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The PAXpress Airway Causes More Pharyngeal Irritation than the Reusable Laryngeal Mask Airway

Goodman, Evan J. MD; Ziegler, E Jane CRNA; Douglas, Allan M. CRNA; Mulgaokar, Girish D. MD

doi: 10.1213/01.ANE.0000156694.85024.BF
Letters to the Editor: Letters & Announcements

Department of Anesthesiology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH, evan.goodman@uhhs.com

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To the Editor:

As part of an evaluation process to determine whether the PAXpress airway should replace the laryngeal mask airway (LMA) in our practice, we reviewed our experience over a 2-mo period with this airway. The records of 15 patients who had been ventilated with a PAXpress airway and 15 who had been ventilated with an LMA were examined. Information about the difficulty of airway placement and any mention of blood being on the airway devices were recorded. The presence of pharyngeal pain in the postanesthesia care unit or on the first postoperative day was determined from routine questions asked in the postanesthesia care unit or the next day from routine postoperative calls. The patients typically are asked to grade their discomfort on a VAS scale (0–10 scale, 10 representing the worst imaginable pain).

We found that the two groups did not differ in demographic variables except that there were more women in the PAXpress group. Insertion of the airway was easy in all of the LMA patients but in only 20% of the PAXpress patients. Blood was noticed on 27% (4 of 15) of the PAXpress airways either during insertion or removal, whereas no mention of blood on the airway device was found among patients in the LMA group. None of the patients in the LMA group complained of pharyngeal soreness in the postanesthesia care unit, whereas 33% (5 of 15) in the PAXpress group had a sore throat. The next day, only two patients in the LMA group (13%) complained of a slightly sore throat. In the PAXpress group, all but two of the patients who were contacted (84%) reported having a sore throat. More than half of the people in this group graded their soreness as 5 or higher, and the average degree of soreness for this group (4.5) was significantly higher than was reported in the LMA group (P < 0.001).

We concluded that the PAXpress airways caused severe throat soreness in a high percentage of patients. Although ventilation could be provided as well with a PAXpress airway as it could with an LMA, the degree of dissatisfaction of the patients in the postoperative period with the irritation in their throat led us to discontinue the use of the PAXpress airways.

Evan J. Goodman, MD

E. Jane Ziegler, CRNA

Allan M. Douglas, CRNA

Girish D. Mulgaokar, MD

Department of Anesthesiology

Case Western Reserve University School of Medicine

University Hospitals of Cleveland

Cleveland, OH

evan.goodman@uhhs.com

© 2005 International Anesthesia Research Society