title: The laryngeal mask airway is effective (and probably safe) in selected healthy parturients for elective Cesarean section: a prospective study of 1067 cases.
abstract: OBJECTIVE
  To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia.
  
  
  METHODS
  Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N(2)O and 50% O(2) and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO(2) <94%, or end-tidal CO(2) >45 mmHg. Postdelivery, vecuronium and fentanyl were administered.
  
  
  RESULTS
  An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO(2) <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were >/=7 after five minutes.
  
  
  CONCLUSIONS
  We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.
authors.affiliation: Department of Anesthesiology Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea.
authors.forename: T H
authors.initials: TH
authors.lastname: Han
authors.forename: J
authors.initials: J
authors.lastname: Brimacombe
authors.forename: E J
authors.initials: EJ
authors.lastname: Lee
authors.forename: H S
authors.initials: HS
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D001034:Apgar Score; D002585:Cesarean Section; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017214:Laryngeal Masks / Q000009:adverse effects; D011247:Pregnancy; D011446:Prospective Studies