• Masafumi Fujimoto, Fumiyo Kubota, and Tatsuo Yamamoto.
• Department of Anesthesiology, Nishinihon Hospital, Kumamoto-City, Kumamoto, Japan.
• Acta Anaesthesiol Scand. 2020 Sep 1; 64 (8): 1120-1127.

BackgroundThe transition of ventilatory leak and sealing pressure in supraglottic airway devices after administration of neuromuscular blocking agents is unclear. We hypothesized that ventilatory leak would decrease due to the increase in sealing pressure after administration of 0.15 and 0.30 mg/kg rocuronium iv.MethodsForty patients were randomly assigned to a control group or one of two rocuronium groups. After induction of general anaesthesia, an i-gel® was inserted before rocuronium administration. The ventilatory leak and sealing pressure were measured immediately. Then, 0.15 mg/kg or 0.30 mg/kg rocuronium iv was administered and the ventilatory leak and sealing pressure were measured again. In the control group, measurements were obtained just after insertion of the supraglottic airway device and 5 minutes later, without any additional drug administration.ResultsSimilar decrements in ventilatory leak of approximately 3% were registered in all three groups. There were no changes in sealing pressure in any of the groups. However, multiple logistic regression analysis demonstrated that the reduced height of the first twitch response to train-of-four stimulation after administration of rocuronium was a determinant of a decrease in sealing pressure (odds ratio: 0.97, 95% confidence interval: 0.95-0.99, P = .04).ConclusionsOur results suggest that ventilatory leak with a supraglottic airway device decreases independently of neuromuscular blockade, although the neuromuscular blockade may potentially decrease sealing pressure. Registration of Clinical trials: UMIN Clinical Trials Registry (registration ID: UMIN000027061, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000031018).© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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