title: Oropharyngeal leak pressure with the laryngeal mask airway Supreme™ at different intracuff pressures: a randomized controlled trial.
abstract: BACKGROUND
  A higher oropharyngeal leak pressure (OLP) is a marker of efficacy and safety when using laryngeal mask airway devices. The new disposable laryngeal mask airway (LMA™) Supreme™ has lower OLP compared with the LMA ProSeal™. Increased intracuff pressure of laryngeal mask airway devices may improve OLP but may result in more postoperative pharyngolaryngeal adverse events. This study was designed to compare the OLP of the LMA Supreme at varying intracuff pressures.
  
  
  METHODS
  One hundred and twenty-three patients were divided randomly into three groups. General anesthesia was standardized using a propofol-fentanyl induction and desflurane in air-oxygen for maintenance. Intracuff pressures of the LMA Supreme were adjusted to 80 cm H(2)O, 60 cm H(2)O, and 40 cm H(2)O according to group allocation. The primary outcome was OLP. Secondary outcomes included postoperative pharyngolaryngeal adverse events and the satisfaction scores of patients and anesthesiologists. The OLP was compared amongst groups using analysis of variance with Bonferroni correction. All reported P values are two-sided.
  
  
  RESULTS
  The OLP with an intracuff pressure of 80 cm H(2)O was significantly higher compared with 60 cm H(2)O and 40 cm H(2)O (26 [6] vs 20 [6] vs 18 [5] cm H(2)O, respectively; P < 0.001). The incidence of postoperative pharyngolaryngeal adverse events (P = 0.6), patient satisfaction scores (P = 0.2), and anesthesiologist satisfaction scores (P = 0.8) were comparable amongst the three groups.
  
  
  CONCLUSIONS
  An intracuff pressure of 80 cm H(2)O with the LMA Supreme is associated with a higher OLP compared with 60 cm H(2)O or 40 cm H(2)O without a greater incidence of postoperative pharyngolaryngeal adverse events. For a superior glottic seal when using the LMA Supreme, we recommend intracuff pressures up to 80 cm H(2)O.
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada.
authors.forename: Lianfeng
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Anesthesia, Alexandra Health Private Limited, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Edwin
authors.initials: E
authors.lastname: Seet
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada.
authors.forename: Vanita
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Subramanyam
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada.
authors.forename: Saravanan P
authors.initials: SP
authors.lastname: Ankichetty
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada.
authors.forename: David T
authors.initials: DT
authors.lastname: Wong
authors.affiliation: Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst St., McL 2-405, Toronto, ON, M5T 2S8, Canada. Frances.Chung@uhn.on.ca.
authors.forename: Frances
authors.initials: F
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D004209:Disposable Equipment; D004867:Equipment Design; D005260:Female; D006801:Humans; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D011312:Pressure