Laryngeal Mask Airway Use in Morbidly Obese Patients Undergoing General Anesthesia.

The use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery. One Cochrane systematic review and a randomized controlled trial met our inclusion criteria. Subjects received general anesthesia with a laryngeal mask airway. Outcomes included the ability to successfully place a laryngeal mask airway, ease and time of insertion, ability to ventilate, hypoxemia, presence of laryngospasm/ bronchospasm, and/or evidence of aspiration. The trials had some methodologic concerns including the inability to blind anesthesia providers, not including exclusively morbidly obese subjects, not powered to detect all complications such as aspiration, and overall small sample sizes. The investigators reported few problems when using these devices with obese subjects. However, because of the limited amount and quality of the evidence and the catastrophic nature of potential complications, future research must be done before a recommendation can be made regarding the use of these devices with morbidly obese patients.