (4 (6.6%) vs 4 (0.8%), p = 0.001). There was no difference in sore throat, voice hoarseness, maternal satisfaction and fetal outcomes.

Conclusion: High MP was not associated with reduced SLMA airway outcomes in cesarean section under general anesthesia, but may increase the risk of blood found on SLMA upon removal.

Trial registration: This study was registered at http://www.clinicaltrials.gov , identifier: NCT02026882 , retrospectively registered. Date of registration: December 31, 2013.

Keywords: Airway; Cesarean section; Laryngeal mask; Obstetrics.

Conflict of interest statement

Dr. Ban Leong SNG is associate editor of BMC Anesthesiology. The other authors declare that they have no competing interests.

References

    1. Harmer M. Difficult and failed intubation in obstetrics. Int J Obstet Anesth. 1997;6:25–31. doi: 10.1016/S0959-289X(97)80048-9.
    1. Mushambi MC, Kinsella SM. Obstetric Anaesthetists' Association/difficult airway society difficult and failed tracheal intubation guidelines--the way forward for the obstetric airway. Br J Anaesth. 2015;115:815–818. doi: 10.1093/bja/aev296.
    1. Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, Herkner H. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018;5:CD008874.
    1. Barnardo PD, Jenkins JG. Failed tracheal intubation in obstetrics: a 6-year review in a UK region. Anaesthesia. 2000;55:690–694. doi: 10.1046/j.1365-2044.2000.01536.x.
    1. Hawthorne L, Wilson R, Lyons G, Dresner M. Failed intubation revisited: 17-yr experience in a teaching maternity unit. Br J Anaesth. 1996;76:680–684. doi: 10.1093/bja/76.5.680.
    1. McDonnell NJ, Paech MJ, Clavisi OM, Scott KL. Group AT. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth. 2008;17:292–297. doi: 10.1016/j.ijoa.2008.01.017.
    1. Quinn AC, Milne D, Columb M, Gorton H, Knight M. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case-control study in the UK. Br J Anaesth. 2013;110:74–80. doi: 10.1093/bja/aes320.
    1. Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia. 2005;60:168–171. doi: 10.1111/j.1365-2044.2004.04069.x.
    1. Bercker S, Schmidbauer W, Volk T, Bogusch G, Bubser HP, Hensel M, et al. A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure. Anesth Analg. 2008;106:445–448. doi: 10.1213/ane.0b013e3181602ae1.
    1. Keller C, Brimacombe J, Kleinsasser A, Loeckinger A. Does the ProSeal laryngeal mask airway prevent aspiration of regurgitated fluid? Anesth Analg. 2000;91:1017–1020. doi: 10.1097/00000539-200010000-00046.
    1. Lim Y, Goel S, Brimacombe JR. The ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care. 2007;35:52–56. doi: 10.1177/0310057X0703500106.
    1. Yao WY, Li SY, Sng BL, Lim Y, Sia AT. The LMA supreme in 700 parturients undergoing cesarean delivery: an observational study. Can J Anaesth. 2012;59:648–654. doi: 10.1007/s12630-012-9718-4.
    1. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists' Association and difficult airway society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015;70:1286–1306. doi: 10.1111/anae.13260.
    1. Li SY, Yao WY, Yuan YJ, Tay WS, Han NLR, Sultana R, et al. Supreme™ laryngeal mask airway use in general anesthesia for category 2 and 3 cesarean delivery: a prospective cohort study. BMC Anesthesiol. 2017;17:169. doi: 10.1186/s12871-017-0460-x.
    1. McCrory CR, Moriarty DC. Laryngeal mask airway positioning is related to Mallampati grading in adults. Anesth Analg. 1995;81:1001–1004.
    1. Brimacombe J. Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia. Anaesthesia. 1996;51:76–80. doi: 10.1111/j.1365-2044.1996.tb07660.x.
    1. Joo HJ, Jong HK, Hee JB, Youn JK, Doo GY. Analysis of predictive factors for difficult ProSeal laryngeal mask airway insertion and suboptimal positioning. Anesth Pain Med. 2013;8:271–278.
    1. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105–1111. doi: 10.1111/j.1365-2044.1984.tb08932.x.
    1. Brain AI. Three cases of difficult intubation overcome by the laryngeal mask airway. Anaesthesia. 1985;40:353–355. doi: 10.1111/j.1365-2044.1985.tb10788.x.
    1. Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102:1867–1878. doi: 10.1213/01.ane.0000217211.12232.55.
    1. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology. 2005;103:429–437. doi: 10.1097/00000542-200508000-00027.
    1. Brimacombe J, Keller C, Fullekrug B, Agrò F, Rosenblatt W, Dierdorf SF, et al. A multicenter study comparing the ProSeal and classic laryngeal mask airway in anesthetized, nonparalyzed patients. Anesthesiology. 2002;96:289–295. doi: 10.1097/00000542-200202000-00011.
    1. Ramachandran SK, Mathis MR, Tremper KK, Shanks AM, Kheterpal S. Predictors and clinical outcomes from failed laryngeal mask airway unique: a study of 15,795 patients. Anesthesiology. 2012;116:1217–1226. doi: 10.1097/ALN.0b013e318255e6ab.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel