Depth of Anesthesia

31: Do LMAs increase the risk of aspiration compared to ETTs? - Part I of II

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Aug 10, 2022
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ANECDOTE

Origin of LMA Interest

  • Chris Di Capua became intrigued by LMAs during a medical school rotation, observing easier insertion and more comfortable emergence compared to endotracheal tubes.
  • He questioned their infrequent use, prompting a mentor to cite aspiration risk, leading him to investigate the literature.
INSIGHT

Early LMA Regurgitation Study

  • Barker et al.'s 1992 study suggested LMAs increase regurgitation risk, finding dye in the larynx/pharynx of 25% of LMA patients versus 0% in face mask patients.
  • However, no dye reached the trachea, and a later study by El-Macadi et al. couldn't replicate the results, questioning the clinical significance.
INSIGHT

Clinical Validity of Early LMA Study

  • The initial LMA regurgitation study lacked clinical validity, as bile-stained secretions aren't observed in 25% of LMA patients.
  • The study's significant effect size should have been readily apparent clinically if true.
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