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Zheng Z, Liang X, Li J, Li Y, Bi L, Sun W, Hu Z, Song J, Zhou Q, Li H. A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study. J Clin Anesth 2024; 98:111590. [PMID: 39178493 DOI: 10.1016/j.jclinane.2024.111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/06/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND The video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. METHODS One hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. RESULTS The first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. CONCLUSIONS The new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. TRIAL REGISTRATION Chinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).
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Affiliation(s)
- Zhihao Zheng
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China
| | - Xiaodong Liang
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China; Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Jinrui Li
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China
| | - Ying Li
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China
| | - Liwei Bi
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Wei Sun
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Zhanfei Hu
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Jiannan Song
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China; Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Qi Zhou
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China; Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Haibo Li
- Affiliated Chifeng Clinical Medical College of Inner Mongolia Medical University, Chifeng, Inner Mongolia, China; Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China.
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Herrera K, Tufail B, Osborn I. Innovative (and Safe) Techniques With Supraglottic Airways. Int Anesthesiol Clin 2024; 62:91-100. [PMID: 39233575 DOI: 10.1097/aia.0000000000000457] [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: 09/06/2024]
Abstract
ABSTRACT Supraglottic airways have been utilized as an alternative to facemask ventilation and endotracheal intubation and thus have been essential to airway management since their introduction in the late 1980s. This chapter describes basic considerations in their use and an update on current clinical practice, with an emphasis on safe management. The devices have evolved to meet today's clinical airway challenges, and they provide benefits for patients and practitioners.
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Affiliation(s)
- Katherine Herrera
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Bilal Tufail
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Irene Osborn
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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van Zundert AAJ, Gatt SP, van Zundert TCRV, Hagberg CA, Pandit JJ. A New Scoring System to Evaluate the Position and Functioning of Supraglottic Airway Devices in Research and Clinical Audits. Anesth Analg 2024:00000539-990000000-00940. [PMID: 39269690 DOI: 10.1213/ane.0000000000006970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Affiliation(s)
- André A J van Zundert
- From the Department of Anaesthesia & Perioperative Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen P Gatt
- Discipline of Anaesthesia, Critical Care & Emergency Medicine, Department of Anaesthesia, University of New South Wales, Kensington, New South Wales, Australia
- Department of Anaesthesia, Udayana University, Bali, Indonesia
| | | | - Carin A Hagberg
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston Texas
| | - Jaideep J Pandit
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, The University of Oxford, Oxford, United Kingdom
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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van Zundert AAJ, Gatt SP, van Zundert TCRV, Hagberg CA, Pandit JJ. Supraglottic Airway Devices: Present State and Outlook for 2050. Anesth Analg 2024; 138:337-349. [PMID: 38215712 DOI: 10.1213/ane.0000000000006673] [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: 01/14/2024]
Abstract
Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents. A close match is needed between the shape and profile of SGDs and the laryngeal inlet. An adequate first seal (with the respiratory tract) and a good fit at the second seal of the distal cuff and the gastrointestinal tract are most desirable. Vision-guided insertion techniques are ideal and should be the way forward. This article recommends the use of third-generation vision-incorporated-video SGDs, which allow for direct visualization of the insertion process, corrective maneuvers, and, when necessary, insertion of a nasogastric tube (NGT) and/or endotracheal tube (ETT) intubation. A videoscope embedded within the SGD allows a visual check of the glottis opening and position of the epiglottis. This design affords the benefit of confirming and/or correcting a SGD's position in the midline and rotation in the sagittal plane. The first clinically available video laryngeal mask airways (VLMAs) and multiple prototypes are being tested and used in anesthesia. Existing VLMAs are still not perfect, and further improvements are recommended. Additional modifications in multicamera technology, to obtain a panoramic view of the SGD sitting correctly in the hypopharynx and to prove that correct sizes have been used, are in the process of production. Ultimately, any device inserted orally-SGD, ETT, NGT, temperature probe, transesophageal scope, neural integrity monitor (NIM) tubes-could benefit from correct vision-guided positioning. VLMAs also allow for automatic recording, which can be documented in clinical records of patients, and could be valuable during teaching and research, with potential value in case of legal defence (with an airway incident). If difficulties occur with the airway, documentation in the patient's file may help future anesthesiologists to better understand the real-time problems. Both manufacturers and designers of SGDs may learn from optimally positioned SGDs to improve the design of these airway devices.
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Affiliation(s)
- André A J van Zundert
- From the Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, & The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen P Gatt
- Department of Anaesthesia, University of New South Wales, Kensington, New South Wales, Australia
- Department of anaesthesia, Udayana University, Bali, Indonesia
| | | | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaideep J Pandit
- Department of Anaesthesia, University of Oxford, Oxford, United Kingdom
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Sun Y, Zhang M, Gao X, Gao Z, Zou T, Guo Y, Liu M, Chen L, Zhang X, Liu Y, Feng H, Wang Y. Effect of the new video laryngeal mask airway SaCoVLM on airway management in lateral laparoscopic urological surgery: A single center randomized controlled trial. Sci Rep 2024; 14:2132. [PMID: 38272937 PMCID: PMC10810894 DOI: 10.1038/s41598-024-51856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
There are few pertinent studies about the application of laryngeal mask airways (LMAs) in lateral decubitus surgery. Therefore, the aim of our study was to evaluate the effects of lateral position and pneumoperitoneum on oropharyngeal leak pressure (OLP) and ventilation efficiency for the LMA SaCoVLM. Patients undergoing elective retroperitoneal laparoscopic urological surgery were randomized 1:1 to the Supreme group or SaCoVLM group. The primary outcome was the OLP with LMA insertion. The secondary outcomes were the first-attempt success rate, insertion time, adjustment times, gastric tube success rate, LMA alignment accuracy, LMA removal time, regurgitation or aspiration, LMA blood staining, and incidence of adverse events 24 h after surgery. We recruited 70 patients to complete the study. Regardless of lateral position and pneumoperitoneum, the OLP was greater in the SaCoVLM group (n = 35) than in the Supreme group (n = 35), with a median difference of 4-7 cmH2O. The first-attempt success rate of the SaCoVLM group was higher than that of the Supreme group (91.4% vs. 77.1%, risk ratio (RR): 1.19; 95% CI 0.96 to 1.46, P = 0.188). Thus, in the lateral position with pneumoperitoneum, although the new video LMA SaCoVLM has a higher OLP than the LMA Supreme, both devices provide sufficient ventilation efficiency.
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Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China.
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Zhongquan Gao
- Department of Anesthesiology, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China
| | - Ting Zou
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250014, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Hai Feng
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Yuelan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, 250014, China.
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250014, China.
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Gaszyński T, Gómez-Ríos MÁ, Serrano-Moraza A, Sastre JA, López T, Ratajczyk P. New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review. Healthcare (Basel) 2023; 11:2468. [PMID: 37761667 PMCID: PMC10650429 DOI: 10.3390/healthcare11182468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.
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Affiliation(s)
- Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | - Manuel Ángel Gómez-Ríos
- Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain;
| | | | - José Alfonso Sastre
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Teresa López
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
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Kumar R, Bihani P, Mohammed S, Syal R, Bhatia P, Jaju R. Comparison of Clinical Performance of C-MAC Video Laryngoscope Guided vs Blind Placement of I-Gel® in Paediatric Patients: A Randomized Controlled Open-Label Trial. Turk J Anaesthesiol Reanim 2023; 51:347-353. [PMID: 37587678 PMCID: PMC10440480 DOI: 10.4274/tjar.2023.221010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/09/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Placement of the supraglottic airway devices under direct vision has been shown to decrease the incidence of malposition in adults. This study was designed to compare the clinical performance of C-MAC guided and blind placement of i-gel® in paediatric patients. Methods The present prospective, randomized controlled study was conducted on 102 paediatric patients scheduled to undergo elective infraumbilical surgeries under general anaesthesia. Patients were randomly divided into group "B" (blind) and group "C" (C-MAC) based on the technique used for placement of i-gel®. The primary objective of the study was to compare the incidence of malposition based on the fiberoptic bronchoscope (FOB) score of the glottic view. Oropharyngeal leak pressure (OPLP), hemodynamic parameters, and insertion characteristics (time taken to insert and the number of attempts) were secondary objectives. Categorical data were presented as ratio or percentage and continuous data were presented as mean ± standard deviation or median [95% confidence interval (CI)]. Results The incidence of malposition (Brimacombe score 1 or 2) was significantly lower in group C compared to group B (7.8% vs 49% respectively) (P < 0.001); implying a relative risk reduction of 2.42 (95% CI 1.72 to 3.40) with C-MAC. On FOB assessment, the median (interquartile range) Brimacombe score was significantly better in group C [4 (4-4)] compared to group B [3 (2-3)] (P < 0.001). The OPLP was significantly higher in group C compared to group B. Other insertion characteristics were comparable in both the study groups. Conclusion Compared to blind placement, C-MAC guided placement ensures proper alignment of i-gel® with periglottic structures and proper functioning of i-gel®.
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Affiliation(s)
- Rakesh Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Pooja Bihani
- Department of Anaesthesiology, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Sadik Mohammed
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Rashmi Syal
- Department of Anaesthesiology, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Rishabh Jaju
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Deoghar, India
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Castillo-Monzón CG, Gaszyński T, Marroquín-Valz HA, Orozco-Montes J, Ratajczyk P. Supraglottic Airway Devices with Vision Guided Systems: Third Generation of Supraglottic Airway Devices. J Clin Med 2023; 12:5197. [PMID: 37629238 PMCID: PMC10455808 DOI: 10.3390/jcm12165197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Supraglottic airway devices are currently widely used for airway management both for anaesthesia and emergency medicine. First-generation SADs only had a ventilation channel and did not provide protection from possible aspiration of gastric content if regurgitation occurred. Second-generation SADs are equipped with a gastric channel to allow the insertion of a gastric catheter and suctioning of gastric content. Additionally, the seal was improved by a change in the shape of the cuff. Some second-generation SADs were also designed to allow for intubation through the lumen using fiberscopes. Although the safety and efficacy of use of SADs are very high, there are still some issues in terms of providing an adequate seal and protection from possible complications related to misplacement of SAD. New SADs which allow users to choose the insertion scope and control the position of SAD can overcome those problems. Additionally, the Video Laryngeal Mask Airway may serve as an endotracheal intubation device, offering a good alternative to fibre-optic intubation through second-generation SADs. In this narrative review, we provide knowledge of the use of video laryngeal mask airways and the possible advantages of introducing them into daily clinical practice.
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Affiliation(s)
- Caridad G. Castillo-Monzón
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | | | - Javier Orozco-Montes
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
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Kundra P, Vinayagam S. Supraglottic airway devices: Standard airway management tool, but still not without concerns. Indian J Anaesth 2023; 67:483-485. [PMID: 37476435 PMCID: PMC10355365 DOI: 10.4103/ija.ija_420_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - Stalin Vinayagam
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
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11
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Yan CL, Zhang YQY, Chen Y, Qv ZY, Zuo MZ. To compare the influence of blind insertion and up-down optimized glottic exposure manoeuvre on oropharyngeal leak pressure using SaCoVLM™ video laryngeal mask among patients undergoing general anesthesia. J Clin Monit Comput 2023; 37:593-598. [PMID: 36308611 PMCID: PMC10068663 DOI: 10.1007/s10877-022-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/06/2022] [Indexed: 10/31/2022]
Abstract
To compare the potential influences of blind insertion and up-down optimized glottic exposure manoeuvre on the oropharyngeal leak pressure (OPLP) in using SaCoVLM™ video laryngeal mask (VLM) among patients undergoing general anesthesia. A randomized self-control study controlled was conducted to investigate the effect of two insertion techniques on OPLP. A total of 60 patients (male or female, 18-78 years, BMI 18.0-30.0 kg m-2 and ASA I-II) receiving selective surgery under general anesthesia were randomly recruited. After induction of anesthesia, the SaCoVLM™ was inserted by blind insertion manoeuvre. The glottic exposure grading(V1) of the SaCoVLM™ visual laryngeal mask and the OPLP(P1) were recorded. And the glottic exposure grading(V2) and OPLP(P2) of SaCoVLM™ were recorded again when the glottic exposure grading was optimal. The glottis exposure grading and OPLP were compared before and after different insertion manoeuver. The glottic exposure grading (V2) obtained by using up-down optimized glottic exposure manoeuvre was better than that obtained by using blind insertion manoeuvre (V1)(P < 0.001). The OPLP was significantly lower in the blind insertion manoeuvre (P1) than in the up-down optimized glottic exposure manoeuvre (P2) (32.4 ± 5.0 cmH2O vs. 36.3 ± 5.2 cmH2O, P < 0.001). In using SaCoVLM™, higher OPLP and better glottic exposure grading were achieved through up-down optimized glottic exposure manoeuvre, protecting the airway while real-time monitoring of conditions around the glottis, which significantly improves airway safety. Our results suggests that up-down optimized glottic exposure manoeuver may be a useful technique for SaCoVLM™ insertion.Trial registration: ChiCTR, ChiCTR2000028802. Registered 4 January 2020, http://www.chictr.org.cn/ChiCTR2000028802.
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Affiliation(s)
- Chun-ling Yan
- Department of Anesthesia, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yi-qi-yuan Zhang
- Department of Anesthesia, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ying Chen
- Department of Anesthesia, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Zong-yang Qv
- Department of Anesthesia, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ming-zhang Zuo
- Department of Anesthesia, Institute of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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12
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Gaszynski T. New vision-incorporated third-generation video laryngeal mask airways for intubation of patients in prone position. J Clin Monit Comput 2023; 37:705-707. [PMID: 36929275 PMCID: PMC10068630 DOI: 10.1007/s10877-022-00925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Tomasz Gaszynski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland.
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13
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Ní Eochagáin A, Athanassoglou V, Cumberworth A, Morris O, Corbett S, Jefferson H, O'Sullivan EP, Pandit JJ. Assessing a novel second generation laryngeal mask airway using the 'ADEPT' approach: results from the LMA® Protector™ observational study. J Clin Monit Comput 2023; 37:517-524. [PMID: 36063277 PMCID: PMC9441326 DOI: 10.1007/s10877-022-00910-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
To address the problem of lack of clinical evidence for airway devices introduced to the market, the Difficult Airway Society (UK) developed an approach (termed ADEPT; Airway Device Evaluation Project Team) to standardise the model for device evaluation. Under this framework we assessed the LMA Protector, a second generation laryngeal mask airway. A total of 111 sequential adult patients were recruited and the LMA Protector inserted after induction of general anaesthesia. Effective insertion was confirmed by resistance to further distal movement, manual ventilation, and listening for gas leakage at the mouth. The breathing circuit was connected to the airway channel and airway patency confirmed with manual test ventilation at 20 cm H20 (water) pressure for 3 s. Data was collected in relation to the time for placement, intraoperative performance and postoperative performance of the airway device. Additionally, investigators rated the ease of insertion and adequacy of lung ventilation on a 5-point scale. The median (interquartile range [range]) time taken to insertion of the device was 31 (26-40[14-780]) s with the ability to ventilate after device insertion 100 (95% CI 96.7- 100)%. Secondary endpoints included one or more manoeuvres 60.3 (95% CI 50.6-69.5)% cases requiring to assist insertion; a median ease of insertion score of 4 (2-5[3-5]), and a median adequacy of ventilation score of 5 (5-5[4-5]). However, the first time insertion rate failure was 9.9% (95% CI 5.1-17.0%). There were no episodes of patient harm recorded, particularly desaturation. The LMA Protector appears suitable for clinical use, but an accompanying article discusses our reflections on the ADEPT approach to studying airway devices from a strategic perspective.
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Affiliation(s)
- A Ní Eochagáin
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - V Athanassoglou
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Cumberworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - O Morris
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - S Corbett
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - H Jefferson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E P O'Sullivan
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - J J Pandit
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- University of Oxford, Oxford, UK.
- St John's College, Oxford, OX1 3JP, UK.
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14
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Van Zundert TCRV, Gatt SP, Van Zundert AAJ. Videolaryngeal mask airway - a new monitor in airway management. J Clin Monit Comput 2023; 37:717-721. [PMID: 36929276 DOI: 10.1007/s10877-022-00926-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Tom C R V Van Zundert
- Department of Emergency Medicine, Holy Heart Hospital, Mol, Belgium.
- Udayana University, Bali, Indonesia.
| | - Stephen P Gatt
- Udayana University, Bali, Indonesia
- University of New South Wales, Kensington, NSW, Australia
| | - André A J Van Zundert
- Udayana University, Bali, Indonesia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD, Australia
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15
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Zhi J, Deng XM, Zhang YM, Wei LX, Wang QY, Yang D. Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children. BMC Anesthesiol 2023; 23:49. [PMID: 36755214 PMCID: PMC9906825 DOI: 10.1186/s12871-023-01996-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUNDS To preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children. METHODS One hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation. RESULTS The first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04-1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03-1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia. CONCLUSION The SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management. TRIAL REGISTRATION This study was approved by the University's Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn . Principal investigator: Juan Zhi; Date of registration: 26/06/2022.
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Affiliation(s)
- Juan Zhi
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144 China
| | - Xiao-Ming Deng
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| | - Yan-Ming Zhang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144 China
| | - Ling-Xin Wei
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144 China
| | - Qian-Yu Wang
- grid.506261.60000 0001 0706 7839Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144 China
| | - Dong Yang
- Department of Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Plastic Surgery Hospital and Institute, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
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16
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Bidaye S, Sommerville A, Straker T. When is it Safe to Use a Supraglottic Airway Device? Advanced Uses for SGA Devices. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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Zhi J, Yan FX, Wei LX, Yang D, Deng XM. Intubation using video laryngeal mask airway SaCoVLM and laryngeal mask airway Ambu® Aura-i in anesthetized children with microtia: a randomized controlled study. J Clin Monit Comput 2022; 37:857-865. [PMID: 36550347 DOI: 10.1007/s10877-022-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
The Ambu Aura-i laryngeal mask is considered to be a device for blind intubation as well as for fiberoptic guided intubation. The novel video laryngeal airway mask SaCoVLM is a supraglottic airway device that allows intubation under direct vision. We hypothesized that success rates for device placement and tracheal intubation with the SaCoVLM would be comparable with the Ambu Aura-i mask. A prospective, randomized clinical trial was conducted from March 2021 to December 2021. One hundred and twenty patients were enrolled and randomized in the study. Direct intubation was performed with the SaCoVLM, and fiberoptic guided intubation was performed with the Ambu Aura-i mask. The primary outcome measure was the first success rate of LMA placement. Secondary outcome measures were the time from device placement and time from endotracheal intubation (as well as the time for LMA removal after successful intubation), differences in airway leak pressure, fiberoptic grade of the laryngeal view, and incidence of blood staining. The first success rate of LMA placement was similar for the two devices. There was no difference in the time for successful endotracheal intubation between the Ambu Aura-i and SaCoVLM groups (24.1 s ± 6.3 versus 25.7 s ± 2.1; p > 0.05). The time for removal was slower in the SaCoVLM group than in the Ambu Aura-i group (20.8 s ± 0.8 versus 14.7 s ± 6.1; p < 0.01). The airway leak pressure was higher in the SaCoVLM group than in the Ambu Aura-i group (27.0 s ± 1.0 versus 22.3 s ± 3.6; p < 0.01), and the incidence of blood staining was higher in the SaCoVLM group (16.7%). The SaCoVLM has an overall comparable performance to the Ambu Aura-i mask. However, the SaCoVLM is better relative to direct intubation without the assistance of a flexible intubation scope, which reduces the device's demand.
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Affiliation(s)
- Juan Zhi
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Fu-Xia Yan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North-li-shi Rd, Xicheng District, Beijing, 100037, China
| | - Ling-Xin Wei
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| | - Xiao-Ming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
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18
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Gao Z, Guo Y, Gao X, Wang W, Zhang M, Liu MJ, Chen L, Liu Y, Zhang X, Sun Y, Wang Y. Comparison of a polyvinyl chloride tube with a wire-reinforced tube for tracheal intubation through the SaCoVLM video laryngeal mask airway: protocol for a randomised controlled study. BMJ Open 2022; 12:e066084. [PMID: 36517088 PMCID: PMC9756190 DOI: 10.1136/bmjopen-2022-066084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The SaCoVLM is a new type of video intubating laryngeal mask airway (LMA), and it is the first LMA to realise continuous visual monitoring. There is a lack of studies on intubation using the SaCoVLM. The aim of this study is to compare the success rate of intubation with polyvinyl chloride (PVC) tubes and wire-reinforced (WR) tubes using the SaCoVLM. METHODS AND ANALYSIS This prospective, single-centre, single-blind, parallel-arm, randomised controlled study will be conducted in a tertiary university hospital in China. We will include 104 patients undergoing elective laparoscopic surgery under general anaesthesia. Patients will be randomly assigned to the PVC tracheal tube group (n=52, PVC group) or the WR tracheal tube group (n=52, WR group). The primary outcome is the total success rate of intubation. The secondary outcomes are the first success rate of intubation, the time of tracheal intubation, the site of the first contact, the adjustment action for tracheal intubation, haemodynamic fluctuation during intubation and extubation, incidence of trauma as evidenced by blood, and the incidence rates of postoperative sore throat, hoarseness, and dysphagia. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the First Affiliated Hospital of Shandong First Medical University (YXLL-KY-2022 (008)). All participants will provide written informed consent. The results will be disseminated through peer-reviewed publications and at conferences or congresses. TRIAL REGISTRATION NUMBER NCT05338827.
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Affiliation(s)
- Zhongquan Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Weiwei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Meng Jie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
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19
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Gasteiger L, Hornung R, Woyke S, Hoerner E, Neururer S, Moser B. Evaluation of the New Singularity TM Air versus Ambu ® Aura Gain TM: A Randomized, Crossover Mannequin Study. J Clin Med 2022; 11:jcm11247266. [PMID: 36555884 PMCID: PMC9787694 DOI: 10.3390/jcm11247266] [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] [Received: 10/31/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background: This randomised crossover mannequin study aimed to compare the insertion time for the newly developed SingularityTM Air and the Ambu® AuraGainTM. The SingularityTM Air includes a bendable tube in order to allow optimal passform. Methods: Fifty anaesthetists with a minimum of 100 supraglottic airway device insertions were recruited and randomly assigned to start either with the SingularityTM Air or with the Ambu® AuraGainTM. Participants watched a tutorial video the day before the assessment and received a standardized introduction immediately before the assessment. The primary outcome was the time for successful insertion. Secondary parameters were the overall insertion success rate, the numbers of insertion attempts (maximum three), the glottic view through a flexible bronchoscope, and the success rate for gastric tube insertion. Results: Fifty participants were eventually recruited and randomly assigned to insert both devices according to the randomization. The insertion time was 24 s for SingularityTM Air as compared to 20 s for Ambu® AuraGainTM (p < 0.001). Overall insertion rate was 92% for the SingularityTM Air as compared to 100% for the Ambu® AuraGainTM (p could not be derived as one variable is a constant). The primary insertion success rate was better for the Ambu® AuraGainTM than for the SingularityTM Air (94% versus 68%; p: 0.002, respectively). Conclusion: The time for successful insertion and the insertion success rate for the newly developed SingularityTM Air is inferior to that for the Ambu® AuraGainTM.
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Affiliation(s)
- Lukas Gasteiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Rouven Hornung
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Simon Woyke
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elisabeth Hoerner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence: ; Tel.: +43-512-504-22400
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, 6020 Innsbruck, Austria
| | - Berthold Moser
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Anaesthesiology and Intensive Care Medicine, See-Spital Horgen, 8810 Horgen, Switzerland
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20
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Vasconcelos Pereira A, Simões AV, Rego L, Pereira JG. New technologies in airway management: A review. Medicine (Baltimore) 2022; 101:e32084. [PMID: 36482552 PMCID: PMC9726337 DOI: 10.1097/md.0000000000032084] [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] [Indexed: 12/13/2022] Open
Abstract
The evolution of medical knowledge and technological growth have contributed to the development of different techniques and devices for airway management. These appear to play a role in optimizing the number of attempts and overall success, ultimately reducing the negative consequences of airway manipulation. In this literature review, we highlight the recent evidence regarding new technologies applied to airway management. Before intubation, every patient should have an individualized structured airway management plan. Technology can help with both airway evaluation and tracheal intubation. Point-of-care cervical ultrasound and artificial intelligence models with automated facial analysis have been used to predict difficult airways. Various devices can be used in airway management. This includes a robotic video endoscope that guides intubation based on real image recognition, a laryngeal mask with a non-inflatable cuff that tries to reduce local complications, video laryngeal masks that are able to confirm the correct position and facilitate intubation, Viescope™, a videolaryngoscope developed for combat medicine with a unique circular blade, a system that uses cervical transillumination for glottis identification in difficult airways and Vivasight SL™ tracheal tube, which has a high-resolution camera at its tip guaranteeing visual assurance of tube position as well as guiding bronchial blocker position. To conclude, we detailed the challenges in airway management outside the operating room as well as described suction-assisted laryngoscopy and airway decontamination technique for contaminated airways. Further research in the clinical setting is recommended to better support the use of these technologies.
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Affiliation(s)
- Ana Vasconcelos Pereira
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
- * Correspondence: Ana Vasconcelos Pereira, Department of Anesthesiology, Hospital Vila Franca de Xira, Estrada Carlos Lima Costa Nº 2, Povos 2600-009 - Vila Franca DE Xira, Portugal (e-mail: )
| | - André Vicente Simões
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - Luísa Rego
- Anesthesiology Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
| | - João Gonçalves Pereira
- Intensive Care Department, Hospital de Vila Franca de Xira, Vila Franca DE Xira, Portugal
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21
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Tan LZ, Seet E, Kumar CM. Besdata Video Laryngeal Mask (BD-VLM)- a New Vision-Incorporated 3rd Generation Video Laryngeal Mask Airway : Dear editor. J Clin Monit Comput 2022; 36:1907-1908. [PMID: 35616796 DOI: 10.1007/s10877-022-00850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
Since the recent editorial 2, we were approached to evaluate another video laryngeal mask airway - the Besdata Video Laryngeal Mask (BD-VLM) TM, which has a different design concept, specifications and characteristics (Figure 1) compared to the other two.
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Affiliation(s)
- Leng Zoo Tan
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Edwin Seet
- Department of Anaesthesia, National University of Singapore, Yong Loo Lin School of Medicine, Yishun, Singapore
| | - Chandra M Kumar
- Newcastle University Medical School, Nusajaya, Johor, Malaysia.
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22
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Gómez-Ríos MÁ, López T, Sastre JA, Gaszyński T, Van Zundert AAJ. Video laryngeal masks in airway management. Expert Rev Med Devices 2022; 19:847-858. [DOI: 10.1080/17434440.2022.2142558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Manuel Á. Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, Galicia, Spain
| | - Teresa López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - José Alfonso Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy Medical University of Lodz, Poland
| | - André A. J. Van Zundert
- Professor & Chairman Discipline of Anesthesiology, The University of Queensland
- Faculty of Medicine & Biomedical Sciences, Brisbane, QLD, Australia
- Chair, University of Queensland Burns, Trauma & Critical Care Research Centre
- Chair, RBWH/University of Queensland Centre for Excellence & Innovation in Anaesthesia
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Yoo JY, Kwak HJ, Ha EJ, Min SK, Kim JY. Comparison of McGrath videolaryngoscope-assisted insertion versus standard blind technique for flexible laryngeal mask airway insertion in adults. Singapore Med J 2022; 63:342-344. [DOI: 10.11622/smedj.2022080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Simsek T, Saracoglu A, Sezen O, Cakmak G, Saracoglu KT. Blind vs. video-laryngoscope-guided laryngeal mask insertion: A prospective randomized comparison of oropharyngeal leak pressure and fiberoptic grading. J Clin Monit Comput 2022; 36:1249-1255. [PMID: 35616795 DOI: 10.1007/s10877-022-00841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Laryngeal Mask Airway (LMA) insertion may not always be smooth without complications. Controversial results of several studies evaluating ideal insertion conditions have been published. This study compared the oropharyngeal leak pressure values and fiberoptic grading scores between blind and video-laryngoscope-guided LMA insertion. METHODS Patients were randomly assigned into blind insertion (n = 50) and video-laryngoscope guided insertion (n = 50) groups. The oropharyngeal leak pressure, peak airway pressure, fiberoptic grading score, first attempt success rate, hemodynamic parameters, and complications were recorded. RESULTS All laryngeal mask airways were successfully inserted in both groups at the first attempt. The fiberoptic staging scores were: grade 1 in 8.2% of patients, grade 2 in 24.4% of patients, grade 3 in 44.8% of patients, grade 4 in 22.4% of patients in the control group. On the other hand, grade 1 in 2.2% of patients, grade 2 in 28.6% of patients, grade 3 in 51% of patients, grade 4 in 8.2% of patients in the VL group (p = 0.260). The peak airway pressure and LMA insertion time were similar between groups. However, the oropharyngeal leak pressure before extubation was significantly higher in the video-laryngoscope-guided insertion than blind insertion (36.29 ± 7.09 vs. 33.79 ± 8.84 cmH2O respectively, p = 0.04). CONCLUSIONS The findings of our study suggest that the video-laryngoscope-guided LMA-Classic insertion with a standard blade technique may be a helpful alternative to blind insertion.
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Affiliation(s)
- Tahsin Simsek
- Department of Anesthesiology and Intensive Care, Health University Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey
| | - Ozlem Sezen
- Department of Anesthesiology and Intensive Care, Health University Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Gul Cakmak
- Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul, Turkey.
| | - Kemal Tolga Saracoglu
- Department of Anesthesiology and Intensive Care, Health University Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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What is new in airway management. J Clin Monit Comput 2022; 36:301-304. [PMID: 35262837 PMCID: PMC8904714 DOI: 10.1007/s10877-022-00839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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Features of new vision-incorporated third-generation video laryngeal mask airways. J Clin Monit Comput 2021; 36:921-928. [PMID: 34919170 DOI: 10.1007/s10877-021-00780-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. Both devices are made up of two interlocking components-the SAD and a videoscope. The 3rd generation, direct vision SADs allow vision-guided insertion, corrective manoeuvres, if needed, and correct placement in the hypopharynx and possess additional features which permit insertion of a gastric tube and endotracheal intubation should the need arise. This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLMTM, UE Medical®) and the SafeLM® Video Laryngeal Mask System (SafeLMTM VLMS, Magill Medical Technology®) consist of two parts: (a) a disposable 2nd generation SAD with a silicone cuff and an anatomically curved tube; and (b) a reusable patient-isolated videoscope and monitoring screen, with the flexible scope located into a specially-designed, blind-end channel terminating in the bowl of the SAD, preventing the videoscope from contacting patient body fluids in the SAD bowl. Third generation placement-under-direct-vision supraglottic airway devices possess several theoretical safety and ease of use advantages which now need to be validated in clinical use.
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