Bronchial mucus transport velocity in paralyzed anesthetized patients: a comparison of the laryngeal mask airway and cuffed tracheal tube

Abstract

We compared bronchial mucus transport velocity (BTV), an index of mucociliary clearance, between the laryngeal mask airway (LMA) and the tracheal tube (TT). Forty patients were studied during propofol anesthesia and muscle relaxation with rocuronium. BTV was measured 10 and 60 min after insertion of the airway device by fiberoptic observation of the movement of methylene blue dye injected onto the dorsal surface of the left main bronchus. BTV for the LMA was similar at 10 and 60 min (13.9 +/- 2.0 and 13.6 +/- 2.1 mm/min, respectively). BTV for the TT was significantly faster at 10 min that at 60 min (13.0 +/- 1.4 vs 6.9 +/- 1.2 mm/min, respectively; P < 0.00001). BTV was similar for both devices at 10 min (TT 13.0 +/- 1.4 mm/min versus LMA 13.9 +/- 2.0 mm/min), but was significantly faster for the LMA than for the TT at 60 min (LMA 13.6 +/- 2.1 mm/min versus TT 6.9 +/- 1.2 mm/min; P < 0.00001). We conclude that the LMA impedes mucociliary clearance less than the TT in anesthetized patients. This may have implications for reducing the risk of retention of secretions, atelectasis, and pulmonary infection.

Implications: This study compares bronchial mucus transport velocity, an index of mucociliary clearance, in anesthetized patients between two airway devices, the cuffed tracheal tube and the laryngeal mask airway. We have shown that the laryngeal mask airway impairs mucociliary clearance less than the tracheal tube. This may have implications for reducing the risk of retention of secretions, atelectasis, and pulmonary infection.