Intubation: use of laryngeal mask airways rarely led to aspiration.

Clinical bottom line (level 2a)

  1. Patients who underwent anaesthesia with laryngeal mask airways very rarely aspirated.
Brimacombe and Berry: Journal of Clinical Anesthesia 1995; 7: 297-305
Expires December 2003

The study

Systematic review of observational studies of
  • Patients: requiring intubation
  • Intervention: laryngeal mask airways
  • Outcome: aspiration (presence of bilious secretions or particulate matter in the tracheobronchial tree, or post-operative infiltrates on chest x-ray)


    • Articles found in all using MEDLINE, 48 hours, Reference Manager Update, up to 1993 (search terms: not detailed ) and from 14 major anaesthetic journals.

    Selection criteria: detailed in text
    Appraisal criteria: not given
    Articles excluded if:
    • LMA not main form of airway management
    • duplicate publication
    • reliable translations unavailable


    64 papers, 26 abstracts and 11 letters were found, involving 12901 patients (51% female; aged 0 to 98 years, mean 32; 20% children; 85% ASA I or II)

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    aspiration ? 3/12901 0.023%
    (0.00% to 0.050%)

    • Aspiration occurred during one emergency case, and one case with the patient in the Trendelberg position with intra-abdominal sufflation.

    Comments

    1. The safety of laryngeal mask airways in emergency intubations is less clear.

    Citation

    1. Brimacombe JR, and Berry A: The incidence of aspiration associated with the laryngeal mask airway: A meta-analysis of published literature. Journal of Clinical Anesthesia 1995; 7: 297-305
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer: Kenneth Ballew

    Clinical Question.
    Patient intubation
    Intervention or Exposure laryngeal mask airways
    Outcome aspiration