Cuff filling volumes and pressures in pediatric laryngeal mask airways

Background: Hyperinflation of LMA cuffs carries the risk of airway morbidity by exerting pressure on laryngeal and pharyngeal structures. Cuff hyperinflation in LMAs can result from nitrous oxide diffusion into the LMA cuff and from deliberate manual cuff inflation. Methods: In an in vitro set up, maximum recommended cuff filling volumes for size 1, 1.5, 2, 2.5, 3 disposable LMAs from different manufacturers [SoftSeal LMA (Portex); Unique LMA (Intavent); Marshall LAD, LaryngoSeal (Tyco)] and reusable Classic and ProSeal LMAs (Intavent) were inflated into completely emptied LMA-cuffs and into LMA-cuffs at resting volume. Cuff pressures were measured using a cuff manometer. Experiments were performed eight times using two exemplars of each brand/size. Results: Maximum recommended cuff filling volumes for pediatric LMAs resulted in hyperinflation (cuff pressure > 60 cmH(2)O) in almost all LMAs, starting with emptied cuff. Starting from resting cuff volume, the maximum recommended inflation volume resulted in cuff pressures of > 120 cmH(2)O in all LMAs and sizes except in the ProSeal size 3 (101 +/- 1 cmH(2)O). Conclusions: Since the volume of air which is effectively required depends on several factors and varies between patients, the cuffs should be inflated only with the minimum volume of air required to form an effective seal with the respiratory and gastrointestinal tracts and the cuff pressure should be controlled.