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Laryngeal Mask AirwayNCT04795544

Three Inflation Methods of Ambú Auragain™ and Its Adverse Effects

A study testing Intracuff pressure measurement in people with Laryngeal Mask Airway, run by Instituto de Investigación Hospital Universitario La Paz at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Laryngeal mask is a common supraglottic device (SGD) used in the daily practice for airway management. Consecutive generations have permitted an expansion of its use. At the moment, the SGD is being used in several situations, which include general anesthesia, cardiopulmonary resuscitation, and difficult airway… Read more about this study

Who is it for?
Ages 18 to 90 yearsHealthy volunteers can take part
Conditions the study is for
Laryngeal Mask Airway
What is being tested?
Intracuff pressure measurement
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
210 participants
Where
1 siteSpain
Study dates
18 Jan 2021to 30 Oct 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients age between 18 and 90 years
  • American Society of Anesthesiologist (ASA) physical status I-III
  • fiberoptic bronchoscopy procedure and EBUS-TBNA procedure programmed.
  • Fasted for 6 hours before procedure.
  • Management of the airway for the same anesthetic.
  • Use de laryngeal mask airway for boarding and maintenance of airway permeability.

Who cannot join

  • LMA is contraindicated because high risk of aspiration (full stomach, gastroesophageal reflux history, pregnant)
  • predictors of difficult airway such restricted mouth opening (< 2 cm of interincisal distance)
  • patients with any pathology of the neck, upper respiratory or upper alimentary tract
  • dysphagia o hoarseness.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Teresa Prim Martinez

    Madrid, 28034

Other trials in Spain

About this study

Official title: Three Inflation Methods of the Laryngeal Mask Airway Ambú Auragain™ and Its Pharyngolaryngeal Adverse Effects

Laryngeal mask is a common supraglottic device (SGD) used in the daily practice for airway management. Consecutive generations have permitted an expansion of its use. At the moment, the SGD is being used in several situations, which include general anesthesia, cardiopulmonary resuscitation, and difficult airway management.

To insert the SGD safely in these situations, the Fourth National Audit Project has encouraged the use of second-generation SGD equipped with the passage of a nasogastric tube. Ambu Auragain™ is a recent second-generation SGD with an incorporated gastric drainage channel and the capability of working as a conduit for tracheal intubation. It has higher leak pressure than the ones of first generation, which is a key marker of efficacy and safety of its use; a higher leak pressure suggests a better seal between the artificial airway and patient's airway.

Read more

However, there are still few reports of which volume of cuff is the most appropriate for it use. The cuff inflating volume is not standardized and it is common practice to inflate the SGD cuff according to the manufacturer's recommendations, without using a manometer.

A hyperinflation of the laryngeal mask cuff was associated with complications ranging from sore throat, or dysphagia and dysphonia, to more serious complications such as paralysis of the vocal cord, arytenoid cartilages dislocation, recurrent laryngeal nerve injury and hypoglossal nerve injury. Also, the excess of volume or pressure is related to poor ventilation and increase the risk of gastric insufflation.

The aim of this study is to evaluate the best cuff inflation method, in order to limit the intracuff pressure beyond the recommended maximum pressure (PM < 60 cmH2O) and to allows decrease the pharyngo-laryngeal complications.

The Primary outcome is to compare three different cuff inflating methods using Auragain™ laryngeal mask during fibro bronchoscopy and endobronchial ultrasound (EBUS) procedures, and to control the intracuff pressure, and the effect on pharyngo-laryngeal complications.

The three different cuff inflating methods are: 1) residual volume group (RV group ) 2) half of the maximum volume group (MV group) 3) unchanged volume group (NV group)

Read the detailed description

This is a prospective randomized controlled trial. The study was approved by the Ethics Committee of University Hospital of La Paz, Madrid. Written informed consent will be obtained from each participant before the procedure. The investigators plan to include 210 participants scheduled for fibrobronchoscopy with EBUS-trans-bronchial needle aspiration (TBNA)) procedures under general anesthesia using a laryngeal mask airway device (LMA). Participants will be allocated randomly to one of three groups of cuff inflating methods according to computer-generated randomization. The size of LMA will be chosen according to body weight, following the manufacturer recommendations (LMA size 3 for patients of 30-50 kg, LMA size 4 for patients of 50-70 kg and LMA size 5 for patients with a weight >70 kg). After standard monitoring with electrocardiography, noninvasive blood pressure device and pulse oximeter were applied, general anesthesia will be induced with Propofol 2.5 mg.kg-1 and fentanyl 1 mcg.kg-1 intravenously, face mask ventilation with 100% oxygen will be used after participants have lost eyelash reflex. Then, the assigned LMA will be inserted, after appropriate conditions for laryngeal mask insertion are obtained. LMA Insertion will be performed with standard maneuver according to LMA practice manual by the same experienced anesthesiologist (> 1-year use experience). The initial position of LMA will be assessed by visualization of bilateral chest movement when positive pressure ventilation will be performed and the square capnography waveform is observed on the monitor screen.

If the LMA is not in the proper position at the first attempt, anesthetist will use an "up and down" maneuver to adjust and reposition LMA to attain satisfactory ventilation. If this maneuver fails, LMA will be withdrawn from the mouth of the participants and a second attempt will be authorized to acquire a correct position. If the proper position of LMA cannot be achieved after two attempts, the airway will be controlled with another device or a tracheal intubation will be performed and the participants will be excluded from the trial.

The patient´s lungs will be ventilated with the anesthesia machine in controlled volume mode, using the following parameters: Tidal volume, 8 ml/kg; frequency, 12-14 per min; the ratio of inspiratory and expiratory, (I: E) = 1:2; and positive end expiratory pressure, 5 cmH20.

After the laryngeal mask will be fixed with adhesive tape and the vital signs will be stable, the laryngeal mask cuff will be connected with a closed system manometer composed of a three-way stopcock, a 5 ml syringe and a manometer. Intracuff pressure will be measured and recorded, if it exceeds of 60 cmH20 we will deflate the cuff 1 mL by 1 mL with the syringe until intracuff pressure reaches 60 cmH20. The deflated volume and the final intracuff pressure will be recorded. We will measure the inspiratory peak airway pressure, the volume difference of inspiratory and expiratory tidal volume under the positive pressure ventilation. The plateau pressure, medium pressure and Compliance will also be recorded at the corresponding cuff inflating volume, before and after measuring OLP. The OLP will be measured simultaneously at the corresponding cuff inflating volume, by setting the airway pressure relief valve (APL) of the breathing circuit to 40 cmH20 at a fixed gas flow rate of 4 L/ min and reading the airway pressure on manometer at which equilibrium of airway pressure will be established or at the pressure the air leakage will be heard.

Fiberoptic visibility scores will be recorded on a scale of 1 to 4 (4: only vocal cords visible, 3: vocal cords plus posterior epiglottis visible, 2: vocal cords plus anterior epiglottis visible, 1: vocal cords not seen). A score of 1 will be considered the worst and a score of 4 was considered the best.

Any adverse events (i.e., desaturation (pulse oximetry< 90%), aspiration/regurgitation, bronchospasm, airway obstruction, coughing, gagging or vomiting) and corresponding interventions will be recorded.

After the procedure, all participants will be transferred to the recovery unit and observed for at least 1 hour. Observed adverse effects, such as sore throat, hoarseness, aphasia, nausea and vomiting will be recorded in the recovery room period.

At 24h, a home telephone interview will record these parameters, as well as participants satisfaction scores using visual analog scales.

Being tested
Intracuff pressure measurement
Keywords
laryngeal mask, intracuff pressure, sore throat, oropharyngeal leak pressure
Medical subject headings
Pharyngitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intracuff pressure measurementProcedure or surgery

    Intracuff pressure is measured by a pressure manometer.

Study groups in NCT04795544
Study groupRoleWhat they receive
cuff inflation by the residual volumeExperimentalLMA will be inserted with the initial inflating volume correspondent to residual volume group (RV group): volume result of equilibrating pressure between intracuff pressure and atmospheric pressure. A 20 mL syringe without plunger is connected to the laryngeal cuff for 5 minutes
Receives: Procedure: Intracuff pressure measurement
cuff inflation by half of the maximum volumeExperimentalLMA will be inserted with the initial inflating volume correspondent to half of the maximum volume recommended by manufacturers (MV group)
Receives: Procedure: Intracuff pressure measurement
unchanged cuff inflation volumePlacebo comparatorLMA will be inserted unchanged (NV group): LMA is unpacked and used without inflating or deflating the cuff.
Receives: Procedure: Intracuff pressure measurement

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. intracuff pressure

    Compare Intracuff Pressure of three different cuff inflating volume methods with laryngeal mask, to control the intracuff pressure

    Measured: procedure ( after correct placement of SGD)

Secondary outcomes (5)
  1. time of insertion

    Compare time of insertion in the three different cuff inflating volume methods

    Measured: procedure ( from pick up to correct placement of SGD

  2. insertion attempts

    Compare insertion attempts in the three different cuff inflating volume methods

    Measured: procedure ( from pick up to correct placement of SGD

  3. OLP

    We measure the oropharyngeal leak pressure (OLP) as a sealing efficacy test

    Measured: procedure ( after correct placement of SGD)

  4. positioning of the LMA

    Compare the positioning of the LMA with the three methods of inflating cuff. Fiberoptic visibility scores will be recorded on a scale of 1 to 4 (4: only vocal cords visible, 3: vocal cords plus posterior epiglottis visible, 2: vocal cords plus anterior epiglottis visible, 1: vocal cords not seen). A score of 1 will be considered the worst and a score of 4 was considered the best.

    Measured: procedure (after correct placement of SGD)

  5. pharyngolaryngeal complications

    Describe sore throat, dysphagia and dysphonia

    Measured: day 2

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Mar 2021
  2. Study start18 Jan 2021
  3. Primary completion20 Oct 2021
  4. Study completion30 Oct 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
210 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04795544
Sponsor's protocol ID
idipaz 5735
Status last verified
Jan 2022
First submitted
10 Mar 2021
Last updated
11 Jan 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT, Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology. 2010 Mar;112(3):652-7. doi: 10.1097/ALN.0b013e3181cf4346.

    PubMed 20179502
  • Ghai B, Sethi S, Ram J, Wig J. Cuff filling volumes for pediatric classic laryngeal mask airways: comparison of clinical end points versus adjusted cuff pressure. Paediatr Anaesth. 2013 Feb;23(2):122-6. doi: 10.1111/pan.12023. Epub 2012 Sep 18.

    PubMed 22985184
  • Keller C, Puhringer F, Brimacombe JR. Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway. Br J Anaesth. 1998 Aug;81(2):186-7. doi: 10.1093/bja/81.2.186.

    PubMed 9813520
  • Li BB, Yan J, Zhou HG, Hao J, Liu AJ, Ma ZL. Application of Minimum Effective Cuff Inflating Volume for Laryngeal Mask Airway and its Impact on Postoperative Pharyngeal Complications. Chin Med J (Engl). 2015 Oct 5;128(19):2570-6. doi: 10.4103/0366-6999.166034.

    PubMed 26415792
  • Ruananukun N, Watcharotayangul J, Jeeranukosol S, Komonhirun R. Correlation and variation of cuff inflating volumes and pressures in different adult models of laryngeal mask: a prospective randomized trial. BMC Anesthesiol. 2020 May 7;20(1):108. doi: 10.1186/s12871-020-01028-4.

    PubMed 32380954
  • Shariffuddin II, Teoh WH, Tang E, Hashim N, Loh PS. Ambu(R) AuraGain versus LMA Supreme Second Seal: a randomised controlled trial comparing oropharyngeal leak pressures and gastric drain functionality in spontaneously breathing patients. Anaesth Intensive Care. 2017 Mar;45(2):244-250. doi: 10.1177/0310057X1704500215.

    PubMed 28267947

Questions about this trial

What is this clinical trial studying?

A study testing Intracuff pressure measurement in people with Laryngeal Mask Airway, run by Instituto de Investigación Hospital Universitario La Paz at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Jan 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

intracuff pressure (time frame: procedure ( after correct placement of SGD)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04795544, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jan 2022.

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