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Massoth C, Wenk M. [The Myth about the Laryngeal Mask]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:325-327. [PMID: 38759687 DOI: 10.1055/a-2199-4692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Peak pressures ≥ 20 mbar are not a contraindication for laryngeal masks. The oropharyngeal leak pressure of a laryngeal mask does not correspond to the pressure at which oesophagogastric air leakage occurs. Setting a peak pressure limit of 20 cm H2O on the respirator can lead to critical situations because the tidal volume may then remain too low. A good alternative is to use a pressure alarm limit. The use of laryngeal masks does not preclude the use of PEEP and/or relaxation.
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Lorente C, Kiss E, Kastner G, Dariya VS, Olomu P, Szmuk P. Unanticipated difficult airway after prolonged use of a laryngeal mask airway. Paediatr Anaesth 2024; 34:371-373. [PMID: 38063288 DOI: 10.1111/pan.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 03/04/2024]
Abstract
The laryngeal mask airway (LMA) is recognized as a safe alternative to endotracheal intubation for short-term airway maintenance. In this case report we present the case of a term neonate with upper airway obstruction which was managed with a deflated LMA for 7 consecutive days. Despite previous reports of extended LMA use in neonates without complications, this patient experienced significant pharyngeal mucosal injury and edema, leading to difficulty with subsequent intubation attempts.
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Affiliation(s)
- Claudia Lorente
- Department of Anesthesiology and Pain Management, Division of Anesthesiology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edgar Kiss
- Department of Anesthesiology and Pain Management, Division of Anesthesiology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Galit Kastner
- Department of Anesthesiology and Pain Management, Division of Anesthesiology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vedanta Singh Dariya
- Department of Pediatrics, Division of Neonatology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, Division of Anesthesiology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, Division of Anesthesiology, Children's Health System of Texas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Outcome Research Consortium, Cleveland, Ohio, USA
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Kim D, Park S, Kim JM, Choi GS, Kim GS. Second generation laryngeal mask airway during laparoscopic living liver donor hepatectomy: a randomized controlled trial. Sci Rep 2021; 11:3532. [PMID: 33574495 PMCID: PMC7878811 DOI: 10.1038/s41598-021-83173-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022] Open
Abstract
The second-generation laryngeal mask airway (LMA) provides a higher sealing pressure than classical LMA and can insert the gastric drainage tube. We investigated the difference in respiratory variables according to the use of second-generation LMA and endotracheal tube (ETT) in laparoscopic living liver donor hepatectomy (LLDH). In this single-blind randomized controlled trial, intraoperative arterial carbon dioxide partial pressure at 2 h after the airway devices insertion (PaCO2_2h) was compared as a primary outcome. Participants were randomly assigned to the following groups: Group LMA (n = 45, used Protector LMA), or Group ETT (n = 43, used cuffed ETT). Intraoperative hemodynamic and respiratory variables including mean blood pressure (MBP), heart rate (HR), and peak inspiratory pressure (PIP) were compared. Postoperative sore throat, hoarseness, postoperative nausea and vomiting (PONV), and pulmonary aspiration were recorded. The PaCO2_2h were equally effective between two groups (mean difference: 0.99 mmHg, P = 0.003; 90% confidence limits: − 0.22, 2.19). The intraoperative change in MBP, HR, and PIP were differed over time between two groups (P < 0.001, P = 0.015, and P = 0.039, respectively). There were no differences of the incidence of postoperative complications at 24 h following LLDH (sore throat and hoarseness: P > 0.99, PONV: P > 0.99, and P = 0.65, respectively). No case showed pulmonary aspiration in both groups. Compared with endotracheal tube, second-generation LMA is equally efficient during LLDH. The second-generation LMA can be considered as the effective airway devices for securing airway in patients undergoing prolonged laparoscopic surgery.
Trial Registration This study was registered at the Clinical Trial Registry of Korea (https://cris.nih.go.kr. CRiS No. KCT0003711).
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sukhee Park
- Department of Anesthesiology and Pain Medicine, International St. Mary's Hospital, Catholic Kwandong University School of Medicine, Incheon, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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What should we expect in anaesthesia, critical care and pre-hospital care from extra glottic airways? Proven clinical performance for a variety of indications and patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Jannu A, Shekar A, Balakrishna R, Sudarshan H, Veena GC, Bhuvaneshwari S. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask. Arch Craniofac Surg 2017; 18:223-229. [PMID: 29349045 PMCID: PMC5759658 DOI: 10.7181/acfs.2017.18.4.223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/18/2017] [Accepted: 12/07/2017] [Indexed: 11/11/2022] Open
Abstract
The beauty of the laryngeal mask is that it forms an air tight seal enclosing the larynx rather than plugging the pharynx, and avoid airway obstruction in the oropharynx. The goal of its development was to create an intermediate form of airway management face mask and endotracheal tube. Indication for its use includes any procedure that would normally involve the use of a face mask. The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anesthetic practice. Despite wide spread use the definitive role of the laryngeal mask airway is yet to be established. In some situations, such as after failed tracheal intubation or in oral surgery its use is controversial. There are several unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoids pressure prevents placement of mask. We review the techniques of insertion, details of misplacement, and complications associated with use of the laryngeal mask. We then attempt to clarify the role of laryngeal mask in air way management during anesthesia, discussing the advantages and disadvantages as well as indications and contraindications of its use in oral and maxillofacial surgery.
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Affiliation(s)
- Anubhav Jannu
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Ashim Shekar
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Ramdas Balakrishna
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - H Sudarshan
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - G C Veena
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - S Bhuvaneshwari
- Department of Oral and Maxillofacial Surgery, Rajiv Gandhi University of Health Sciences, Bangalore, India
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Zhang ZJ, Zheng ML, Nie Y, Niu ZQ. Comparison of Arndt-endobronchial blocker plus laryngeal mask airway with left-sided double-lumen endobronchial tube in one-lung ventilation in thoracic surgery in the morbidly obese. ACTA ACUST UNITED AC 2017; 51:e6825. [PMID: 29267506 PMCID: PMC5734186 DOI: 10.1590/1414-431x20176825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the feasibility and performance of Arndt-endobronchial blocker (Arndt) combined with laryngeal mask airway (LMA) compared with left-sided double-lumen endobronchial tube (L-DLT) in morbidly obese patients in one-lung ventilation (OLV). In a prospective, randomized double-blind controlled clinical trial, 80 morbidly obese patients (ASA I-III, aged 20-70) undergoing general anesthesia for elective thoracic surgeries were randomly allocated into groups Arndt (n=40) and L-DLT (n=40). In group Arndt, a LMA™ Proseal was placed followed by an Arndt-endobronchial blocker. In group L-DLT, patients were intubated with a left-sided double-lumen endotracheal tube. Primary endpoints were the airway establishment, ease of insertion, oxygenation, lung collapse and surgical field exposure. Results showed similar ease of airway establishment and tube/device insertion between the two groups. Oxygen arterial pressure (PaO2) of patients in the Arndt group was significantly higher than L-DLT (154±46 vs 105±52 mmHg; P<0.05). Quality of lung collapse and surgical field exposure in the Arndt group was significantly better than L-DLT (effective rate 100 vs 90%; P<0.05). Duration of surgery and anesthesia were significantly shorter in the Arndt group (2.4±1.7 vs 3.1±1.8 and 2.8±1.9 vs 3.8±1.8 h, respectively; P<0.05). Incidence of hoarseness of voice and incidence and severity of throat pain at the post-anesthesia care unit and 12, 24, 48, and 72 h after surgery were significantly lower in the Arndt group (P<0.05). Findings suggested that Arndt-endobronchial blocker combined with LMA can serve as a promising alternative for morbidly obese patients in OLV in thoracic surgery.
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Affiliation(s)
- Z J Zhang
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - M L Zheng
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Y Nie
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Z Q Niu
- Department of Anesthesiology, the Cangzhou Central Hospital, Cangzhou, Hebei, China
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The effect of esophagogastroduodenoscopy probe insertion on the intracuff pressure of airway devices in children during general anesthesia. J Anesth 2016; 31:278-281. [PMID: 28004199 DOI: 10.1007/s00540-016-2297-8] [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] [Received: 08/25/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
Given the size of the esophagogastroduodenoscopy (EGD) probe and the compressibility of the pediatric airway, the EGD probe may increase the intracuff pressure (IP) of an airway device. The current study evaluated IP changes during EGD examination under general anesthesia in pediatric patients. Following the induction of anesthesia, a laryngeal mask airway (LMA) or endotracheal tube (ETT) was placed without neuromuscular blockade. The IP was measured at baseline, during EGD probe insertion, while the EGD probe was in place, and after probe removal. The study cohort included 101 patients (mean age 11.3 years). The airway was secured with an LMA and an ETT in 88 and 13 patients, respectively. The IP increased from 27 ± 15 cmH2O at baseline to 34 ± 17 cmH2O during probe insertion (p < 0.001), remained at 33 ± 16 cmH2O while the probe was in place, and decreased to 26 ± 14 cmH2O after probe removal. The IP of the LMA or ETT increased during EGD probe insertion and remained elevated while the probe was in place. High IP may compromise mucosal perfusion resulting in a sore throat when using an LMA or the potential for airway damage if an ETT is used. Removal of air from the cuff and titration of the IP should be considered after EGD insertion.
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Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine. BIOMED RESEARCH INTERNATIONAL 2015; 2015:746560. [PMID: 26783527 PMCID: PMC4691459 DOI: 10.1155/2015/746560] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.
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Affiliation(s)
- Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
- University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - William Donaldson
- Department of Anaesthetics, Antrim Area Hospital, Bush Road, Antrim BT41 4RD, UK
| | - Eliska Vobrubova
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
| | - Marek Hakl
- Department of Anaesthesia and Intensive Medicine, St. Anne University Hospital, Pekarska 53, 656 91 Brno, Czech Republic
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11
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Bick E, Bailes I, Patel A, Brain AIJ. Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care. Anaesthesia 2014; 69:1304-8. [DOI: 10.1111/anae.12902] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. Bick
- Royal National Throat Nose and Ear Hospital; London UK
| | - I. Bailes
- Royal National Throat Nose and Ear Hospital; London UK
| | - A. Patel
- Royal National Throat Nose and Ear Hospital; London UK
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Li Q, Li P, Xu J, Gu H, Ma Q, Pang L, Liang W. A novel combination of the Arndt endobronchial blocker and the laryngeal mask airway ProSeal™ provides one-lung ventilation for thoracic surgery. Exp Ther Med 2014; 8:1628-1632. [PMID: 25289071 PMCID: PMC4186338 DOI: 10.3892/etm.2014.1966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/27/2014] [Indexed: 01/01/2023] Open
Abstract
In this study, the feasibility and performance of the combination of the Arndt endobronchial blocker and the laryngeal mask airway (LMA) ProSeal™ in airway establishment, ventilation, oxygenation and lung isolation was evaluated. Fifty-five patients undergoing general anesthesia for elective thoracic surgeries were randomly allocated to group Arndt (n=26) or group double-lumen tube (DLT; n=29). Data concerning post-operative airway morbidity, ease of insertion, hemodynamics, lung collapse, ventilators, oxygenation and ventilation were collected for analysis. Compared with group DLT, group Arndt showed a significantly attenuated hemodynamic response to intubation (blood pressure, 149±31 vs. 115±16 mmHg; heart rate, 86±15 vs. 68±15 bpm), less severe injuries to the bronchus (injury score, 1.4±0.2 vs. 0.4±0.1) and vocal cords (injury score, 1.3±0.2 vs. 0.6±0.1), and lower incidences of post-operative sore throat and hoarseness. Furthermore, the novel combination of the Arndt and the LMA ProSeal showed similar ease of airway establishment, comparable ventilation and oxygenation performance, and an analogous lung isolation effect to DLT. The novel combined use of the Arndt endobronchial blocker and the LMA ProSeal can serve as a promising alternative for thoracic procedures requiring one-lung ventilation. The less traumatic properties and equally ideal lung isolation are likely to promote its use in rapidly spreading minimally invasive thoracic surgeries.
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Affiliation(s)
- Qiong Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Peiying Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Jianghui Xu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Huahua Gu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Qinyun Ma
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
| | - Weimin Liang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200042, P.R. China
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Prolonged use of the LMA Supreme™. Can J Anaesth 2013; 60:411-2. [DOI: 10.1007/s12630-013-9894-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 01/16/2013] [Indexed: 11/30/2022] Open
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Russo SG, Moerer O, Nickel EA, Goetze B, Timmermann A, Quintel M. [Extraglottic airway devices in the intensive care unit]. Anaesthesist 2010; 59:555-63. [PMID: 20502847 DOI: 10.1007/s00101-010-1728-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extraglottic airway devices (EGA) are not only used in routine anaesthesia practice, they also have a distinct value for in-hospital and out-of-hospital difficult airway management. In the environment of the intensive care unit (ICU) EGA are not used on a regular basis. However, expertise and knowledge regarding EGA coming from the operating theatre or the out-of-hospital setting may also be of value for the ICU setting. This review presents the potential indications for EGA on the ICU for the management of difficult airway situations as well as during percutaneous tracheotomy. Furthermore, the possible advantages of EGA during postoperative recovery from anaesthesia as well as termination of controlled ventilation for intensive care patients are discussed.
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Affiliation(s)
- S G Russo
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Deutschland.
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Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. Eur J Anaesthesiol 2009; 26:1010-4. [DOI: 10.1097/eja.0b013e3283313fdd] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Micaglio M, Bonato R, De Nardin M, Parotto M, Trevisanuto D, Zanardo V, Doglioni N, Ori C. Prospective, randomized comparison of ProSealTM and ClassicTM laryngeal mask airways in anaesthetized neonates and infants. Br J Anaesth 2009; 103:263-7. [DOI: 10.1093/bja/aep106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fabregat-López J, Garcia-Rojo B, Sanchez-Ferragut E, Cook TM. Use of a ProSeal laryngeal mask airway for eight hours of unplanned abdominal surgery. Can J Anaesth 2009; 56:625-6. [PMID: 19455381 DOI: 10.1007/s12630-009-9114-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022] Open
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ProSeal LMA — how long is too long? Can J Anaesth 2007; 54:786-9. [DOI: 10.1007/bf03021705] [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] Open
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