Respiratory mechanics, gastric insufflation pressure, and air leakage of the laryngeal mask airway

A potential risk of the laryngeal mask airway (LMA) is incomplete mask seal, which causes air leakage or insufflation of air into the stomach. The objective of the present study was to assess respiratory mechanics, quantify air leakage, and measure gastric air insufflation in patients ventilated via the LMA. Thirty patients were studied after induction of anesthesia but prior to any surgical manipulations. After the insertion of the LMA, patients were ventilated with increasing tidal volumes until one of the three following end points were reached: 1) gastric air insufflation, 2) airway pressure >40 cm H2O, or 3) limitation of further increase in tidal volume by air leakage. The following variables were determined: inspired volume (V-I), expired volume (V-E), maximum inspiratory pressure (P-max), airway pressure at gastric inflation (P-infl), respiratory time constant (RC), compliance (C), resistance (R), and leakage fraction (F-I). Respiratory mechanics were in the physiological range. Gastric insufflation occurred in 27% of the patients at inspiratory pressures between 19 and 33 cm H2O. Air leakage of more than 10% was evident at inspiratory pressures between 25 and 34 cm H2O. The end point of 40 cm H2O airway pressure was reached in only three patients. We conclude that the LMA is not better in preventing airway pressure transmission to the esophagus than a conventional face mask. However, a high F-L is associated with reduced gastric air insufflation.