The reinforced laryngeal mask airway for dento-alveolar surgery

We have evaluated the reinforced laryngeal mask airway (LMA) for use during dento-alveolar surgery in 100 ASA I and II day-case patients allocated randomly to receive either a nasotracheal tube or reinforced LMA. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In addition, a fibreoptic assessment was made of laryngotracheal soiling, and the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway positioning or perioperative oxygen desaturation. Nineteen patients in the nasotracheal tube group had epistaxis (P = 0.001) and laryngotracheal soiling occurred in three of these patients. Two reinforced LMA were dislodged on moving into the operating theatre and in a further five patients in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by downward pressure on the mandible by the surgeon. There were no differences in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.