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Das PP, Tiwari T, Raman R, Gautam S, Kushwaha BB, Kumar Y. Clinical Performance of I-gel ® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison. Int J Appl Basic Med Res 2024; 14:108-113. [PMID: 38912364 PMCID: PMC11189260 DOI: 10.4103/ijabmr.ijabmr_520_23] [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: 11/27/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 06/25/2024] Open
Abstract
Background Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Methods Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Results Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Conclusions Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.
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Affiliation(s)
- Prerna Prabhat Das
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Raman
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - B. B. Kushwaha
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Yatendra Kumar
- Department of Anesthesia and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
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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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Bandyopadhyay A, Puri S, Ashok V. Supraglottic airway device versus tracheal tube for pediatric laparoscopic surgery-A systematic review and meta-analysis. Paediatr Anaesth 2023; 33:905-912. [PMID: 37386873 DOI: 10.1111/pan.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Conventionally, tracheal tubes have been used for general anesthesia in pediatric laparoscopic surgeries. Recently, supraglottic devices are being used for the same. The performance of supraglottic devices versus tracheal tubes in children undergoing laparoscopic surgery is uncertain. METHODS A systematic review and meta-analysis of randomized controlled trials that compared supraglottic devices versus tracheal tubes in patients ≤18 years undergoing laparoscopic surgery under general anesthesia was conducted. The outcomes were peak airway pressures (cm H2 O), end-tidal carbon dioxide during pneumoperitoneum (mm Hg), recovery time (min), postoperative sore throat and adverse events. Mean difference and odds ratio, with 95% confidence intervals were reported using a random effect model. RESULTS Eight trials (n = 591) were included in the final meta-analysis. There was no statistically significant difference in the peak airway pressures (MD 0.58, 95% CI: -0.65 to 1.8; p = .36) and end-tidal carbon dioxide (MD -0.60, 95% CI: -2.00 to 0.80; p = .40) during pneumoperitoneum in the supraglottic device and the tracheal tube group. The tracheal tube group had higher odds of sore throat (OR 3.30, 95% CI: 1.69-6.45; p = .0005) and the supraglottic airway group had faster recovery time (MD 4.21, 95% CI: 3.12-5.31; p < .0001), which were statistically significant. The certainty of evidence is graded low. CONCLUSION There is low quality evidence to suggest that for pediatric laparoscopic surgeries of short duration, supraglottic devices could provide comparable intraoperative ventilation in terms of peak airway pressures and end tidal carbon dioxide, with lower odds of postoperative sore throat and faster recovery time when compared to tracheal tubes.
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Affiliation(s)
- Anjishnujit Bandyopadhyay
- Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sunaakshi Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Raman R, Prabha R, Rampal S, Tiwari T, Gautam S, Prakash R. Comparison of clinical performance of Baska mask and Ambu AuraGain in patients undergoing surgery: A single-blinded, randomised comparative trial. Indian J Anaesth 2023; 67:S227-S231. [PMID: 38187974 PMCID: PMC10768903 DOI: 10.4103/ija.ija_152_23] [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: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims The Baska mask (BM) and the Ambu AuraGain (AAG) have shown promising results in recent trials but have not been compared. Therefore, we aimed to compare the clinical performance of the BM and the AAG for airway management of adult patients. Methods In this randomised comparative study, patients aged 18-60 years and with an expected surgical duration of less than 2 h were enroled. Patients were randomly allocated to AAG (Group A, n = 37) and BM (Group B, n = 37) for airway management. After induction of anaesthesia, an allocated supraglottic airway device (SAD) was inserted. Oropharyngeal leak pressure (OLP), time taken to insert SAD, number of insertion attempts, leak fraction (LF), first-attempt success rate, overall success rate, ease of insertion, fiberoptic view of the glottis, and complications were compared. The data were analysed using Student's t-test, Mann-Whitney U test, and Fisher's exact tests. Results Baseline and demographic characteristics were comparable. OLP (31.32 ± 2.59 versus 27.54 ± 1.32 cmH2O) was higher (P < 0.001), and LF (6.19% ± 1.20% versus 7.24% ± 1.72%) was lower (P = 0.003) in the BM group. First-attempt and overall success rate, time taken to insert, number of insertion attempts, ease of insertion, and fibreoptic view of glottis through the SADs were statistically similar between groups. However, the incidence of sore throat (P = 0.007) and cough (P = 0.028) was higher with AAG. Conclusion Clinical performance of BM was better than AAG as the former had higher OLP, lower LF and complications.
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Affiliation(s)
- Rajesh Raman
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Rati Prabha
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Surbhi Rampal
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
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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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6
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Selvin CC, Singariya G, Bihani P, Kamal M, Paliwal N, Ujwal S. Comparison of oropharyngeal leak pressure of I-gelTM and BlockbusterTM laryngeal mask airway in anaesthetized pediatric patients. Anesth Pain Med (Seoul) 2023; 18:51-56. [PMID: 36746902 PMCID: PMC9902638 DOI: 10.17085/apm.22209] [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: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. METHODS A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. RESULTS The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. CONCLUSIONS The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.
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Affiliation(s)
- Caren Candace Selvin
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India
| | - Geeta Singariya
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India
| | - Pooja Bihani
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India
| | - Manoj Kamal
- Department of Anesthesiology and Critical Care, Dr S N Medical College Jodhpur, Jodhpur, India,Corresponding Author Manoj Kamal, M.D. Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, 123, Vaishali Avenue, Jhanwar Road, Jodhpur 342008, Rajasthan, India Tel: 91-291-2705705, Fax: 91-291-2434376
| | - Naveen Paliwal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India
| | - Shobha Ujwal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India
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7
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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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8
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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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9
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Klementova O, Bhoday TK, Werner J, Lopez AM, Donaldson W, Lichnovsky E, Gaszyński T, Henlin T, Bruthans J, Ulrichova J, Lukes M, Blaha J, Kral M, Gomez L, Berge R, Holland J, McAleavey F, Arava S, Merjava Skripecka L, Sobczyk S, Tyll T, Michalek P. Evaluation of the insertion parameters and complications of the i-gel Plus airway device for maintaining patent airway during planned procedures under general anaesthesia: a protocol for a prospective multicentre cohort study. BMJ Open 2021; 11:e053215. [PMID: 34930740 PMCID: PMC8689171 DOI: 10.1136/bmjopen-2021-053215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalisation of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this cohort study is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications. METHODS AND ANALYSIS This is a multicentre, prospective, interventional cohort study. The enrolment will take place in seven centres in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months. ETHICS AND DISSEMINATION The cohort study has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences. TRIAL REGISTRATION NUMBER ISRCTN86233693;Pre-results.
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Affiliation(s)
- Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Taranpreet Kaur Bhoday
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jakub Werner
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Ana M Lopez
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Will Donaldson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Erik Lichnovsky
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomas Henlin
- Department of Anesthesia and Intensive Medicine, Military University Hospital Prague, Praha, Czech Republic
| | - Jan Bruthans
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jitka Ulrichova
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Martin Lukes
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jan Blaha
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Michal Kral
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lidia Gomez
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raquel Berge
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Shiva Arava
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | | | - Sebastian Sobczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomas Tyll
- Department of Anesthesia and Intensive Medicine, Military University Hospital Prague, Praha, Czech Republic
| | - Pavel Michalek
- Anaesthesia and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
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10
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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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Zheng J, Du L, Wang J, Zhang L, Chen G. Prewarming i-gel laryngeal mask for mechanical ventilation: a meta-analysis of randomised control trials and trial sequential analysis. BMJ Open 2021; 11:e045461. [PMID: 34376440 PMCID: PMC8356164 DOI: 10.1136/bmjopen-2020-045461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To systematically evaluate the efficiency of prewarming i-gel laryngeal mask for mechanical ventilation by meta-analysis and trial sequential analysis. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane library, Web of Science, Ovid Medline and PubMed were searched from their inception to 31 August 2020. Only articles published in English language were considered. METHODS Randomised controlled trials (RCTs) comparing the efficiency of prewarming i-gel laryngeal mask versus keeping it at room temperature for mechanical ventilation were included. Primary outcome was sealing pressure immediately after successful ventilation. Secondary outcomes were the first-attempt insertion success rate and the incidence of postoperative pharyngeal pain. Two authors independently selected studies. Quality analysis was performed using the modified Jadad Scale. Trial sequential analysis (TSA) was used to control risk of random errors. Sensitivity analysis was done to assess the effect of a single study on the pooled estimates. Publication bias was assessed by funnel plots and Egger's regression test. RESULTS Four RCTs comprising 374 patients were included. The results of meta-analysis showed that compared with the control group, prewarming i-gel laryngeal mask provides a higher sealing pressure immediately after successful ventilation (mean difference 2.19 cm H2O; 95% CI (1.17 to 3.21); p<0.0001; high quality), with firm evidence from TSA and lower publication bias (p=0.7372). No significant difference was observed in the first-attempt insertion success rate (relative ratio (RR) 1.06; 95% CI (1.00 to 1.12); p=0.07; high quality) with lower publication bias (p=0.1378). The TSA indicating further trials are required. No significant difference was assessed in the incidence of postoperative pharyngeal pain (RR 1.0; 95% CI (0.14 to 6.90); p=1.0; high quality). CONCLUSION Prewarming i-gel laryngeal mask provides higher sealing pressure compared with keeping it at room temperature. But prewarming i-gel laryngeal mask did not increase the first-attempt insertion success rate, nor did it decrease the incidence of postoperative pharyngeal pain.
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Affiliation(s)
- Jianqiao Zheng
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
| | - Jia Wang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Lu Zhang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Guo Chen
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
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van Zundert A, Lee J, Reynolds H. Intraoperative cuff pressure measurements of endotracheal tubes in the operating theater: A prospective audit. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_11_21] [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] Open
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