Document Detail


Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway.
MedLine Citation:
PMID:  10598608     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pharyngeal airway devices can exert substantial pressures against the pharyngeal mucosa. The authors assess the relation between pharyngeal mucosal perfusion and directly measured mucosal pressure (MP) in the posterior pharynx using a fiberoptic technique with a modified cuffed oropharyngeal airway (COPA). The authors also measure in vivo intracuff pressure (CP), airway sealing pressure and MP at four locations using an unmodified COPA. METHODS: Twenty adult patients, American Society of Anesthesiologists status I or II, undergoing general anesthesia were allocated randomly to receive either (1) a COPA with a millimeter microchip sensor fixed on the external cuff surface to record distal posterior pharyngeal MP or (2) a COPA with a fiberoptic scope inserted inside the cuff to record digitized images of the distal posterior pharyngeal mucosa. MP and digitized images were obtained at the same location over an in vivo CP range of 10-160 cm H2O in 10- to 20-cm H2O increments. The digitized images were scored according to blood vessel caliber and mucosal color by two investigators blinded to MP and CP. In an additional 20 matched patients, in vivo CP, airway sealing pressure, and MP was measured at four different cuff locations (corresponding to the anterior, lateral, and posterior pharynx and the distal oropharynx) with increasing cuff volume. RESULTS: Blood vessel caliber and mucosal color was normal in all patients when the mean mucosal pressure was 17 cm H2O. Blood vessel caliber was first reduced when the mean mucosal pressure was 34 cm H2O. There was a progressive incremental reduction in blood vessel caliber and mucosal color when the mean mucosal pressure increased from 34 to 80 cm H2O (P < or = 0.05). Complete blood vessel collapse and mucosal paling first occurred with the mean mucosal pressure was 73 cm H2O and was present in 90% of patients when the mean mucosal pressure was 80 cm H2O. Mean MP was always higher in the posterior pharynx compared with the other locations when the cuff volume was 20 ml or greater (P < 0.001). In vivo CP is an excellent predictor of mucosal pressure. Mean (95% confidence interval [CI]) MP in the posterior pharynx was 35 (5-67) and 78 (50-109) cm H2O when the airway sealing pressure was 10 (6-16) and 17 (13-21) cm H2O respectively. CONCLUSION: Pharyngeal mucosal perfusion is reduced progressively in the posterior pharynx when MP is increased from 34 to 80 cm H2O with the COPA. CP provides reliable information about MP and should be less than 120 cm H2O to prevent mucosal ischemia.
Authors:
J Brimacombe; C Keller; F Pühringer
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  91     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-30     Completed Date:  1999-12-30     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1661-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia and Intensive Care, Cairns Base Hospital, Australia. 100236,2343@compuserve.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, Inhalation*
Female
Fiber Optic Technology
Humans
Image Processing, Computer-Assisted
Intubation, Intratracheal* / adverse effects,  instrumentation
Male
Middle Aged
Mucous Membrane / blood supply,  physiology
Oropharynx / anatomy & histology
Pharynx / blood supply,  physiology*
Pressure
Regional Blood Flow / physiology
Tongue / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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