Laryngeal mask airway position and the risk of gastric insufflation

A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage. The objective of the present study was to assess the incidence of LMA malpositions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyngeal air leakage. One hundred eight patients were studied after the induction of anesthesia, before any surgical manipulations. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 40 cm H2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using a flexible bronchoscope. The overall incidence of LMA malpositions was 40% (43 of 108). Gastric air insufflation occurred in 19% (21 of 108), and in 90% (19 of 21) of these patients, the LMA was malpositioned. Oropharyngeal air leakage occurred in 42%, and was independent of LMA position. We conclude that clinically unrecognized LMA malposition is a significant risk factor for gastric air insufflation. Implications: Routine placement of laryngeal mask airways does not require laryngoscopy. In our study, fiberoptic verification of mask position revealed suboptimal placement in 40% of cases. Such malpositioning considerably increased the risk of gastric air insufflation.