The incidence of aspiration associated with the laryngeal mask airway: A meta-analysis of published literature

Study Objective: To determine the incidence of pulmonary aspiration with the laryngeal mask airway (LMA). Design: A meta-analysis of all published literature on the LMA to September 1993. Measurements and Main Results: All 547 publications were reviewed and coded, and those observational studies in which the LMA was the main form of airway management were analyzed. Pulmonary aspiration was defined as either the presence of bilious secretions or particulate matter in the tracheobronchial tree or, if bronchoscopy was not performed, a postoperative chest radiograph with infiltrates present on preoperative chest radiograph or physical examination. In the study population, there were 3 cases of aspiration in 12,901 patients, and when combined with four independent reports excluded from the detailed analysis, this gave a final incidence of 2 in 10,000. Ten confirmed pulmonary aspiration events from published case reports showed that most cases had one or more predisposing factors. No death or permanent disability occurred. Conclusions: The evidence to date suggests that pulmonary aspiration with the LMA is uncommon and comparable to that for outpatient anesthesia with the face mask and tracheal tube. Meticulous attention to selection of low-risk patients and appropriate operative procedures and avoidance of light anesthesia should reduce the incidence even further.