The Laryngoscope V C 2017 The American Laryngological, Rhinological and Otological Society, Inc. Safety and Efficacy of Laryngeal Mask Airway Ventilation in Obese Patients With Airway Stenosis D. Cole Pourciau, CRNA, DNP; D. Peter Hotard III, SRNA; Schuylor Hayley, CRNA; Kasey Hayley, CRNA, DNAP; Collin Sutton, MD; Andrew J. McWhorter, MD; Daniel S. Fink, MD Objective: To assess the efficacy of laryngeal mask airway (LMA) ventilation in obese patients with airway stenosis. Study Design: A retrospective chart review was conducted in an academic practice in a tertiary care center. Methods: We retrospectively reviewed our experience using LMA ventilation in obese patients with airway stenosis. Lowest intraoperative O 2 saturation and maximum-end tidal carbon dioxide (CO 2 ) levels were recorded. Complications includ- ing intubation, unplanned admission, re-admission, postoperative pain, dysphonia, oral trauma, pneumothorax, pneumome- diastinum, and tracheostomy were recorded. Results: Fourteen bronchoscopies with laser incisions and dilation were performed in patients with airway stenosis exclusively using LMA ventilation. Thirteen of 14 procedures were performed on patients who had body mass index (BMI) > 30 kg/m 2 . Mean BMI was noted to be 38 kg/m 2 (range 25–54). All patients underwent successful laser incisions and dilation via LMA anesthesia without major or minor adverse events. The mean lowest O 2 saturation level was noted to be 92%; the mean highest CO 2 level was noted to be 56 mm Hg; and no patients required endotracheal intubation. Conclusion: In this small series of obese patients with airway stenosis, LMA anesthesia was effectively used without major or minor complications. Key Words: Laryngeal stenosis, tracheal stenosis, airway, laryngeal mask airway. Level of Evidence: 4. Laryngoscope, 00:000–000, 2017 INTRODUCTION Treatment of laryngotracheal stenosis in the operat- ing room requires special techniques and methods of ventilation. This typically is accomplished by using mask ventilation, laryngeal mask airway (LMA) ventila- tion, intermittent placement of an endotracheal tube, or jet ventilation. All of these methods carry risks such as hypoxemia, hypercarbia, aspiration, airway fire, and air- way obstruction. Jet ventilation offers an unobscured view of the air- way without the potential for traumatizing the stenosis with an endotracheal tube. 1,2 At our institution, patients with laryngotracheal stenosis generally are managed with low-frequency jet ventilation. However, concern exists over the safety of jet ventilation in patients with elevated body mass index (BMI). Previous studies have shown increased risk of carbon dioxide (CO 2 ) retention in jet-ventilated patients with BMI > 25 kg/m 2 . 1,3 Review of our own experience reveals that patients with BMI > 35 kg/m 2 have significantly higher CO 2 retention and are significantly more likely to require intubation during the surgery. 4 In our practice, there is a relatively large population of obese patients with airway stenosis; therefore, a more consistent management tool was sought. The LMA has been in use for over 2 decades. There have been reports of successful use of the LMA for air- way management in both endoscopic and open airway procedures. 5,6 In some protocols, the LMA is the initial method of airway management in the treatment of the obese population. 7–9 Supportive findings for LMA use in the obese population include: successful airway place- ment on first attempt, adequate tidal volumes with posi- tive pressure ventilation, appropriate end-tidal CO 2 (ETCO 2 ), improved postoperative lung function, and O 2 saturation. 7–9 As demonstrated by Nouraei et al., the ability to use positive pressure ventilation is particularly important in this population because the positive pres- sure generated can maximize the airway, whereas nega- tive intratracheal pressure generated by spontaneous ventilation can worsen ventilation in the setting of an extrathoracic obstruction. 10 The benefits of a closed From the Our Lady of the Lake Regional Medical Center (D.C.P ., S.H., K.H., C.S., A.J.MCW.), Baton Rouge; the Our Lady of the Lake College Nurse Anesthesia Program (D.C.P ., D.P .H., C.S.); the Department of Otolar- yngology–Head and Neck Surgery (A.J.MCW.), Louisiana State University Health Sciences Center, New Orleans, Louisiana; and the Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine (D.S.F .), Denver, Colorado, U.S.A. Editor’s Note: This Manuscript was accepted for publication April 24, 2017. Institution where work was performed: Louisiana State University School of Medicine and Our Lady of the Lake Regional Medical Center, Voice Center, New Orleans, Louisiana, U.S.A. Editor’s Note: This Manuscript was accepted for publication on April 24, 2017. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Daniel S. Fink, MD, Department of Oto- laryngology, University of Colorado School of Medicine, Academic Office Building 1, 12631 E 17th Ave Rm 3001, Aurora, CO 80045. E-mail: Dan- iel.Fink@ucdenver.edu DOI: 10.1002/lary.26684 Laryngoscope 00: Month 2017 Pourciau et al.: LMA Ventilation in Obese Patients 1