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    The effect of nitrous oxide diffusion on laryngeal mask airway cuff inflation in children
    (Blackwell Science Ltd, 1998) Algren, JT; Gursoy, F; Johnson, TD; Skjonsby, BS
    We studied the effect of nitrous oxide (N2O) diffusion on size 2 LMA cuff inflation in 52 children, 38+/-21 months of age. LMA cuffs were inflated with air (Group A) or 65% N2O, oxygen and halothane (Group B). Cuffs were inflated in a stepwise manner, achieving a cuff leak pressure of 17+/-4 cm H2O for all patients. Cuff volume and intracuff pressure increased in Group A (8.5+/-1.0 mi to 10.8+/-1.4 mi and 101+/-36 mmHg to 152+/-42 mmHg, respectively) and decreased in Group B (8.9+/-1.0 mi to 6.6+/-1.5 mi and 90+/-30 mmHg to 53+/-37 mmHg, respectively). Cuff leak pressure did not change significantly in either group. We conclude that cuff inflation with a mixture of N2O/oxygen prevents N2O diffusion into the cuff, avoiding cuff overinflation without compromising LMA function.
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    Positive pressure ventilation with the laryngeal mask airway in children
    (Lippincott Williams & Wilkins, 1996) Gursoy, F; Algren, JT; Skjonsby, BS
    We studied the safety of positive pressure ventilation (PPV) when using the size 2 laryngeal mask airway (LMA) in 46 ASA physical status I or II children (aged 38 +/- 21 mo) undergoing elective surgery. The LMA cuff was inflated in incremental steps to achieve a cuff leak pressure greater than or equal to 15 cm H2O. Abdominal circumference was measured before and after PPV in study patients, as well as in a control group managed with tracheal intubation. Cuff leak pressure was 17 +/- 4 cm H2O (range 12-34 cm H2O). Forty-five patients successfully underwent PPV. Gas leak around the LMA cuff prevented PPV in one infant. The only respiratory variable that changed significantly was end-tidal CO2, which decreased from 40 +/- 6 to 34 +/- 5 mm Hg. Abdominal circumference increased in 28 patients but was not associated with any complications. Change in abdominal circumference in the study group was not significantly different from that observed in the control group. However, abdominal circumference increased 8 cm in one study patient, prompting insertion of an orogastric tube. The size 2 LMA provides an effective airway for PPV. Mild gastric distention often occurs. The risk of clinically significant gastric distention appears to be small, but it warrants close monitoring. We conclude that with certain precautions described in the text, the size 2 LMA provides a relatively safe airway for PPV in children.
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    Thoracic epidural anaesthesia and analgesia with bupivacaine for transsternal thymectomy for myasthenia gravis
    (Blackwell Science Ltd, 1997) Akpolat, N; Tilgen, H; Gursoy, F; Saydam, S; Gurel, A
    The present study describes the management of a myasthenic patient undergoing transsternal thymectomy for whom thoracic epidural anaesthesia using 15 mt of bupivacaine 0.5% combined with isoflurane 0.4% and nitrous oxide in oxygen 50% provided good intra-operative relaxation followed by an uneventful recovery and eliminated the need for other post-operative analgesics.