Clinical Outcomes of a Modified Laryngeal Mask Airway (LMA(®) Gastro™ Airway) During Esophagogastroduodenoscopy in Children and Adolescents: A Randomized Study

INTRODUCTION: During esophagogastroduodenoscopy (EGD), general anesthesia (GA) may be provided using a laryngeal mask airway (LMA) with the endoscope inserted behind the cuff of the LMA into the esophagus. Passage of the endoscope may increase the intracuff of the LMA. We evaluated a newly designed LMA (LMA(®) Gastro™ Airway) which has an internal channel exiting from its distal end to facilitate EGD. The current study compared the change of LMA cuff pressure between this new LMA and a standard clinical LMA (Ambu(®) AuraOnce™) during EGD. METHODS: Patients less than 21 years of age and weighing more than 30 kg were randomized to receive airway management with one of the two LMAs during EGD. After anesthetic induction and successful LMA placement, the intracuff pressure of the LMAs was continuously monitored during the procedure. The primary outcome was the change of intracuff pressure of the LMAs. RESULTS: The study cohort included 200 patients (mean age 13.6 years and weight 56.6 kg) who were randomized to the LMA(®) Gastro™ Airway (n=100) or the Ambu(®) AuraOnce™ LMA (n=100). Average intracuff pressures during the study period (before and after endoscope insertion) were not different between the two LMAs. Ease of the procedure was slightly improved with the LMA(®) Gastro™ Airway (p<0.001). DISCUSSION: The LMA(®) Gastro™ Airway blunted, but did not prevent an increase in intracuff pressure during EGD when compared to the Ambu(®) AuraOnce™ LMA. Throat soreness was generally low, and complications were infrequent in both groups. The ease of the procedure was slightly improved with the LMA(®) Gastro™ Airway compared to the Ambu(®) AuraOnce™ LMA.