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LETTER TO THE EDITOR
Year : 2015  |  Volume : 8  |  Issue : 1  |  Page : 1-2

An indigenous multipurpose low-cost bite-block: A novel method for use with laryngeal mask airway


Department of Oncoanaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India

Date of Submission03-Aug-2014
Date of Acceptance30-Aug-2014
Date of Web Publication25-Mar-2015

Correspondence Address:
Uma Hariharan
Fellowship Oncoanesthesia, BH - 41, East Shalimar Bagh, Delhi 110088
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.153925

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How to cite this article:
Hariharan U. An indigenous multipurpose low-cost bite-block: A novel method for use with laryngeal mask airway. Ain-Shams J Anaesthesiol 2015;8:1-2

How to cite this URL:
Hariharan U. An indigenous multipurpose low-cost bite-block: A novel method for use with laryngeal mask airway. Ain-Shams J Anaesthesiol [serial online] 2015 [cited 2021 Apr 19];8:1-2. Available from: http://www.asja.eg.net/text.asp?2015/8/1/1/153925

Laryngeal mask airways (LMAs) have now been used successfully for two decades. LMA-classic usually requires a bite-block after insertion, so as to protect the airway tube and the pilot balloon [1],[2] . There are several variants of bite-blocks [3],[4],[5] being used in anesthesia practice. Biting on the silicone tube and pilot balloon of the LMA may obstruct or damage them with the teeth. The recommended bite-block is a wad of gauze swabs rolled into a cylindrical shape and placed alongside the LMA. This avoids irritation of the posterior pharyngeal wall and damage to teeth, while supporting the LMA tube when taped to it. The Guedel airway is commonly used as a bite-block with the tracheal tube, and many anesthesiologists also use it with the LMA. A recent study concluded that the combination of LMA and Guedel airway [6] probably prevents either from sitting in the correct anatomical position.

All types of bite-blocks have their advantages and disadvantages. I describe a low-cost alternative, which is easily made with readily available materials in the operation theater and ICU. This is of special significance in the developing world. It is both soft and sturdy.

A sterile, standard, commercially available 2 ml syringe was taken and its plunger was removed. The injection end was cut circularly just above the narrow needle insertion portion and discarded, to give a hollow cylinder with both ends open, having equal internal diameters on both ends ([Figure 1]). The other end with bilateral flanges can be used to prevent inward migration of the bite-block. After smoothening of the cut circular edge, a normal-sized sterile gauze piece was wrapped around the outer aspect of the hollow cylinder in a spiral fashion, so as to externally cover the syringe body fully. With the assistant holding on to the gauze piece firmly, it was covered by sticking leucoplast or durapore (small piece cut linearly into a longitudinal strip as for endotracheal tube fixation). The ends of the sticking tape were stuck tightly on the undersurface of the flanges. A similar bite-block can be made for insertion on the other side of the LMA. Of all the sizes of syringes tried (2, 5, and 10 ml), perfectly the barrel of a 2 ml syringe was found to fit for LMA-classic sizes 2, 2.5, 3, and 4. For also adults, the barrel of a 5 ml syringe can be made into a bite-block after removing the plunger. This novel bite-block has not been tried in smaller children and infants for fear of accidental injury to the fragile gums and lips. The main advantages of this bite-block are its low cost, easy availability of raw materials, and presence of flange to prevent migration. Another important and unique aspect is the presence of a hollow channel on either side of the LMA, which can be used for inserting suction catheters and even orogastric tube. Intraoral suctioning can be carried out before LMA removal under deep anesthesia with bite-block in situ. Furthermore, it can also be used for insertion of orogastric tubes through the hollow port alongside the LMA, as well as along with the endotracheal tube (both in ICU and operation theater).
Figure 1: Bite-block made from syringe barrel with fl ange, externally wrapped with gauze, showing the hollow through which orogastric tube and suction catheter can be inserted.

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  Acknowledgements Top


Conflicts of interest

None declared.

 
  References Top

1.
JA Dorsch, SE Dorsch. Understanding anesthesia equipment. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins 2008; 452-453.  Back to cited text no. 1
    
2.
Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth 1994; 41:930-960.  Back to cited text no. 2
    
3.
Brimacombe J, Berry A. Translucent vinyl tubing - an alternative bite guard for the LMA. Anaesth Intensive Care 1993; 21:893.  Back to cited text no. 3
    
4.
Maltby JR, Loken RG, Low JS. Bite guard for laryngeal mask airway. Anaesthesia 1993; 48:273.  Back to cited text no. 4
    
5.
Townsend M, Frew RM, Hoyle JR. Bite block for the laryngeal mask airway. Anaesthesia 1995; 50:918.  Back to cited text no. 5
    
6.
Keller C, Sparr HJ, Brimacombe JR. Laryngeal mask bite blocks - rolled gauze versus Guedel airway. Acta Anaesthesiol Scand 1997; 41:1171-1174.  Back to cited text no. 6
    


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