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Chaki T, Tachibana S, Kumita S, Sato S, Hirahata T, Ikeshima Y, Ohsaki Y, Yamakage M. I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel. Sci Rep 2023; 13:18381. [PMID: 37884591 PMCID: PMC10603072 DOI: 10.1038/s41598-023-45631-0] [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: 06/30/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4-39.0) s, vs standard i-gel: 54.7 (29.6-135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0-105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.
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Affiliation(s)
- Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sho Kumita
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Sato
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoki Hirahata
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuta Ikeshima
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Ohsaki
- Department of Anatomy (I), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Schmucker Agudelo E, Farré Pinilla M, Andreu Riobello E, Franco Castanys T, Villaverde Castillo I, Monclus Diaz E, Aragonés Panadés N, Muñoz Luz A. An update in paediatric airway management. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:472-486. [PMID: 36096882 DOI: 10.1016/j.redare.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Schmucker Agudelo
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain.
| | | | - E Andreu Riobello
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain
| | | | | | | | | | - A Muñoz Luz
- Hospital Universitario Dr. Josep Trueta, Girona, Spain
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3
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Pandey RK, Sharma A, Garg R, Depal V, Punj J, Darlong V, Sinha R, Baidya DK, Subramanian R. Air-Q ILA as a conduit for orotracheal intubation in children: A randomized control trial for comparison between supine and lateral patient positions. J Anaesthesiol Clin Pharmacol 2022; 38:480-486. [PMID: 36505210 PMCID: PMC9728458 DOI: 10.4103/joacp.joacp_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/19/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Airway management in children is always challenging and becomes a concern if required in the lateral position. We evaluated the efficacy of orotracheal intubation using the Air-Q intubating laryngeal Airway (Air-Q ILA) in supine and lateral positions in children. Material and Methods This study included 100 children weighing 7-30 kg, scheduled for elective surgeries under general anesthesia. They were randomized into the supine (S) group or lateral (L) group. After anesthesia induction, the child was placed in a standard sniffing position for conventional laryngoscopy in the S group, and the child was turned into the lateral position in the L group. Both Air-Q ILA and endotracheal tube were placed blindly in the supine position in the S group and lateral position in group L. The grading of glottic view, success rate, insertion time of the Air-Q ILA, and endotracheal intubation were noted in both the groups. Results The Air-Q ILA was successfully placed at the first attempt in 47 children in group S and 48 in group L. The overall blind orotracheal intubations, including first and second attempts, were successful in 45 children in the S group and 47 in the L group (P = 0.715). Eighty percent of patients in group L and 70% in group S had glottis grade 1 or 2 compared to grade 3, 4,5 (P = 0.249). The mean time of Air-Q ILA placement in groups S and L was 15.73 ± 5.64 s and 14.42 ± 4.16 s (P = 0.195). The mean duration of blind endotracheal intubation through the Air-Q ILA was 24.88 ± 14.75 s in group S and 17.57 ± 5.35 s in group L (P = 0.002). In both the groups, none of the children had bronchospasm, laryngospasm, desaturation, or aspiration. The airway trauma evident by blood staining on the Air-Q ILA on removal was revealed in 2 cases in group S, and 3 cases in group L. None of the children in group S and 4 children in group L had postoperative stridor. Postoperative hoarseness was reported in 3 children in group S and none in group L within 24 hours. Conclusion The Air-Q ILA can be used as a conduit for blind orotracheal intubation in children in both supine and lateral positions while maintaining an effective airway seal.
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Affiliation(s)
- Ravinder K. Pandey
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India,Address for correspondence: Prof. Ravinder K. Pandey, Department of Anaesthesiology, Pain Medicine and Critical Care, Room No. 5016, 5th Floor Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Ankur Sharma
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Rakesh Garg
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vini Depal
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jyotsna Punj
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - V Darlong
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Renu Sinha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Dalim K. Baidya
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Rajkumar Subramanian
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Wahba RM, Ragaei MZ, Metry AA, Nakhla GM. Supraglottic Airway Devices for Elective Pediatric Anesthesia: I-gel versus Air-Q, Which is the Best? Anesth Essays Res 2021; 14:461-466. [PMID: 34092859 PMCID: PMC8159035 DOI: 10.4103/aer.aer_107_20] [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: 12/08/2020] [Revised: 01/01/2021] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: The objectives of the study were to compare the insertion facility, the effect on hemodynamic parameters, and effective ventilation using I-gel versus Air-Q supraglottic airway devices (SADs) for pediatric patients undergoing short-duration surgical procedures. Patients and Methods: One hundred and fifty children aged 3–10 years were randomly divided into two equal groups: Group I received I-gel and Group Q received Air-Q SAD. All patients were anesthetized by sevoflurane inhalation using a face mask without neuromuscular blockade. Study outcomes included SAD insertion success rate (SR), insertion time, anatomic alignment of the SAD to the larynx as judged using fiberoptic bronchoscope (FOB) inserted through the SAD, and tidal volume leak, and incidence of postoperative complications. Results: Total and first attempt SRs were 97.3% and 85.3% for I-gel and 94.7% and 82.7% respectively, for Air-Q with nonsignificant differences. However, I-gel insertion time (12.3 ± 3.6 s.) was significantly (P = 0.034) shorter than Air-Q (13.7 ± 4.2 s). FOB grading of laryngeal view through SAD was better with I-gel but without significant difference for patients who had view Grades 1-2. Percentage of tidal volume loss was significantly decreased at 5 min after insertion than immediately after insertion, in all patients, with a nonsignificant difference in favor of I-gel. Intraoperative hemodynamic changes and postoperative complications showed a nonsignificant difference between both the groups. Conclusion: Both Air-Q and I-gel SAD provided advantages for pediatric anesthesia during short-duration surgical procedure with nonsignificant differences. However, I-gel SAD required a shorter insertion time and provided a high SR which is satisfactory for trainees and during an emergency. I-gel SAD allowed minimization of tidal volume leak and gastric inflation and is associated with infrequent complications.
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Affiliation(s)
- Rami Mounir Wahba
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Milad Zekry Ragaei
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Anis Metry
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - George Mikhael Nakhla
- Department of Anesthesia and ICU, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Cohen E, Coluzzi F, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D. A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2021; 87:253-265. [PMID: 33599441 DOI: 10.23736/s0375-9393.21.15570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Pierangelo DI Marco
- Department of Internal Anesthesiologic and Cardiovascular Clinical Studies, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anaesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
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7
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Sawa T, Kainuma A, Akiyama K, Kinoshita M, Shibasaki M. Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy. Front Pediatr 2021; 9:654291. [PMID: 34026688 PMCID: PMC8138561 DOI: 10.3389/fped.2021.654291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS). Some VLSs are equipped with small blades for infants. Advanced SADs have small sizes for infants, and some effectively function as conduits for endotracheal intubation. The smallest FOS has an outer diameter of 2.2 mm and enables intubation with endotracheal tubes with an inner diameter of 3.0 mm. DAM in neonates and infants can be improved by effectively selecting the appropriate device combination and ensuring that available providers have the necessary skills.
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Affiliation(s)
- Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsushi Kainuma
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koichi Akiyama
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Anesthesia, Yodogawa Christian Hospital, Osaka, Japan
| | - Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayuki Shibasaki
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gasteiger L, Oswald E, Keplinger M, Putzer G, Luger M, Neururer S, Keller C, Moser B. A randomized trial comparing the Ambu® Aura-i™ and the Ambu® Aura Gain™ laryngeal mask as conduit for tracheal intubation in children. Minerva Anestesiol 2020; 86:1143-1150. [DOI: 10.23736/s0375-9393.20.14422-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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The distance between the glottis and the cuff of a tracheal tube placed through three supraglottic airway devices in children: A randomised controlled trial. Eur J Anaesthesiol 2020; 36:721-727. [PMID: 31415305 DOI: 10.1097/eja.0000000000001070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND After tracheal tube insertion via various types of supraglottic airway devices, the distance from the tube cuff to the vocal cords has not been evaluated in children. OBJECTIVES The aim of this study was to evaluate the position of a tracheal tube cuff relative to the glottis in children when one of three supraglottic airway devices (I-gel, AuraGain and air-Q laryngeal airway) are used as intubation conduits. DESIGN A randomised controlled trial. SETTING Tertiary children's hospital. PATIENTS Children aged less than 7 years. INTERVENTION In vivo fibre-optic assessment and in vitro measurement. MAIN OUTCOME MEASURES The main outcome was the safety margin: the distance between the ventilation outlet of the supraglottic airway device and the beginning of the proximal cuff minus that from the ventilation outlet to the glottis. The maximum inner diameter of the cuffed tracheal tube that could be inserted, the fibre-optic view score and the oropharyngeal leak pressure were also evaluated. RESULTS The three devices exhibited significant differences in the distance from the ventilation outlet to the glottis (mean ± SD): I-gel 3.6 ± 0.6 cm, AuraGain 3.8 ± 0.7 cm, air-Q 2.8 ± 1.0 cm (P < 0.001). The safety margin was greatest with the air-Q and narrowest with the I-gel: I gel 1.9 ± 1.1 cm, AuraGain 4.4 ± 0.7 cm and air-Q 7.9 ± 1.1 cm. Using the AuraGain and air-Q, the cuffs of the tracheal tubes were predicted to be located below the glottis with one-size and two-size smaller tracheal tubes in all patients. However, using I-gel, the cuffs would be below the glottis in 69% (95% CI 49.6 to 84.5) and 29% (95% CI 14.0 to 48.4) of the patients with a one-size and two-size smaller tube, respectively. CONCLUSION The AuraGain and air-Q are well tolerated intubating conduits. The possibility of vocal cord damage is higher when the I-gel is used. TRIAL REGISTRATION www.clinicaltrials.gov (number: NCT03156166).
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10
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Huang AS, Sarver A, Widing A, Hajduk J, Jagannathan N. The design of the perfect pediatric supraglottic airway device. Paediatr Anaesth 2020; 30:280-287. [PMID: 31837186 DOI: 10.1111/pan.13785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
The design evolution of the pediatric supraglottic airway device has experienced a long and productive journey. We have a wealth of clinical studies to support progress and advancements in pediatric clinical practice. While all of the supraglottic airway devices have been used successfully in millions of children, it is important to be aware of design advantages and disadvantages of the different models of supraglottic airway devices. Current pediatric supraglottic airway devices may be improved in design to be more ideal. Industry-changing technological advancements are likely to occur in the near future, which may further improve clinical performance of these devices.
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Affiliation(s)
- Andrea S Huang
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashley Sarver
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amanda Widing
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Gaddam M, Sethi S, Jain A, Saini V. Comparison of Air-QⓇ insertion techniques in pediatric patients with fiber-optic bronchoscopic assessment: a prospective randomized control trial. Korean J Anesthesiol 2019; 72:570-575. [PMID: 31159533 PMCID: PMC6900414 DOI: 10.4097/kja.d.18.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques. Methods This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied. Results FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups. Conclusions The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.
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Affiliation(s)
- Manasa Gaddam
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Sameer Sethi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Aditi Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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12
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Comparison of the clinical performance of i-gel and Ambu AuraGain in children. Eur J Anaesthesiol 2019; 36:411-417. [DOI: 10.1097/eja.0000000000000987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Dadure C, Sabourdin N, Veyckemans F, Babre F, Bourdaud N, Dahmani S, Queiroz MD, Devys JM, Dubois MC, Kern D, Laffargue A, Laffon M, Lejus-Bourdeau C, Nouette-Gaulain K, Orliaguet G, Gayat E, Velly L, Salvi N, Sola C. Management of the child's airway under anaesthesia: The French guidelines. Anaesth Crit Care Pain Med 2019; 38:681-693. [PMID: 30807876 DOI: 10.1016/j.accpm.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide French guidelines about "Airway management during paediatric anaesthesia". DESIGN A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded. METHODS The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology. RESULTS The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions. CONCLUSIONS Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
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Affiliation(s)
- Christophe Dadure
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France.
| | - Nada Sabourdin
- Département d'anesthésiologie-réanimation hôpital Armand Trousseau, AP-HP, 26, avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Francis Veyckemans
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Florence Babre
- Department of anaesthesia, Bergonié institute, 33000 Bordeaux, France
| | - Nathalie Bourdaud
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Souhayl Dahmani
- Department of anaesthesia and intensive care. Robert-Debré university hospital, assistance publique Hôpitaux de Paris, Paris Diderot University, Paris Sorbonne Cité, Paris, Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, Paris, DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Mathilde De Queiroz
- Département d'Anesthésiologie Réanimation Pédiatrique, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Jean-Michel Devys
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Marie-Claude Dubois
- Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France
| | - Delphine Kern
- Departments of anaesthesia and intensive care, university hospital of Toulouse, place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Anne Laffargue
- Department of paediatric anaesthesia, Jeanne de Flandre hospital, university hospitals of Lille, 59037 Lille, France
| | - Marc Laffon
- Department of anesthesia and intensive care, university hospital and medical university François-Rabelais, Tours, France
| | - Corinne Lejus-Bourdeau
- Service d'anesthesie réanimation chirurgicale, Hôtel Dieu, Hôpital Mère Enfant, CHU de Nantes, 44093 Nantes cedex, France
| | - Karine Nouette-Gaulain
- Service d'anesthésie réanimation Pellegrin, hôpital Pellegrin, CHU de Bordeaux, place Amélie Raba Léon, 33000 Bordeaux, France; Université Bordeaux, Inserm U12-11, laboratoire de maladies rares: génétique et métabolisme (MRGM), 176, rue Léo-Saignat, 33000 Bordeaux, France
| | - Gilles Orliaguet
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades hospital, EA08 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, 75743 Paris, France
| | - Etienne Gayat
- Department of anesthesiology and Intensive care, Saint Louis, Lariboisière university hospital, université Paris Diderot, BioCANVAS, UMR-S 942, Inserm, 75010 Paris, France
| | - Lionel Velly
- Service d'anesthesie réanimation, CHU de Timone adultes, 264, rue St Pierre, 13005 MeCA, institut de neurosciences de la Timone, UMR 7289, Aix Marseille université, Marseille, France
| | - Nadège Salvi
- Department of anaesthesia and intensive care, assistance publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, 75743 Paris, France
| | - Chrystelle Sola
- Département d'anesthesiologie réanimation femme-mère-enfant, CHU de Lapeyronie, institut de génomique fonctionnelle, UMR 5203 CNRS - U 1191 Inserm, université de Montpellier, 34285 Montpellier, France
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Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study. Eur J Pediatr 2019; 178:871-882. [PMID: 30903306 PMCID: PMC6511343 DOI: 10.1007/s00431-019-03345-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 10/31/2022]
Abstract
Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios.Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. What is Known: • For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation. • Endotracheal intubation is considered by many scientific societies the gold standard for airway management. • Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation. What is New: • The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. • It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.
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Massoudi N, Fathi M, Nooraei N, Salehi A. A Comparison between the i-gel® and air-Q® Supraglottic Airway Devices Used for the Patients Undergoing General Anesthesia with Muscle Relaxation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5202957. [PMID: 30581857 PMCID: PMC6276498 DOI: 10.1155/2018/5202957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/30/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of the present study was to compare two supraglottic airway (SGA) devices (i.e., the i-gel® © Intersurgical Ltd and air-Q® (Reusable) Cookgas company) in terms of the insertion time, amount of leak during ventilation with maximum positive pressure, and postoperative complications in patients referring to Modarres Hospital in Tehran. METHOD The present double-blind clinical trial was performed on 60 patients undergoing elective surgeries that required general anesthesia with muscle relaxation. Patients were randomly assigned to either i-gel® (n = 30) or Air-Q® (n = 30) groups. RESULTS The mean age, body mass index, duration of surgery, duration of anesthesia, and gender ratio were not significantly different between the two groups. Mean ± SD values of the SGA devices' insertion time (in seconds) in the air-Q® and i-gel® groups were 4.87 ± 1.6 and 6.80 ± 1.2, respectively (P < 0.001). The mean OLP in the Air-Q® group was significantly higher than that of the i-gel® group (35.9 ± 9.6 versus 24.8 ± 3.7, p < 0.001). The frequency of complications occurred after the supraglottic airway insertion was higher in the i-gel® group. However, only in terms of sore throat, the difference between the two groups was statistically significant: 6 (20%) had sore throat (P = 0.024) in the i-gel groups, but in in the Air-Q® groups no one had this side effect after surgery. CONCLUSION It was concluded that the Air-Q® supraglottic airway was placed faster and easier with fewer complications than the i-gel in general anesthesia with muscle relaxation. The frequency of the occurrence of all three complications, cough, sore throat, and blood, on the cuff (6 (20%) was higher in the i-gel group than that in the air-Q® group (cough3 (10%), sore throat 0 (0%), and blood on the cuff 3 (10%) (P < 0.05).
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Affiliation(s)
- Nilofar Massoudi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Fathi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Nooraei
- Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Salehi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ahn E, Choi G, Kang H, Baek C, Jung Y, Woo Y, Bang S. Supraglottic airway devices as a strategy for unassisted tracheal intubation: A network meta-analysis. PLoS One 2018; 13:e0206804. [PMID: 30395614 PMCID: PMC6218066 DOI: 10.1371/journal.pone.0206804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/19/2018] [Indexed: 12/03/2022] Open
Abstract
We aimed to compare the effectiveness of supraglottic airway devices as a strategy for unassisted tracheal intubation. Accordingly, we searched the OVID-MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, KoreaMed, and Google Scholar databases to identify all relevant randomized controlled trials (RCTs) on supraglottic airway devices as a strategy for tracheal intubation published until May 2017. The primary outcome was the overall success rate of intubation by the intention to treat (ITT) strategy. The secondary outcomes of the study were the overall success rate of tracheal intubation by the per protocol (PP) strategy and the success rate of tracheal intubation at first attempt by ITT and PP. We conducted a network meta-analysis with a mixed-treatment comparison method to combine direct and indirect comparisons among supraglottic airway devices. Of 1396 identified references, 16 RCTs (2014 patients) evaluated unassisted intubation with supraglottic airway devices. Patients were grouped according to the type of device used: LMA-CTrach, LMA-Fastrach, Air-Q, i-gel, CobraPLA, Ambu-Aura, or single-use LMA devices. Based on the surface under the cumulative ranking curve, the three best supraglottic airway devices for use as a strategy for unassisted tracheal intubation were LMA-CTrach (which included video-assisted tracheal tube guidance), single-use LMA-Fastrach, and LMA-Fastrach. LMA-Fastrach showed a higher success rate of intubation than did i-gel, CobraPLA, Air-Q, and Ambu-Aura. However, this study was limited by the small number of eligible RCTs. Therefore, well-designed RCTs performed on large patient populations are required to increase the confidence of the results.
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Affiliation(s)
- EunJin Ahn
- Department of Anaesthesiology and Pain Medicine, InJe University Seoul Paik Hospital, Seoul, Korea
| | - GeunJoo Choi
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Kang
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- * E-mail:
| | - ChongWha Baek
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - YongHun Jung
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - YoungCheol Woo
- Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - SiRa Bang
- Department of Anaesthesiology and Pain Medicine, InJe University Seoul Paik Hospital, Seoul, Korea
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Krishna SG, Syed F, Hakim M, Hakim M, Tumin D, Veneziano GC, Tobias JD. A comparison of supraglottic devices in pediatric patients. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:361-365. [PMID: 30319293 PMCID: PMC6171511 DOI: 10.2147/mder.s177866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q® laryngeal mask airway (LMA) and the i-gel® SGA, in pediatric patients. Methods Patients ≤18 years of age were prospectively randomized to receive either the Air-Q® LMA or the i-gel® SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmH2O were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen. Results Fifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q® LMA and i-gel® SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: - 2 to 7; P=0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: - 9 to 8; P=0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q® and 6 i-gel® supraglottic devices sealed the airway at 20 cmH2O. Discussion The time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q® LMA and the i-gel® SGA did not differ.
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Affiliation(s)
- Senthil G Krishna
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
| | - Faizaan Syed
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Mohammed Hakim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Mumin Hakim
- Department of Surgery, Montefiore Medical Centre, Bronx, NY, USA
| | - Dmitry Tumin
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
| | - Giorgio C Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA, .,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
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Prabha R, Raman R, Khan MP, Kaushal D, Siddiqui AK, Abbas H. Comparison of I-gel for general anesthesia in obese and nonobese patients. Saudi J Anaesth 2018; 12:535-539. [PMID: 30429733 PMCID: PMC6180705 DOI: 10.4103/sja.sja_79_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Context: I-gel is a second-generation supraglottic airway device. Despite several studies on i-gel, there are very few studies on the use of i-gel in obese patients. Aims: The aim of the study was to compare the clinical performance of i-gel between obese and nonobese patients. Settings and Design: Prospective, controlled, nonrandomized, hospital-based study. Subjects and Methods: After obtaining informed consent, patients were divided into two groups of 16 patients each: group O consisted of patients with body mass index (BMI) >30 kg/m2 and Group C consisted of patients with BMI 18.5–29.9 kg/m2. I-gel was inserted after induction of anesthesia and muscle relaxation. Oropharyngeal leak pressure (OLP) (primary outcome variable), leak fraction, time taken to insert the device, ease of insertion, fiberoptic view of glottis through i-gel's airway tube, and adverse effects were recorded. Statistical Analysis Used: Data were analyzed using SPSS 20. Continuous, ordinal, and categorical variables were analyzed using students t-test, Mann–Whitney U–test, and Fischer's exact test, respectively. Results: OLP was slightly higher in Group O (25.38 ± 4.79 cm H2O) but was not statistically different than Group C (27.38 ± 4.38 cm H2O). Other parameters except weight and BMI (which were higher in Group O) were statistically similar in both groups. There was no statistical difference in side effects. Conclusions: We concluded that i-gel is as effective in obese patients as in nonobese patients when used for securing the airway for surgical procedures.
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Affiliation(s)
- Rati Prabha
- Department of Cardiac Anesthesia, LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India
| | - Rajesh Raman
- Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mohammad Parvez Khan
- Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Dinesh Kaushal
- Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ahsan Khaliq Siddiqui
- Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Haider Abbas
- Department of Emergency Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Saikia P. Use of supraglottic airway devices in paediatric patients in the Indian context - some we know, some we need to know and march ahead. Indian J Anaesth 2018; 62:249-253. [PMID: 29720749 PMCID: PMC5907429 DOI: 10.4103/ija.ija_241_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Priyam Saikia
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India E-mail:
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Paediatric supraglottic airway devices update☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712002-00007] [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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Stendall C, Glaisyer H, Liversedge T. Paediatric supraglottic airway devices update. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Actualización en dispositivos supraglóticos para la vía aérea pediátrica. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Damodaran S, Sethi S, Malhotra SK, Samra T, Maitra S, Saini V. Comparison of oropharyngeal leak pressure of air-Q™, i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial. Saudi J Anaesth 2017; 11:390-395. [PMID: 29033717 PMCID: PMC5637413 DOI: 10.4103/sja.sja_149_17] [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: 01/07/2023] Open
Abstract
Study Objective: Various randomized controlled trials and a meta-analysis have compared i-gel™ and laryngeal mask airway Supreme™ (LMA-S™) in adult patients and found that both the devices provided equivalent oropharyngeal leak pressure (OLP). However, no randomized controlled trial has compared air-Q™ with i-gel™ and LMA-S™ in adult patient. Hence, we designed this study to compare air-Q™ with LMA-S™ and i-gel™ in adult patients. Materials and Methods: A total of 75 adult patients of the American Society of Anesthesiologists physical status I/II of both sexes, between 18 and 60 years, were included in this prospective randomized controlled trial conducted in a tertiary care center. Randomization of patients was done in three equal groups according to the insertion of supraglottic airway device by a computer-generated random number sequence: group air-Q™ (n = 25), group i-gel™ (n = 25), and group LMA-S™ (n = 25). Primary outcome of this study was OLP. We also recorded time for successful placement of device, ease of device insertion, number of attempts to insert device, and ease of gastric tube insertion along with postoperative complications. Results: The mean ± standard deviation OLP of air-Q™, i-gel™, and LMA-S™ was 26.13 ± 4.957 cm, 23.75 ± 5.439 cm, and 24.80 ± 4.78 cm H2O (P = 0.279). The first insertion success rate for air-Q™, i-gel™, and LMA-S™ was 80%, 76%, and 92%, respectively (P = 0.353). The insertion time of air-Q™, i-gel™, and LMA-S™ was 20.6 ± 4.4, 14.8 ± 5.4, and 15.2 ± 4.7 s, respectively (P = 0.000). Time taken for air-Q™ insertion was significantly higher than time taken for i-gel™ (mean difference 5.8 s, P < 0.0001) and LMA-S™ (mean difference 5.4 s, P = 0.0001) insertion. Postoperative complications were similar with all three devices. Conclusions: We concluded that air-Q™, i-gel™, and LMA-S™ were equally efficacious in terms of routine airway management in adult patients with normal airway anatomy.
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Affiliation(s)
- Srinath Damodaran
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surender Kumar Malhotra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Souvik Maitra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Frontoethmoidal encephalocele: a pediatric airway challenge. Can J Anaesth 2017; 65:208-209. [DOI: 10.1007/s12630-017-0983-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/09/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022] Open
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The LMA Supreme: Is it a suitable alternative to the i-gel and LMA ProSeal for airway maintenance in children? J Clin Anesth 2017. [DOI: 10.1016/j.jclinane.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mihara T, Asakura A, Owada G, Yokoi A, Ka K, Goto T. A network meta-analysis of the clinical properties of various types of supraglottic airway device in children. Anaesthesia 2017; 72:1251-1264. [PMID: 28737223 DOI: 10.1111/anae.13970] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 01/02/2023]
Abstract
We conducted both conventional pairwise and Bayesian network meta-analyses to compare the clinical properties of supraglottic airway devices in children. We searched six databases for randomised clinical trials. Our primary end-points were oropharyngeal leak pressure, risk of insertion failure at first attempt, and blood staining risk. The risk of device failure, defined as the abandonment of the supraglottic airway device and replacement with a tracheal tube or another device, was also analysed. Sixty-five randomised clinical trials with 5823 participants were identified, involving 16 types of supraglottic airway device. Network meta-analysis showed that the i-gel™, Cobra perilaryngeal airway™ and Proseal laryngeal mask airway (LMA® -Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the LMA® -Classic, with mean differences (95% credible interval, CrI) of 3.6 (1.9-5.8), 4.6 (1.7-7.6) and 3.4 (2.0-4.8) cmH2 O, respectively. The i-gel was the only device that significantly reduced the risk of blood staining of the device compared with the LMA-Classic, with an odds ratio (95%CrI) of 0.46 (0.22-0.90). The risk (95%CI) of device failure with the LMA-Classic, LMA® -Unique and LMA-Proseal was 0.36% (0.14-0.92%), 0.49% (0.13-1.8%) and 0.50% (0.23-1.1%), respectively, whereas the risk (95%CI) of the i-gel and PRO-Breathe was higher, at 3.4% (2.5-4.7%) and 6.0% (2.8-12.5%), respectively. The risk, expressed as odds ratio (95%CrI), of insertion failure at first attempt, was higher in patients weighing < 10 kg at 5.1 (1.6-20.1). We conclude that the LMA-Proseal may be the best supraglottic airway device for children as it has a high oropharyngeal leak pressure and a low risk of insertion. Although the i-gel has a high oropharyngeal leak pressure and low risk of blood staining of the device, the risk of device failure should be evaluated before its routine use can be recommended.
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Affiliation(s)
- T Mihara
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan.,Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - A Asakura
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - G Owada
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - A Yokoi
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan
| | - K Ka
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan
| | - T Goto
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Park JH, Lee JS, Nam SB, Ju JW, Kim MS. Standard versus Rotation Technique for Insertion of Supraglottic Airway Devices: Systematic Review and Meta-Analysis. Yonsei Med J 2016; 57:987-97. [PMID: 27189296 PMCID: PMC4951479 DOI: 10.3349/ymj.2016.57.4.987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated. MATERIALS AND METHODS We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways. RESULTS Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique. CONCLUSION The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.
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Affiliation(s)
- Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Beom Nam
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Wu Ju
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6406391. [PMID: 27419134 PMCID: PMC4935900 DOI: 10.1155/2016/6406391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
Abstract
Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view.
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Huang AS, Hajduk J, Jagannathan N. Advances in supraglottic airway devices for the management of difficult airways in children. Expert Rev Med Devices 2016; 13:157-69. [PMID: 26700886 DOI: 10.1586/17434440.2016.1136210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are innumerable tools and devices available to facilitate airway management and life-saving gas exchange of the patient's lungs. Over the years, various designs and generations of supraglottic airway devices have proven to be effective in accomplishing this function. Their application has grown beyond the original purpose of controlling the normal pediatric airway without tracheal intubation, and has been incorporated in the difficult airway management algorithms of anesthesia societies around the world based on clear evidence of efficacy. Older supraglottic airway devices since the 1980's have been validated in multiple clinical trials to be safe and effective in the pediatric population, however there is also sufficient evidence that the newer designs have features that help overcome some limitations. These newer designs and features are effective in managing both the normal and difficult pediatric airway, and will be discussed in this comprehensive review.
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Affiliation(s)
- Andrea S Huang
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - John Hajduk
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - Narasimhan Jagannathan
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Huang A, Jagannathan N. The Role of Supraglottic Airways in Pediatric Emergency Medicine. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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