title: High laryngeal mask airway pressures resulting from nitrous oxide do not increase pharyngeal mucosal injury in dogs.
abstract: OBJECTIVE
  During general anesthesia, nitrous oxide (N2O) diffuses rapidly into the air-filled laryngeal mask airway (LMA) cuff, increasing intracuff pressure. There is no clear correlation between LMA intracuff pressure and pressure on the pharynx. We have studied the effects of high LMA intracuff pressures secondary to N2O on the pharyngeal mucosa of dogs.
  
  
  METHODS
  Sixteen mongrel dogs were randomly allocated to two groups: G1 (intracuff volume, 30 mL; n=8) breathed a mixture of O2 (l L x min(-1)) and air (l L x min(-1)) and G2 (intracuff volume, 30 mL; n=8) a mixture of O2 (l L x min(-1)) and N2O (l L x min(-1)). Anesthesia was induced and maintained with pentobarbitone. LMA cuff pressure was measured at zero (control), 30, 60, 90 and 120 min after #4 LMA insertion. The dogs were sacrificed, and biopsy specimens from seven predetermined areas of the pharynx in contact with the LMA cuff were collected for light (LM) and scanning electron microscopic (SEM) examination by a blinded observer.
  
  
  RESULTS
  LMA intracuff pressure decreased with time in G1 (P <0.001) and increased in G2 (P <0.001). There was a significant difference between the groups (P <0.001). In both groups, the LM study showed a normal epithelium covering the pharyngeal mucosa and mild congestion in the subepithelial layer. There were no differences between the groups (P >0.10) or among the areas sampled (P >0.05). In both groups, the SEM study showed a normal pharyngeal mucosa with mild superficial desquamation. Few specimens in G1 and G2 showed more intense epithelial desquamation.
  
  
  CONCLUSIONS
  High LMA intracuff pressures produced by N2O do not increase pharyngeal mucosal injury in dogs.
authors.affiliation: Department of Anesthesiology, The School of Medicine of The University Of São Paulo (UNESP), Bottucatu, São Paulo, Brazil. anestesi@fmb.unesp.br
authors.forename: T M
authors.initials: TM
authors.lastname: Abud
authors.forename: J R
authors.initials: JR
authors.lastname: Braz
authors.forename: R H
authors.initials: RH
authors.lastname: Martins
authors.forename: E A
authors.initials: EA
authors.lastname: Gregório
authors.forename: J C
authors.initials: JC
authors.lastname: Saldanha
mesh_terms: D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000818:Animals; D004285:Dogs; D005260:Female; D017214:Laryngeal Masks; D008297:Male; D008855:Microscopy, Electron, Scanning; D009092:Mucous Membrane / Q000473:pathology / Q000648:ultrastructure; D009609:Nitrous Oxide / Q000009:adverse effects*; D010614:Pharynx / Q000473:pathology* / Q000648:ultrastructure; D011312:Pressure
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide