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Simpao AF, Obsekov V, Gálvez JA, Isserman RS, Rehman MA, Schwartz ES. A retrospective study of the impact of supraglottic airway devices on the appearance of neck masses in children undergoing serial magnetic resonance imaging. Paediatr Anaesth 2018; 28:1123-1128. [PMID: 30298970 DOI: 10.1111/pan.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/29/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND General anesthesia and sedation are used routinely for magnetic resonance imaging (MRI) studies in children to optimize image quality. Airway devices such as supraglottic airways (SGAs) can alter the appearance of cervical soft tissue regions on an MRI and increase the risk of misdiagnosis. This phenomenon has not been well described in vivo. AIMS We conducted this retrospective study to determine how often SGAs affected the appearance of neck masses in children who received multiple anesthetics for MRIs with and without an SGA. METHODS We retrieved data on children 17 years old and younger who had multiple MRIs between January 2005 and January 2015. Inclusion criteria were patients with neck masses who had a SGA for at least one MRI and either a natural airway or endotracheal tube (ETT) for another MRI. We reviewed MRI images and imaging reports to determine if SGAs affected the appearance of neck masses. RESULTS Twelve of the 921 patients who received anesthesia for neck MRIs during the study period met the inclusion criteria. SGAs affected the appearance of the neck mass in 11 of the 12 patients. CONCLUSIONS Supraglottic airways can significantly alter the appearance of neck masses in children undergoing MRIs and affect radiologists' ability to assess those masses. Communication with the radiologist prior to the induction of anesthesia is crucial when using supraglottic devices in this patient population. It may be more prudent to use a different airway device and/or anesthetic technique when MRIs of these neck masses are undertaken.
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Affiliation(s)
- Allan F Simpao
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vladislav Obsekov
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca S Isserman
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed A Rehman
- Department of Anesthesiology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Erin S Schwartz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine and Children's Hospital Of Philadelphia, Philadelphia, Pennsylvania
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Kim J, Kim GS, Kim DK, Shin H. Successful use of supraglottic airway in a professional singer undergoing laparoscopic living donor right hepatectomy - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.4.423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab-Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunsu Shin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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In CB, Cho SA, Lee SJ, Sung TY, Cho CK. Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway SupremeTM in geriatric patients: a prospective and randomized study. Korean J Anesthesiol 2018; 72:39-46. [PMID: 30343563 PMCID: PMC6369341 DOI: 10.4097/kja.d.18.00121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/19/2018] [Indexed: 12/15/2022] Open
Abstract
Background Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA SupremeTM) in geriatric patients. Methods The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA SupremeTM group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. Results Insertion time was significantly shorter for the i-gel® than the LMA SupremeTM (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA SupremeTM (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA SupremeTM (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. Conclusions Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA SupremeTM in geriatric patients.
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Affiliation(s)
- Chi Bum In
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | | | | | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Small-incision cholecystectomy (through a cylinder retractor) under local anaesthesia and sedation: a prospective observational study of five hundred consecutive cases. Langenbecks Arch Surg 2018; 403:733-740. [DOI: 10.1007/s00423-018-1707-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/31/2018] [Indexed: 01/03/2023]
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Grande B, Loop T. Anaesthesia management for bronchoscopic and surgical lung volume reduction. J Thorac Dis 2018; 10:S2738-S2743. [PMID: 30210826 DOI: 10.21037/jtd.2018.02.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimizing the patient's condition before the lung volume reduction (LVR) according to recommendations by American College of Cardiology/American Heart Association (ACC/AHA) guideline on perioperative cardiovascular evaluation is mandatory. Implementation of a multimodal analgesia concept and the use short-acting anaesthetics enhances recovery and avoids postoperative pulmonary complications. Normovolemia, normothermia, lung protective ventilation and an evidence-based concept of airway management (i.e., double-lumen tube, bronchus blocker) are suggested for intraoperative management of surgical lung volume reduction (SLVR). General anaesthesia (using remifentanil, propofol and mivacurium) with an i-gel® supraglottic airway device should be used for bronchoscopic lung volume reduction (BLVR). Jet ventilation through rigid bronchoscopy or with a jet catheter may be an alternative concept. Experienced consultants should perform anaesthesia for LVR.
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Affiliation(s)
- Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Torsten Loop
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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General laryngeal mask airway anesthesia with lumbar plexus and sciatic block provides better outcomes than general anesthesia and endotracheal intubation in elderly patients undergoing hip surgery. Arch Gerontol Geriatr 2018; 78:227-232. [DOI: 10.1016/j.archger.2018.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022]
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Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery. Ophthalmic Plast Reconstr Surg 2018; 34:324-328. [PMID: 29933289 DOI: 10.1097/iop.0000000000000969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE This study will determine the safety of laryngeal mask airway (LMA) compared with endotracheal tube (ETT) in patients undergoing general anesthesia for dacryocystorhinostomy (DCR) surgery. METHODS In this retrospective cohort study, intraoperative and postoperative outcomes of patients who underwent DCR at UAB Callahan Eye Hospital using either LMA or ETT were compared. RESULTS Over a period of 52 months, 429 patients underwent external DCR surgery. An ETT was used in 37 patients and LMA in 392 patients. Baseline patient characteristics and anesthetic management were similar. No documented cases of blood or gastric aspiration occurred in the total cohort. Our study confirmed the findings of others that there is less cardiovascular lability on LMA placement than with ETT intubation. A 30% increase in heart rate from baseline after intubation (ETT 10.8%, LMA 1.8%; p = 0.010) and after incision (ETT 8.1%, LMA 1.8%; p = 0.047) occurred more frequently in the ETT group. Airway management with an LMA was also less difficult compared with an ETT (ETT 5.7%, LMA 0.5%; p = 0.035). CONCLUSIONS The use of an LMA for airway control is safe and effective in patients undergoing general anesthesia for DCR surgery. No events of aspiration occurred with LMA use. Heart rate increase was significantly less in the LMA group. In our opinion, use of an LMA for airway control during DCR surgery is superior to use of an ETT. Airway protection, improved hemodynamics, and less difficulty in placement of the laryngeal airway device are all validated by this study.
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Zafirova Z, Dalton A. Neuromuscular blockers and reversal agents and their impact on anesthesia practice. Best Pract Res Clin Anaesthesiol 2018; 32:203-211. [PMID: 30322460 DOI: 10.1016/j.bpa.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 12/17/2022]
Abstract
Neuromuscular blockers have long been an intricate part of the anesthesia regimen. The scientific progress in pharmacology and physiology has strengthened their clinical relevance, has helped to delineate with precision their medical role, and has enhanced the safety and effectiveness of their use. New frontiers in research will define further the role of these agents in modern anesthesia practice and guide their expanding and discrete clinical applications.
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Affiliation(s)
- Zdravka Zafirova
- Department of Cardiovascular Surgery, Icahn School of Medicine, Mount Sinai Hospital System, 321 West 37 St, ap. 5A, New York, NY, 10018, USA.
| | - Allison Dalton
- Department of Anesthesiology and Critical Care, The University of Chicago, Chicago, USA.
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Lee JH, Jang YE, Kim EH, Kim HS, Kim JT. Flexion decreases the ventilation quality of the Ambu ® AuraGain™ laryngeal mask in paralysed children: A prospective randomised crossover study. Acta Anaesthesiol Scand 2018; 62:1080-1085. [PMID: 29797717 DOI: 10.1111/aas.13148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/15/2018] [Accepted: 04/20/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND The influence of different head and neck positions on ventilation with the Ambu® AuraGain™ remains unevaluated in children. This study assessed the influence of different head and neck positions on ventilation with the AuraGain™ in paediatric patients. METHODS In this prospective, randomised crossover study, children ≤7 years of age who were scheduled for elective surgery under general anaesthesia were enrolled. An AuraGain™ was placed in all patients; mechanical ventilation was performed using a volume-controlled mode with a tidal volume of 10 mL/kg. Respiratory rate was adjusted to maintain a ET CO2 of 35-40 mm Hg. The oropharyngeal leak pressure, expiratory tidal volume, peak inspiratory pressure, ventilation score and fibreoptic bronchoscopic view score were assessed for the neutral head and neck position, and then for the flexed, extended and rotated head and neck positions in a random order. RESULTS Compared with the neutral position, the oropharyngeal leak pressure increased in the flexed position (P < .001), and decreased in the extended (P = .014) and rotated position (P = .002). The expiratory tidal volume and ventilation score were significantly reduced during flexion (all P < .005), and were comparable among the neutral, extended and rotated positions. The fibreoptic score improved in the extended and rotated position (all P < .001). Only the flexion ventilation score was lower compared with the neutral position (P = .014). CONCLUSIONS Clinically, the flexed head and neck positions negatively affected ventilation due to obstruction of the airway. Ventilation with AuraGain™ can be effectively performed with the head and neck in the neutral, extended and rotated position in paediatric patients.
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Affiliation(s)
- J-H Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Y-E Jang
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - E-H Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - H-S Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - J-T Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Sorbello M, Zdravkovic I, Cataldo R, Di Giacinto I. Spring recoil and supraglottic airway devices: lessons from the law of conservation of energy. Rom J Anaesth Intensive Care 2018; 25:7-9. [PMID: 29756056 DOI: 10.21454/rjaic.7518.251.sor] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - Ivana Zdravkovic
- Department of Anaesthesia and Reanimation, Clinical Hospital Center "Zvezdara" Belgrade, Serbia
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Ida Di Giacinto
- Anaesthesia, Polyvalent Intensive Care and Transplantation Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
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Adams AS, Wannemuehler TJ, Hull B, Wu J, Chandra RK, VonWahlde K, Shotwell MS, Harvey S, Higgins M, McQueen K, Turner JH. Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery. Int Forum Allergy Rhinol 2018; 8:877-882. [PMID: 29719126 DOI: 10.1002/alr.22132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT. METHODS Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT. At the first postoperative visit, a symptom severity and quality of life questionnaire was completed. Additional objective metrics were extracted from the anesthesia record. RESULTS A total of 102 patients were enrolled; 49 assigned to the SGA group and 53 assigned to the ETT group. No significant differences in swallowing function or cough were identified. SGA patients reported more difficulty returning to a normal diet (p = 0.03) with a trend toward reduced throat pain (p = 0.07) and improved phonation (p = 0.06). No significant difference in perioperative oxygen desaturations, emesis, recovery time, or airway blood penetration were identified. CONCLUSION While the use of the SGA results in patient diet modification postoperatively, it may also be associated with a reduction in throat pain and dysphonia. SGA use had no appreciable effect on postanesthesia recovery times, oxygen desaturations, or emesis. Use of the SGA in sinonasal surgery appears to be a safe and reliable option for airway management in selected adult patients undergoing routine ambulatory sinonasal surgery.
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Affiliation(s)
- Austin S Adams
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Todd J Wannemuehler
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Benjamin Hull
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Jeffanie Wu
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Kate VonWahlde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Matthew S Shotwell
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Stephen Harvey
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Michael Higgins
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Kelly McQueen
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
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Hegde HV, Bandi J, Mudakanagoudar MS, Honnannavar KA. Evaluation of performance of Streamlined Liner of the Pharynx Airway™, Laryngeal Mask Airway-ProSeal and endotracheal tube in prone position: A prospective, randomised study. Indian J Anaesth 2018; 62:173-181. [PMID: 29643550 PMCID: PMC5881318 DOI: 10.4103/ija.ija_691_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Airway used in prone position should be efficacious and safe. The Streamlined Liner of the Pharynx Airway (SLIPA™) and Laryngeal Mask Airway-ProSeal (PLMA) provide better airway seal and protection against aspiration. We planned to evaluate the performance of SLIPA™, PLMA and endotracheal tube (ETT) in prone position. Methods: 114 adult patients undergoing elective surgery in prone position under general anaesthesia were randomised into Group-T (ETT), Group-S (SLIPA™) and Group-P (PLMA). Airways were inserted in supine position and patients turned prone subsequently. Airway characteristics, ventilatory parameters and complications were noted. One-way analysis of variance, Mann–Whitney U-test and Chi-square or Fisher's exact test were used. Results: Tidal volumes, peak airway pressure and compliance were comparable at all times. Leak pressure was significantly higher (P < 0.001) in Group-T (mean leak pressure = 40 cmH2O) when compared to Group-S and Group-P at all the times of recording, and there was no significant difference between Group-S and Group-P. The number of patients requiring airway/neck manipulation in prone position was significantly higher (P < 0.001) in Group-S (19 [55.9%]) when the three groups were compared (none in Group-T) and in comparison with Group-P (5 [14.7%], P < 0.001). On airway removal, the incidence of complications and airway reaction was significantly higher in Group-T. Group-S had a significantly higher incidence of dysphagia at 2 h postoperatively. Conclusion: ETT was most efficacious. SLIPA™ and PLMA were efficacious, safe and less stimulating to the airway during removal. More patients required SLIPA™ airway/neck manipulation.
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Affiliation(s)
- Harihar Vishwanath Hegde
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | - Joshiraj Bandi
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| | | | - Kiran A Honnannavar
- Department of Anaesthesiology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Schieren M, Egyed E, Hartmann B, Aleksanyan A, Stoelben E, Wappler F, Defosse JM. Airway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction. Anesth Analg 2018; 126:1257-1261. [DOI: 10.1213/ane.0000000000002753] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ribeiro Neto ML, Gildea TR, Mehta AC. Health of Your Airways. J Bronchology Interv Pulmonol 2018; 25:81-84. [DOI: 10.1097/lbr.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Keles S, Kocaturk O. Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia: comparison of nasal tracheal intubation and laryngeal mask airway. J Pain Res 2018; 11:103-110. [PMID: 29379311 PMCID: PMC5757964 DOI: 10.2147/jpr.s153637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several studies have identified side effects of general anesthesia with endotracheal intubation, such as laryngeal pain, dysphonia, and postoperative nausea and vomiting (PONV). The laryngeal mask airway (LMAw) is believed to decrease these side effects. The aim of this trial was to compare postoperative discomfort, emergence delirium, and recovery time of patients who received either an LMAw or nasotracheal intubation (NTI). PATIENTS AND METHODS A total of 70 children were randomly assigned to the LMAw group (n=35) or the NTI group (n=35). Both groups underwent mask induction with 8% sevoflurane. The NTI group received muscle relaxant, whereas the LMAw group did not. Postoperative laryngeal pain, dental pain, dysphonia, and PONV were assessed immediately and at 1 hour and 6 hours postoperatively. The Wong-Baker Faces Scale was used to evaluate the patients' self-reported pain. In addition, decayed, missing, and filled teeth (dft/DMFT) values, dental procedure type, number of dental procedures, duration of the dental operation, duration of anesthesia, recovery time, emergence delirium, pediatric dentist's access to the mouth, and parents' satisfaction levels were recorded. Data were analyzed using descriptive statistics, chi-square tests, and two-sample t-tests. RESULTS The incidence of postoperative laryngeal pain was significantly higher in the NTI group immediately (97.2% vs. 8.5%, P=0.00), 1 hour (94.2% vs. 0%, P=0.00), and 6 hours postoperatively (25.7% vs. 0%, P=0.00). There were no statistically significant differences between the two groups in dental pain scores, dft/DMFT values, duration of anesthesia, duration of the dental operation, number of dental procedures, the incidence of PONV, or pediatric dentist's access to the mouth (P>0.05). Emergence delirium and recovery time were significantly higher in the NTI group (P<0.05). CONCLUSION The LMAw provided a more comfortable postoperative period than NTI for children who underwent full-mouth dental rehabilitation under general anesthesia.
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Affiliation(s)
| | - Ozlem Kocaturk
- Deparment of Oral and Maxillofacial Surgery, Division of Anesthesiology, Faculty of Dentistry, Adnan Menderes University, Aydin, Turkey
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Modir H, Moshiri E, Malekianzadeh B, Noori G, Mohammadbeigi A. Endotracheal intubation in patients with difficult airway: using laryngeal mask airway with bougie versus video laryngoscopy. Med Gas Res 2017; 7:150-155. [PMID: 29152207 PMCID: PMC5674652 DOI: 10.4103/2045-9912.215744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Airway management is essential for safe anesthesia and endotracheal intubation is the most important procedure by which critically ill patients can be better managed, especially if done quickly and successfully. This study aimed to compare the techniques of intubation through laryngeal mask airway (LMA) using a bougie versus video laryngoscopy (VL) regarding to intubation success and the quality of intubation indices in patients with difficult airways. This randomized clinical trial was performed on 96 patients aged 16–76 years with Mallampati class 3 or 4 who underwent elective surgery. Once the demographics were recorded, patients were randomly divided into two groups and the first group intubated with VL, and the second group intubated through laryngeal mask using a bougie. Then vital signs, arterial oxygen saturation, the time required for successful intubation, and ease of intubation were recorded. Here t-tests, chi-square, Fisher exact tests, and analysis of variance for repeated measurement were used to analyze the data in SPSS software. The overall success rates of intubation in VL and LMA groups were 46 (96%) and 44 (92%), respectively. The mean duration of intubation for the LMA and VL groups was 18.70 ± 6.73 and 14.21 ± 4.14 seconds, respectively (P < 0.001). Moreover, visual analogue scale score for pain in throat was significantly lower in VL group than LMA (1.65 ± 0.76 vs. 1.33 ± 0.52). Moreover, easy intubation in bougie group was 50%, while the easy intubation in VL was 73% (P = 0.023). In addition, incidence of cough was 31% in the LMA with bougie group and 9% in VL group (P = 0.005). The VL technique is an easier method and has a shorter intubation time than LMA using bougie, and causes a lower incidence of coughing, laryngospasm in patients that need intubation. Moreover, cough and discomfort in the throat tend to be less in VL, and the LMA could be used as replacement of VL in hard situations.
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Affiliation(s)
- Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Moshiri
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bita Malekianzadeh
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Gholamreza Noori
- Department of surgery, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
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Costar EJ, Same M. Laryngeal mask airway or endotracheal tube for tonsillectomy? An update. Br J Hosp Med (Lond) 2017; 78:418. [PMID: 28692366 DOI: 10.12968/hmed.2017.78.7.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Edward J Costar
- Specialist Registrar in Anaesthetics, Royal National Throat Nose and Ear Hospital, London
| | - Melinda Same
- Locum Consultant Anaesthetist, University College Hospital, London NW1 2BU
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Dental injury associated with anaesthesia: An 8-year database analysis of 592 claims from a major French insurance company. Anaesth Crit Care Pain Med 2017; 37:49-53. [PMID: 28838826 DOI: 10.1016/j.accpm.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dental injury is the most common incident associated with anaesthesia. Regarding recent recommendations on informed consent and changes in airway management practices, a large series of claims related to dental injury has not been recently described. The aim of this study was to analyse a recent database in order to describe the characteristics of dental injury in France. METHODS A database that prospectively collected claims reported to Le Sou Médical-MACSF between January 2003 and December 2010, was analysed. Five hundred and ninety-two cases were reported. The following characteristics were analysed: number and type of teeth injured, mechanism of injury, anaesthetic procedure, risk factors and dental outcome after injury. RESULTS Amongst the 1514 claims related to anaesthesia, 592 (39.2%) were classified as dental damage. Preoperative informed consent concerning possible perioperative dental injury was documented in only 34.8% of patients. Only one tooth was affected in 65.2% of patients, dental bridge injury in 12.8% of cases and damage to two or more teeth in 14% of patients. Incisors were involved in 50% of cases. Fracture was the most common type of injury (64.2%). Poor dentition was the most common risk factor (23.1%) followed by difficult intubation (15.4%). Both risks were combined in only 7.6% of cases. Tracheal intubation was the highest risk procedure (41.6%). CONCLUSION Dental injury remains the most common anaesthesia-related claim. Dental examination and documentation in patient medical files requires improvement and better informed consent on dental injury risk needs to be provided to patients.
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Sharma B, Sahai C, Sood J. Extraglottic airway devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:189-205. [PMID: 28860875 PMCID: PMC5566319 DOI: 10.2147/mder.s110186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Extraglottic airway devices (EADs) have revolutionized the field of airway management. The invention of the laryngeal mask airway was a game changer, and since then, there have been several innovations to improve the EADs in design, functionality, safety and construction material. These have ranged from changes in the shape of the mask, number of cuffs and material used, like rubber, polyvinylchloride and latex. Phthalates, which were added to the construction material in order to increase device flexibility, were later omitted when this chemical was found to have serious adverse reproductive outcomes. The various designs brought out by numerous companies manufacturing EADs resulted in the addition of several devices to the airway market. These airway devices were put to use, many of them with inadequate or no evidence base regarding their efficacy and safety. To reduce the possibility of compromising the safety of the patient, the Difficult Airway Society (DAS) formed the Airway Device Evaluation Project Team (ADEPT) to strengthen the evidence base for airway equipment and vet the new extraglottic devices. A preuse careful analysis of the design and structure may help in better understanding of the functionality of a particular device. In the meantime, the search for the ideal EAD continues.
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Affiliation(s)
- Bimla Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Sahai
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Ozmete O, Sener M, Caliskan E, Kipri M, Aribogan A. The use of flexible laryngeal mask airway for Adenoidectomies: An experience of 814Paediatric patients. Pak J Med Sci 2017; 33:823-828. [PMID: 29067047 PMCID: PMC5648946 DOI: 10.12669/pjms.334.12432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess flexible laryngeal mask airway (F-LMA) use during pediatric adenoidectomies in terms of patient safety, comfort, complication rates and surgeon satisfaction levels. METHODS Patients who had undergone an elective adenoidectomy after receiving general anesthesia using F-LMA from June 2012 to November 2015 were included. Patients' demographics and the incidence of perioperative complications were investigated. The surgeon's satisfaction level was also evaluated by questionnaire. RESULTS Eight hundred fourteen patient were included in the study. Conversion from F-LMA to an endotracheal tube was carried out in two patients (0.2%). Airway complications were identified in two patients. The mean duration of stay in the postoperative anesthesia care unit was 17 minutes. All patients were discharged the same day. According to the otolaryngologists F-LMA applications provide a significant reduction in the processing time (100%), postoperative patient comfort is better than when using endotracheal intubation (83.3%) and the consensus was that there should be a complete continuation of the use of the F-LMA (100%) in subsequent adenoidectomies. CONCLUSION Our data show that the use of F-LMA for pediatric adenoidectomies has well tolerability profile and resulted in a lower incidence of complications. We think that the use of F-LMA for pediatric adenoidectomy is safer, simpler and speeder method.
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Affiliation(s)
- Ozlem Ozmete
- Ozlem Ozmete, MD, Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Adana, Turkey
| | - Mesut Sener
- Prof. MesutSener, MD, Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Adana, Turkey
| | - Esra Caliskan
- Asocc. Prof. Esra Caliskan, MD, Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Adana, Turkey
| | - Meltem Kipri
- Meltem Kipri, MD, Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Adana, Turkey
| | - Anis Aribogan
- Prof. Anis Aribogan, MD, Department of Anesthesiology and Reanimation, Baskent University School of Medicine, Adana, Turkey
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71
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Schmutz A, Dürk T, Idzko M, Koehler T, Kalbhenn J, Loop T. Feasibility of a Supraglottic Airway Device for Transbronchial Lung Cryobiopsy—A Retrospective Analysis. J Cardiothorac Vasc Anesth 2017; 31:1343-1347. [DOI: 10.1053/j.jvca.2017.02.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 12/21/2022]
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Takeshita J, Nishiyama K, Fujii M, Tanaka H, Beppu S, Sasahashi N, Shime N. Repetitive postoperative extubation failure and cardiac arrest due to laryngomalacia after general anesthesia in an elderly patient: a case report. J Anesth 2017; 31:779-781. [PMID: 28508288 DOI: 10.1007/s00540-017-2373-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation.
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Affiliation(s)
- Jun Takeshita
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masashi Fujii
- Department of Anesthesiology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Hiroyuki Tanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Drake-Brockman TFE, Ramgolam A, Zhang G, Hall GL, von Ungern-Sternberg BS. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial. Lancet 2017; 389:701-708. [PMID: 28108038 DOI: 10.1016/s0140-6736(16)31719-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/27/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perioperative respiratory adverse events (PRAE) are the most common critical incidents in paediatric anaesthesia and occur more often in infants. Use of laryngeal mask airways (LMAs) is associated with reduced PRAE compared with endotracheal tubes in older children (>1 year). We aimed to evaluate the effect of these devices on the incidence of PRAE in infants. METHODS We did a randomised controlled trial at the Princess Margaret Hospital for Children in Perth (WA, Australia) by recruiting infants (aged 0-12 months) undergoing general (with or without regional or local) anaesthesia with anticipated fentanyl dose 1 μg/kg or lower for minor elective surgery. We excluded patients contraindicated for LMA or endotracheal tube; who had known cardiac disease or airway or thoracic malformations; who were receiving midazolam premedication; who were undergoing airway, thoracic, or abdomen surgery at the time of participation; and if the parents did not speak English. Written parental or guardian consent was obtained before enrolment. Participants were randomly assigned (1:1), by computer-generated variable block randomisation, to receive an LMA (PRO-Breathe, Well Lead Medical Co Ltd, Panyu, China) or an endotracheal tube (Microcuff, Halyard Health Inc, Atlanta, GA, USA). Sealed randomisation envelopes were used to conceal device assignment. An interim analysis was planned once half the number of infants needed (145) had been recruited. The primary outcome was incidence of PRAE, assessed in the intention-to-treat population. The institutional ethics committee at the Princess Margaret Hospital for Children granted ethical approval (1786/EP). The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000250033). FINDINGS The trial began on July 8, 2010, and was ended early on May 7, 2015, after the interim analysis results met the study stopping rules. During this time, 239 infants were assessed and 181 eligible infants were randomly assigned to receive an LMA (n=85) or an endotracheal tube (n=95). Four infants were not included in the analysis (two due to cancelled procedures, one did not meet inclusion criteria, and one with missing dataset). In the intention-to-treat analysis, PRAE occurred in 50 (53%) infants in the endotracheal tube group and in 15 (18%) infants in the LMA group (risk ratio [RR] 2·94, 95% CI 1·79-4·83, p<0·0001). Laryngospasm and bronchospasm (major PRAE) were recorded in 18 (19%) infants in the endotracheal tube group and in three (4%) infants in the LMA group (RR 5·30, 95% CI 1·62-17·35, p=0·002). No deaths were reported. INTERPRETATION In infants undergoing minor elective procedures, LMAs were associated with clinically significantly fewer PRAE and lower occurrence of major PRAE (laryngospasm and bronchospasm) than endotracheal tubes. This difference should be a consideration in airway device selection. FUNDING Princess Margaret Hospital Foundation, National Health and Australian Medical Research Council, Stan Perron Charitable Trust, and Callahan Estate.
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Affiliation(s)
- Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Anoop Ramgolam
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia; Children's Lung Health, Telethon Kids Institute, Perth, WA, Australia
| | - Guicheng Zhang
- Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, WA, Australia; School of Public Health, Curtin University, Perth, WA, Australia; Centre for Genetic Origins of Health and Disease, Curtin University, Perth, WA, Australia
| | - Graham L Hall
- Centre of Child Health Research, University of Western Australia, Perth, WA, Australia; Children's Lung Health, Telethon Kids Institute, Perth, WA, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia; Children's Lung Health, Telethon Kids Institute, Perth, WA, Australia.
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Hung CW, Licina L, Abramson DH, Arslan-Carlon V. Anesthetic complications during general anesthesia without intravenous access in pediatric ophthalmologic clinic: assessment of 5216 cases. Minerva Anestesiol 2017; 83:712-719. [PMID: 28094480 DOI: 10.23736/s0375-9393.17.11565-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND General anesthesia utilizing inhalational agents without intravenous (IV) access for minor procedures is controversial. Eliminating IV access increases efficiency and patient satisfaction; however, the ability to introduce rapid acting medications into the circulation during an unanticipated emergency becomes challenging. The objective of this study was to examine complication risk following pediatric ophthalmologic examinations under anesthesia (EUA) without IV placement. METHODS A retrospective review of consecutive pediatric patients who underwent EUA for retinoblastoma management was performed from 2004 to 2014. The total number of anesthetics and elective IV placement were identified. Patient characteristics, length of the procedure, laryngeal mask airway (LMA) placement, and complications were also recorded. A survey of specialized ophthalmology institutions was performed in order to ascertain the state of standard practices. RESULTS Over 10 years, 5216 anesthetics were identified. The mean age and weight of the patients were 2.7±2.0 years and 14.4±6.6 kg, respectively. In all, 298 elective IVs were placed (6%) and 4918 cases (94%) were performed without IV access. A total of 1687 (32%) anesthetics were administered with a laryngeal mask airway (LMA), of which 1389 (82%) did not have IV access. There were no deaths and no unplanned admissions. There were 8/5216 complications (0.153%) which all resolved safely. CONCLUSIONS The current study shows that it is safe to perform EUA and procedures for the diagnosis and treatment of retinoblastoma in pediatric patients without securing IV access. All emergency post-complication IV placements were successful and no long-term sequelae were seen.
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Affiliation(s)
- Chun W Hung
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren Licina
- Department of Anesthesiology, Weill Cornell Medical Center, New York, NY, USA
| | - David H Abramson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vittoria Arslan-Carlon
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA -
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Shah K. ProSeal laryngeal mask airway as an alternative to standard endotracheal tube in securing upper airway in the patients undergoing beating-heart coronary artery bypass grafting. Ann Card Anaesth 2017; 20:61-66. [PMID: 28074798 PMCID: PMC5290698 DOI: 10.4103/0971-9784.197838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG). Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO2 (pCO2), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG.
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Affiliation(s)
- Kalpana Shah
- Department of Cardiac Anaesthesia, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
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77
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van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications. J Clin Anesth 2016; 36:142-150. [PMID: 28183554 DOI: 10.1016/j.jclinane.2016.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 09/28/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
To determine whether the laryngeal mask airway (LMA) has advantages over the tracheal tube (TT) in terms of incidence of cough, sore throat, laryngospasm, dysphagia, dysphonia, and blood staining. This is a systematic literature review performed at the Universtity Medical Center of Utrecht. The online databases PubMed, Embase, and the Cochrane Library were searched for relevant randomized controlled trials. Two independent reviewers selected relevant articles after title, abstract, and full text screening. Articles were assessed on risk of bias in accordance with the Cochrane risk of bias tool. Study results of the LMA and the TT were related to the method of selection of the device size and the method for cuff inflation. Of the 1718 unique articles, we included 19 studies which used the LMA Classic, the LMA Proseal, the Flexible Reinforced LMA, and the LMA Supreme compared with TT. After methodological inspection, data could not be pooled due to heterogeneity among the selected studies. Overall, no clear advantage of the LMA over the TT was found but the LMA Supreme was related to the lowest incidence of airway complications. In this review, no clear difference in incidence of postoperative airway complications could be demonstrated between LMA and TT. The LMA Supreme may reduce the incidence of airway complication in comparison to the TT but high quality randomized trials are recommended to further objectify if use of the LMA decreases the risk on postoperative airway complications.
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Affiliation(s)
| | - Inge Stegeman
- Department of Otorhinolaryngology, University Medical Center Utrecht, The Netherlands and Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Adriana L Smit
- Department of Otorhinolaryngology, University Medical Center Utrecht, The Netherlands and Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
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Hogg G, Goswamy J, Khwaja S, Khwaja N. Laryngeal Trauma Following an Inhalation Injury: A Review and Case Report. J Voice 2016; 31:388.e27-388.e31. [PMID: 27884557 DOI: 10.1016/j.jvoice.2016.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
The primary concern when managing a patient with inhalation injury is security of the airway. Airflow may be impeded by both edema of the upper airway and reduction of oxygen delivery to the lower respiratory tract. Although there has been much discussion regarding management of the latter, the focus of this article is the management of the former. This review aimed to determine the optimum management in burn victims with upper airway inhalation injury as an attempt to prevent laryngeal trauma leading to long-term voice disorders and upper airway dyspnea. We describe the case of a 57-year-old woman with significant inhalation injury and discuss the natural progression of her injuries and the laryngeal controversies surrounding her care. We conclude with advice on the optimal management of this condition based on our experience, combined with current best evidence.
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Affiliation(s)
- Gemma Hogg
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK.
| | - Jay Goswamy
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
| | - Sadie Khwaja
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
| | - Nadeem Khwaja
- Department of Otolaryngology, University Hospital of South Manchester, Manchester, UK; Department of Plastics and Burns, University Hospital of South Manchester, Manchester, UK
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Lemos J, De Oliveira GS, de Pereira Cardoso HED, Lemos LDCN, de Carvalho LR, Módolo NSP. Gastric regurgitation in patients undergoing gynecological laparoscopy with a laryngeal mask airway: a prospective observational study. J Clin Anesth 2016; 36:32-35. [PMID: 28183569 DOI: 10.1016/j.jclinane.2016.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/06/2016] [Accepted: 07/25/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The use of pneumoperitonium and the placement of patients in Trendelenburg position are commonly cited reasons for the potential development of intraoperative regurgitation of gastric contents and the need for an endotracheal tube in laparoscopic surgery. The main objective of the current investigation was to evaluate the presence of regurgitation of gastric contents in the oropharynx of patients having laparoscopic gynecological surgery with a laryngeal mask airway (LMA). DESIGN Prospective, observational clinical investigation. INTERVENTIONS Not applicable. MEASUREMENTS Healthy subjects having a laparoscopic gynecological surgery under general anesthesia with a ProSeal LMA were included in the study. An insufflation pressure of 15 mm Hg was established as the maximum intra-abdominal pressure for the pneumoperitonium, and patients were placed in Trendelenburg position at a 15° angle. The pH of secretions extracted from subjects' hypopharynx was measured at multiple time points during the surgical procedure. A pH of oropharynx secretions ≤4.1 indicated the regurgitation of gastric contents. MAIN RESULTS Eighty subjects were recruited and completed the study. The median (range) of pH measurements at any time (T3-T9) was 6.5 (5.5-7.0). The median (range) for the lowest pH for each subject was 6.0 (5.5-7.0). The lowest detected pH in the hypopharynx was not correlated (Spearman ρ) with total surgical time (P = .9), total pneumopertitonium time (P = .17), or total Trendelenburg position time (P = .47). CONCLUSIONS Our current results suggest that the use of an LMA in healthy patients undergoing laparoscopic gynecological surgery may be safe. Future studies to confirm or refute our findings are warranted.
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Affiliation(s)
- Jeconias Lemos
- Department of Anesthesiology, Royal Spanish Charitable Society/Hospital (Real Sociedade Espanhola de Beneficência/Hospital), Madrid, Spain
| | - Gildasio S De Oliveira
- Department of Anesthesiology, Feiberg School of Medicine, Northwestern University, Chicago, IL.
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Jain S, Nazir N, Khan RM, Ahmed SM. A prospective randomized control study comparing classic laryngeal mask airway with Guedel's airway for tracheal tube exchange and smooth extubation. Anesth Essays Res 2016; 10:552-556. [PMID: 27746550 PMCID: PMC5062217 DOI: 10.4103/0259-1162.186611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. MATERIAL AND METHODS This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia. These patients were randomly divided into two groups i.e. OPA group and LMA group of 50 patients each. Hemodynamic parameters i.e. systolic blood pressure (SBP) and heart rate (HR) were recorded during exchange of ETT with OPA™ or LMA™. Coughing / bucking during removal of OPA™ and LMA™, and presence of post operative sore throat for both the groups were also graded and recorded. Data within the groups have been analyzed using paired "t" test while those between the groups were analyzed using unpaired "t" test. Chi square test was used to analyze grades of coughing and post operative sore throat. RESULTS In both groups, hemodynamic parameters rose significantly as OPA™/LMA™ was placed (P < 0.05) and then started declining. Hemodynamic parameters continued to fall in LMA group after extubation. However in OPA group, hemodynamic parameters continued to rise even after extubation and declined only when OPA™ was removed. There was no statistical significant difference between the LMA and OPA group in respect to coughing and post operative sore throat. CONCLUSION LMA™ is superior to OPA™ for exchange of ETT as it provides greater hemodynamic stability.
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Affiliation(s)
- Shruti Jain
- Department of Anesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Nazia Nazir
- Department of Anesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Rashid M Khan
- Department of Anaesthesia, Khoula Hospital, Muscat, Oman
| | - Syed M Ahmed
- Department of Anesthesiology, J N Medical College, Aligarh, Uttar Pradesh, India
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Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: A systematic review and meta-analysis. Medicine (Baltimore) 2016; 95:e4598. [PMID: 27537593 PMCID: PMC5370819 DOI: 10.1097/md.0000000000004598] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Comparisons between the efficacies of supraglottic airway devices (SGAs) and endotracheal tubes (ETTs) in patients undergoing laparoscopic surgeries have yielded conflicting results. Therefore, in this meta-analysis, we compared the clinical performance and incidence of complications between SGAs and ETT intubation in laparoscopic surgery. METHODS A comprehensive search was conducted using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar to identify randomized controlled trials that compared SGAs with ETTs in laparoscopic surgery. RESULTS In total, 1433 patients from 17 studies were included in the final analysis. SGAs and ETTs showed no difference in insertion success rate on the first attempt (relative risk [RR] 1.01, 95% confidence interval [CI] 0.99-1.03), insertion time (standardized mean difference 1.57, 95% CI -3.74 to 0.61), and oropharyngeal leak pressure (OLP) (mean difference -2.54, 95% CI -7.59 to 2.50). The incidence of desaturation (RR 3.65, 95% CI 1.39-9.62), gastric insufflations (RR 0.90, 95% CI 0.48-1.71), regurgitation (RR 0.98, 95% CI 0.02-49.13), and aspiration (RR 0.99, 95% CI 0.01-78.4) also showed no intergroup differences. However, the incidence of laryngospasm (RR 3.12, 95% CI 1.29-7.52), cough at removal (RR 6.68, 95% CI 4.70-9.48), dysphagia (RR 1.47, 95% CI 1.12-1.95) or dysphonia (RR 4.41, 95% CI 1.25-15.55), sore throat (RR 1.60, 95% CI 1.33-1.93), and hoarseness (RR 1.53, 95% CI 1.29-1.81) was higher in the ETT group than in the SGA group. CONCLUSIONS The incidence of laryngospasm, cough at removal, dysphagia or dysphonia, sore throat, and hoarseness were higher in the ETT group than in the SGA group. However, the groups showed no differences in the rate of insertion success on the first attempt, insertion time, OLP, and other complications. Therefore, SGAs might be clinically more useful as effective airways in laparoscopic surgery.
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Affiliation(s)
- Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, College of Medicine
| | - Geum Ko
- Medical Course, Jeju National University School of Medicine, Jeju National University, Jeju
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
| | - Eun Jin Ahn
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine
- Correspondence: Hyun Kang, Associate Professor, Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 156–755, Korea (e-mail: )
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Simultaneous Bilateral Endoscopic Manipulation for Bilateral Renal Stones. Urology 2016; 94:265-9. [DOI: 10.1016/j.urology.2016.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 12/15/2022]
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83
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Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One 2016; 11:e0158137. [PMID: 27414807 PMCID: PMC4944923 DOI: 10.1371/journal.pone.0158137] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. METHODS A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. RESULTS Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70-4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13-6.18) and RR = 0.95, 95% CI = (0.81-1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27-1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58-14.33)]; aspiration [RR = 0.76, 95% CI = (0.06-8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10-1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15-0.62)]; coughing [RR = 0.28, 95% CI = (0.15-0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26-0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44-11.18)]. CONCLUSION This systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
| | - Ying Lian
- Department of Case Administration, Shandong Provincial Qian Foshan Hospital of Shandong University, Jinan, China
| | - Wen Xian Li
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
- * E-mail:
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84
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Arevalo-Ludeña J, Arcas-Bellas JJ, Alvarez-Rementería R, Flandes J, Morís L, Muñoz Alameda LE. A comparison of the I-Gel supraglottic device with endotracheal intubation for bronchoscopic lung volume reduction coil treatment. J Clin Anesth 2016; 31:137-41. [DOI: 10.1016/j.jclinane.2016.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 10/21/2022]
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85
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Yousefnia-Darzi F, Hasavari F, Khaleghdoost T, Kazemnezhad-Leyli E, Khalili M. Effects of thoracic squeezing on airway secretion removal in mechanically ventilated patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:337-42. [PMID: 27186214 PMCID: PMC4857671 DOI: 10.4103/1735-9066.180374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Accumulation of secretions in the airways of patients with an endotracheal tube and mechanical ventilation will have serious consequences. One of the most common methods of airway clearance is endotracheal suctioning. In order to facilitate discharge of airway secretion resulting in promotion of gas exchange, chest physiotherapy techniques can be used at the time of expiration before suction. Materials and Methods: In this clinical trial with a cross-over design, 50 mechanically ventilated patients admitted to intensive care units (ICUs) were randomly divided into two groups of thoracic squeezing. In each patient, two interventions of endotracheal suctioning were conducted, one with and the other without thoracic squeezing during exhalation, with a 3 h gap between the two interventions and an elapse of three respiratory cycles between the number of compressions. Sputum secreted was collected in a container connected to a suction catheter and weighed. Data were recorded in data gathering forms and analyzed using descriptive and inferential statistics (Wilcoxon and independent t-test, Chi-square) in SPSS version 16. Results: Findings showed that the mean weight of the suction secretions removed from airway without thoracic squeezing was 1.35 g and that of suction secretions removed by thoracic squeezing was 1.94 g. Wilcoxon test showed a significant difference regarding the rate of secretion between the two techniques (P = 0.003). Conclusions: According to the study findings, endotracheal suction with thoracic squeezing on expiration helps airway secretion discharge more than suction alone in patients on mechanical ventilators and can be used as an effective method.
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Affiliation(s)
- Farkhondeh Yousefnia-Darzi
- Department of Nursing, Faculty of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Farideh Hasavari
- Department of Medical-Surgical Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - Tahereh Khaleghdoost
- Department of Medical-Surgical Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leyli
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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86
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Lee S, Kim J, Kim J, Kim S. The use of laryngeal mask airway in dental treatment during sevoflurane deep sedation. J Dent Anesth Pain Med 2016; 16:49-53. [PMID: 28879295 PMCID: PMC5564118 DOI: 10.17245/jdapm.2016.16.1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 11/15/2022] Open
Abstract
Background General anesthesia is frequently considered for pediatric patients, as they often find it difficult to cooperate and stay calm during administration of potentially painful treatments. Sedation can overcome these adversities; however, this is challenging while maintaining unobstructed airways. Methods The study involved 11 pediatric dental patients treated with LMA under deep sedation with sevoflurane, from 2011 through 2015. LMA size, sevoflurane concentration, and the vital signs of patients were assessed through a chart review. Results The age distribution of the patients ranged from 6 to 10 years old. A total of 3 patients underwent mesiodens extraction, while the remaining 8 underwent an surgically assisted orthodontic forced tooth eruption The average sedation period was approximately 45 minutes and the LMA size was 2½. The sevoflurane concentration was maintained at 2% on average, and overall, the measurements of vital signs were within the normal range; the patients had an average blood pressure of 98/49 mmHg, breathing rate of 26 times/min, pulse frequency of 95 times/min, SpO2s level of 99 mmHg, and ETCO2 level of 41.2 mmHg. Conclusions Deep sedation with sevoflurane coupled with LMA may be applied successfully in pediatric patients who undergo mesiodens extraction or a surgically assisted orthodontic forced tooth eruption.
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Affiliation(s)
- Sangeun Lee
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongsoo Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Jongbin Kim
- Department of Pediatric Dentistry, School of Dentistry, Dankook University, Cheonan, Korea
| | - Seungoh Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Korea
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87
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Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient with Sjögren’sSyndrome. Case Rep Anesthesiol 2016; 2016:8185628. [PMID: 28018681 PMCID: PMC5149601 DOI: 10.1155/2016/8185628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient with Sjögren's syndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings.
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89
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Beleña JM, Ochoa EJ, Núñez M, Gilsanz C, Vidal A. Role of laryngeal mask airway in laparoscopic cholecystectomy. World J Gastrointest Surg 2015; 7:319-325. [PMID: 26649155 PMCID: PMC4663386 DOI: 10.4240/wjgs.v7.i11.319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/26/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway (LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.
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90
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Kim EM, Kim MS, Koo BN, Lee JR, Lee YS, Lee JH. Clinical efficacy of the classic laryngeal mask airway in elderly patients: a comparison with young adult patients. Korean J Anesthesiol 2015; 68:568-74. [PMID: 26634080 PMCID: PMC4667142 DOI: 10.4097/kjae.2015.68.6.568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. Methods Fifty patients aged 65-85 years (elderly group) and 50 patients aged 20-40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. Results In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 ± 19.6 vs. 22.2 ± 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). Conclusions The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.
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Affiliation(s)
- Eun Mi Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sub Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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91
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Barletta M, Kleine SA, Quandt JE. Assessment of v-gel supraglottic airway device placement in cats performed by inexperienced veterinary students. Vet Rec 2015; 177:523. [DOI: 10.1136/vr.103407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 12/26/2022]
Affiliation(s)
- M. Barletta
- Department of Large Animal Medicine; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
| | - S. A. Kleine
- Department of Small Animal Medicine & Surgery; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
| | - J. E. Quandt
- Department of Small Animal Medicine & Surgery; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
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Kang H, Kim DR, Jung YH, Baek CW, Park YH, In Oh J, Kim WJ, Choi GJ. Pre-warming the Streamlined Liner of the Pharynx Airway (SLIPA) improves fitting to the laryngeal structure: a randomized, double-blind study. BMC Anesthesiol 2015; 15:167. [PMID: 26589142 PMCID: PMC4653944 DOI: 10.1186/s12871-015-0151-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background The Streamlined Liner of the Pharynx Airway (SLIPA), a type of supraglottic airway, has a non-inflatable cuff that softens at body temperature to fit the laryngeal structure. We investigated whether pre-warming of SLIPA to body temperature may improve insertion parameters. Methods Ninety adult patients were assigned equally randomized to either Group W or Group R. Anesthesia was induced using propofol, fentanyl, and rocuronium. In Group W, the SLIPA was warmed to 37 ° C before insertion, whereas in Group R, it was inserted at room temperature. The insertion time, oropharyngeal leak pressure, postoperative throat pain, blood staining, regurgitation, number of attempts at insertion, and difficulty of insertion were compared between the two groups. Results The insertion time was shorter in Group W than in Group R (3.60 [3.15–4.06] s vs. 6.00 [4.45–7.50] s; P < 0.001). Oropharyngeal leak pressure from the time of insertion until 3 min after insertion was significantly higher in Group W than in Group R (P < 0.05). Postoperative throat pain, measured using the visual analog scale, was lower in Group W than in Group R (0.00 [0.00–2.50] vs. 2.00 [0.00–4.50]; P = 0.006). The difficulty of insertion was lower in Group W than in Group R (P < 0.004). There were no significant differences in terms of blood staining, regurgitation, and number of attempts. Conclusions Pre-warming the SLIPA to body temperature has significant benefits compared to maintaining the device at room temperature. Specifically, insertion was easier, both insertion and fitting to the laryngeal structure could be performed more quickly, and the incidence of sore throat was reduced. Trial registration Clinical Research Information Identifier NCT01209000
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Affiliation(s)
- Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Dong Rim Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Yong Hun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea.
| | - Chong Wha Baek
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Yong Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Jong In Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Won Joong Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea
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93
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Vaidya S, Kundra P, Gopalakrishnan S, Parida P, Yuvaraj K, Mohan P M. Supraglottic Airway Devices and Effect on Voice-Comparison of LMA Proseal and i-gel: Double-Blind Randomized Clinical Trial. J Voice 2015; 30:631-7. [PMID: 26471807 DOI: 10.1016/j.jvoice.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Laryngeal mask airway (LMA) is an important alternative to endotracheal intubation for all professional voice users undergoing surgery. However, dysphonia is a known complication of LMA Proseal (PLMA) use. The i-gel airway (IGA) provides adequate airway seal without the need for an inflatable cuff. Hence, it helps to minimize the risk of tissue compression. This study compares effect of PLMA and IGA on voice at 24th hour after anesthesia. DESIGN This is a double-blind randomized clinical trial. METHODS Ninety anesthesiologists class 1 adults scheduled for surgeries lasting up to 60-120 minutes were included in the study. Participants were randomly allocated to group PLMA (n = 43) and group IGA (n = 43). Cuff pressure was monitored and maintained at just seal pressure in group PLMA. Voice was evaluated using perceptive and acoustic analysis (jitter, shimmer, and harmonics-to-noise ratio [HNR]) preoperatively and at 24th hour after anesthesia. Voice of patients with pharyngolaryngeal complaints was categorized into rough, breathy, asthenic, strain, or normal pattern. RESULTS Acoustic parameters jitter, shimmer, and HNR deteriorated significantly in both group PLMA and IGA albeit the change being comparable. Incidence of pharyngolaryngeal complaints was similar in both the groups. A total of 10% patients in group PLMA and 12.5% in group IGA developed breathy voice significant deterioration in all acoustic variables at 24th postoperative hour, but differences were not significant between group PLMA and group IGA. CONCLUSIONS PLMA and IGA both produce comparable and significant deterioration in acoustic variables at 24th hour after short duration general anesthesia.
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Affiliation(s)
- Shriram Vaidya
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Surianarayanan Gopalakrishnan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Pradiptakumar Parida
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Kotteeswaran Yuvaraj
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Manju Mohan P
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
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Khosravan S, Alami A, Hamzei A, Borna J. Comparing the effectiveness of airway management devices in pre-hospital emergency care: A randomized clinical trial. Pak J Med Sci 2015; 31:946-9. [PMID: 26430435 PMCID: PMC4590366 DOI: 10.12669/pjms.314.7296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To assess the effectiveness of laryngeal mask airway, endotracheal tube and oropharyngeal airway for airway management in prehospital emergency care. Methods: The study sample of this randomized clinical trial was 54 patients needing pre-hospital airway management. All cases of intubation (ETI); after two failed attempts (37 patients), were randomly assigned to the oropharyngeal airway (OPA), and the laryngeal mask airway (LMA) groups. Patients’ hemodynamic, SaO2 and airway management parameters, were compared in three groups. The study data were analyzed by the Chi-square and one-way ANOVA, Bonferroni post-hoc, using SPSS, v. 18.0. Results: The results demonstrated that before and after the study, there was no significant difference among the study groups in terms of hemodynamic variables (P > 0.05) expect SaO2 (P < 0.001). The results also revealed that in the ETI group (n=17), the number of attempts and the time spent on inserting the airway device was significantly more than other two groups (P < 0.05). Conclusion: Laryngeal mask airway is as effective as oropharyngial airway for pre-hospital airway management by paramedics.
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Affiliation(s)
- Shahla Khosravan
- Shahla Khosravan, Msc, PhD in Nursing. Associate Professor of Nursing and Midwifery School, Social Determinants of Health Research Centre, Gonabad university of Medical Sciences, Gonabad, Iran
| | - Ali Alami
- Ali Alami, MD, PhD in Epidemiology. Assistant Professor of Health School, Social Determinants of Health Research Centre, Gonabad university of Medical Sciences, Gonabad, Iran
| | - Arash Hamzei
- Arash Hamzei, MD. Specialist in Anesthesiology, Assistant Professor of Faculty of Paramedics, Operating and Anaesthesia Department, Gonabad university of Medical Sciences, Gonabad, Iran
| | - Jalal Borna
- Jalal Borna, Msc Medical-Surgical. Student Research Committee, Nursing and Midwifery School, Gonabad university of Medical Sciences, Gonabad, Iran
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95
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Cook T, Kelly F. Time to abandon the ‘vintage’ laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth 2015; 115:497-9. [DOI: 10.1093/bja/aev156] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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96
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Abstract
BACKGROUND Desflurane's short emergence time supports fast track anaesthesia. Data on the rate of upper airway complications and emergence time when desflurane is used with laryngeal mask airway (LMA) are controversial and limited. OBJECTIVES To compare recovery time variables and the rates of upper airway adverse events in patients with an LMA undergoing general surgery with desflurane, sevoflurane, isoflurane or propofol anaesthesia. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES A systematic search for eligible RCTs in Embase (Elsevier) and in PubMed (National Library of Medicine) databases up to September 2013. ELIGIBILITY CRITERIA RCTs investigating the rates of cough overall, cough at emergence, laryngospasm, time to eye opening, time to removal of the LMA, time to respond to command and time to state date of birth in patients with an LMA, during emergence from desflurane, sevoflurane, isoflurane or propofol anaesthesia. RESULTS Thirteen RCTs were included and analysed. We found a strong interstudy variability. There was no difference in the rates of upper airway events between desflurane and sevoflurane or between desflurane and a control group consisting of all the other anaesthetics combined. Comparing desflurane (n = 284) with all other anaesthetic groups (n = 313), the risk ratio [95% confidence interval (95% CI)] was 1.12 (0.63 to 2.02, P = 0.70). Cough at emergence was only measured in patients receiving desflurane (n = 148) and sevoflurane (n = 146): the risk ratio (95% CI) was 1.49 (0.55 to 4.02, P = 0.43). Laryngospasm was rare and there was no significant difference in its incidence when desflurane (n = 262) was compared with all other anaesthetics combined (n = 289; risk ratio 1.03; 95% CI 0.33 to 3.20, P = 0.96). The times of all emergence variables were significantly faster in the desflurane group than in all other groups. CONCLUSION When using an LMA, upper airway adverse reactions in association with desflurane anaesthesia were no different from those noted with sevoflurane, isoflurane or propofol anaesthesia. Emergence from general anaesthesia with desflurane is significantly faster than all the other anaesthetics. Due to interstudy variations and the small size of the trials, further large-scale, multicentre studies are required to confirm or refute the results of this meta-analysis.
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97
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Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial. PLoS One 2015; 10:e0134130. [PMID: 26252522 PMCID: PMC4529079 DOI: 10.1371/journal.pone.0134130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients’ characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.
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98
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Stevanovic A, Rossaint R, Keszei AP, Fritz H, Fröba G, Pühringer F, Coburn M. Emergence times and airway reactions in general laryngeal mask airway anesthesia: study protocol for a randomized controlled trial. Trials 2015. [PMID: 26210907 PMCID: PMC4515321 DOI: 10.1186/s13063-015-0855-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The use of a laryngeal mask airway (LMA) in appropriate patients supports fast-track anesthesia with a lower incidence of postoperative airway-connected adverse events. Data on the most favorable anesthetic in this context, with the lowest rate of upper airway complications and fast emergence times, are controversial and limited. Desflurane seems to match these criteria best, but large randomized controlled trials (RCTs) with a standardized study protocol are lacking. Therefore, we aim to compare desflurane with other commonly used anesthetics, sevoflurane and propofol, in a sufficiently powered RCT. We hypothesize that desflurane is noninferior regarding the frequency of upper airway events and superior regarding the emergence times to sevoflurane and propofol. Methods/Design A total of 351 patients undergoing surgery with an LMA will be included in this prospective, randomized, double-blind controlled, multicenter clinical trial. The patients will be randomly assigned to the three treatment arms: desflurane (n = 117), sevoflurane (n = 117), and propofol (n = 117). The emergence time (time to state the date of birth) will be the primary endpoint of this study. The secondary endpoints include further emergence times, such as time to open eyes, to remove LMA, to respond to command and to state name. Additionally, we will determine the frequency of cough and laryngospasm, measured intraoperatively and at emergence. We will assess the postoperative recovery on the first postoperative day via the Postoperative Quality Recovery Scale. Discussion Despite increasing importance of cost-effective and safe anesthesia application, we lack proof for the most advantageous anesthetic agent, when an LMA is used. There are only a few RCTs comparing desflurane to other commonly used anesthetics (sevoflurane, propofol and isoflurane) in patients with LMA. These RCTs were conducted with small sample sizes, huge interstudy variability, and some also showed strong biases. The present multicenter RCT will provide results from a large sample size with a standardized study protocol and minimized bias, which is feasible in the clinical routine. Furthermore, we will expand our knowledge regarding the most favorable recovery on the first postoperative day, which impacts patients’ comfort after surgery. Trial registration EudraCT Identifier: 2014-003810-96, 5 September 2014 ClinicalTrials.gov: NCT02322502, December 2014 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0855-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana Stevanovic
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - András P Keszei
- Department of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Harald Fritz
- Department of Anesthesiology and Intensive Care Medicine, Martha-Maria Hospital, Röntgenstraße 1, 06120, Halle (Saale), Germany.
| | - Gebhard Fröba
- Department of Anesthesiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Friedrich Pühringer
- Department of Anesthesiology and Intensive Care Medicine, Klinikum am Steinenberg, Steinenbergstr. 31, 72764, Reutlingen, Germany.
| | - Mark Coburn
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Nonanesthesia magnetic resonance enterography in young children: feasibility, technique, and performance. J Pediatr Gastroenterol Nutr 2015; 60:754-61. [PMID: 25996792 DOI: 10.1097/mpg.0000000000000712] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of the present study was to demonstrate the effectiveness and cost savings of a nonanesthesia approach to magnetic resonance enterography (MRE) in 14 young pediatric patients (age 4-7 years) with clinically suspected early-onset inflammatory bowel disease using an MRE protocol. METHODS MRE was performed using a combination of an abbreviated imaging protocol, magnetic resonance imaging video goggles, and Child Life Services support. MRE results were correlated with both colonoscopy and pathology results using Pearson correlation coefficient. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS MRE was performed successfully in 13 of 14 patients (age range 4 years 0 months to 7 years 6 months). MRE findings matched with results in 12 of 13 patients in whom colonoscopy was successfully performed. Both MRE and colonoscopy demonstrated a high specificity (100%) and a positive predictive value (100%), but a low sensitivity (43%) and a negative predictive value (50%). CONCLUSIONS MRE can be successfully performed in children ages 4 to 7 years using this approach. In addition to decreased risks to the child, the lack of anesthesia also offers a potential overall cost reduction.
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100
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Michálek P, Miller DM. Airway management evolution - in a search for an ideal extraglottic airway device. Prague Med Rep 2015; 115:87-103. [PMID: 25626328 DOI: 10.14712/23362936.2014.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Extraglottic airway devices (EADs) are commonly used equipment for airway maintenance during elective procedures under general anaesthesia. They may be used also in other indications such as conduit for tracheal intubation or rescue airway device in prehospital medicine. Current classifications of the EADs lack systematic approach and therefore classification according to the sealing sites and sealing mechanisms is suggested in this review article. Modern EADs are disposable, latex-free devices made of plastic materials most commonly from polyvinylchloride (PVC). The bowl of uncuffed sealers is manufactured from different materials such as thermoplastic elastomers or ethylene-vinyl-acetate co-polymer. EADs create various physical forces exerted on the adjacent tissues which may contribute to different sealing characteristic of particular device or to variable incidence of postoperative complications. Desired features of an ideal EAD involve easy insertion, high insertion success rate even by inexperienced users, protection against aspiration of gastric contents and low incidence of postoperative complications such as sore throat, hoarseness, cough or swallowing difficulties.
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Affiliation(s)
- Pavel Michálek
- Department of Anaesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Donald M Miller
- Department of Anaesthetics, Guys Hospital, London, United Kingdom
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