Laryngeal mask airway cuff pressure and position during anaesthesia lasting one to two hours

The cuff of the laryngeal mask airway (LMA) is highly permeable to nitrous oxide (N2O), and cuff pressure increases during N2O/O2 anaesthesia. The extent of these changes and their effect on LMA position have previously only been investigated for short procedures. The current study was designed to investigate the effects of nitrous oxide-oxygen (N2O/O2) anaesthesia lasting one to two hours on cuff pressure, LMA positioning and pharyngeal morbidity. Twenty-four male patients underwent spontaneous ventilation anaesthesia with 66% N2O in oxygen and isoflurane. Following insertion and inflation of a #4 LMA with 30 ml air, mean (SD) cuff pressures immediately increased from 107 (9) to 145 (12) mmHg and then at a decreasing rate for 90 min to peak at 215 (12) mmHg. There was a correlation between N2O concentration and final cuff volume (P < 0.001). There was no displacement of the LMA cuff in any patient. Three of 19 patients had a mild sore throat. This study demonstrates that the increase in LMA cuff pressure is self limiting over a one-to-two-hour period and does not cause displacement of the LMA. There is no evidence that cuff pressure monitoring and pressure limitation is necessary during LMA anaesthesia.