title: Fiberoptic assessment of the Laryngeal Mask Airway (Laryseal) position after one hour of positive pressure ventilation: an observational study.
abstract: OBJECTIVE
  To determine, by fiberoptic endoscope, malpositioning of the Laryngeal Mask Airway (LMA) and other extraglottic devices.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  60 adult, ASA physical status 1 and 2 patients, aged 20 - 60 years, scheduled to undergo ophthalmic procedures with general anesthesia during controlled ventilation via LMA (Laryseal).
  
  
  METHODS
  Adequacy of ventilation was determined by the absence of audible leak and appropriate capnograph trace. Fiberoptic assessment and imaging of LMA position were done after proper insertion of the LMA and after one hour of positive pressure ventilation (PPV). Assessment included position of the epiglottis, glottis, and cuff.
  
  
  RESULTS
  The epiglottis was visible in 50 patients (83.3%). Vocal cords were visible in 58 patients at the time of insertion, and in 52 patients after one hour of PPV (P = 0.047). The arytenoids were herniating through the mask aperture after one hour of PPV (P = 0.0132). The cuff position was less optimal after one hour of controlled ventilation (P = 0.032).
  
  
  CONCLUSIONS
  LMA position may change spontaneously with time during PPV, especially when the LMA position is not optimum at the time of insertion. The LMA should be adequately inserted with all possible measures in cases with general anesthesia and PPV. Fiberoptic assessment of LMA position intraoperatively may be advantageous.
authors.affiliation: Department of Anaesthesia, Alexandria Faculty of Medicine, Alexandria, Egypt. Electronic address: m.3abdelaziz@hotmail.com.
authors.forename: Moustafa Abdelaziz
authors.initials: MA
authors.lastname: Moustafa
authors.affiliation: Department of Anaesthesia, Alexandria Faculty of Medicine, Alexandria, Egypt.
authors.forename: Mohamed Mahmoud
authors.initials: MM
authors.lastname: Abdelhady
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005931:Glottis / Q000473:pathology; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D011446:Prospective Studies; D055815:Young Adult
keywords: Fiberoptics; Laryngeal Mask Airway; Positive pressure ventilation