The incidence of gastroesophageal reflux with the laryngeal mask: a comparison with the face mask using esophageal lumen pH electrodes.
To test the hypothesis that the laryngeal mask airway (LMA) predisposes patients to gastroesophageal reflux, we randomly assigned 55 patients having elective surgery to receive standardized anesthesia with the LMA or with conventional face mask (FM) plus airway. A pH-sensitive probe with two electrodes, 10 cm apart, was passed nasally into the esophagus 1 h before induction of anesthesia, and recordings were made continuously until 30 min after surgery. At the distal electrode, 30 cm from the anterior nares, there was a significant difference in the incidence of reflux: 53.6% with the LMA versus 22.2% with the FM (P < 0.05). At the level of the proximal electrode, 20 cm from the anterior nares, there was no difference between groups. Multiple reflux events, defined as two or more reflux events before, during, or after anesthesia, were significantly more frequent in the LMA group (P < 0.05). Reflux events continued in the postanesthesia care unit (PACU) in both groups with no significant difference between groups. There was no clinical evidence of aspiration of gastric contents in either group. Use of the LMA appears to result in increased reflux to the level of the mid to upper esophagus, and is associated with a more frequent incidence of multiple reflux events than use of the FM.
Owens
T M
TM
Department of Anesthesia and Intensive Care, St. Vincent's Hospital, Dublin, Ireland.
Robertson
P
P
Twomey
C
C
Doyle
M
M
McDonald
N
N
McShane
A J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000776:Anesthesiology / Q000295:instrumentation; D004566:Electrodes; D004947:Esophagus / Q000378:metabolism*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D008397:Masks / Q000009:adverse effects*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods