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Kim WJ, Kang H, Yang SY, Shin HY, Baek CW, Jung YH, Woo YC, In JY. Effective Dose of Remifentanil for Control of Haemodynamic Response to Insertion of the Streamlined Liner of the Pharyngeal Airway. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the dose of remifentanil needed to achieve successful insertion of the Streamlined Liner of the Pharyngeal Airway (SLIPA™) without the development of hypertension in 95% of the patients. Design Randomised controlled trial. Setting operating theatre of a university hospital Methods A total of 100 ASA I or II patients requiring SLIPA insertion were randomly assigned to receive normal saline (Group C) or one of the four different doses (0.5 µg/kg [Group R0.5], 1.0 µg/kg [Group R1], 1.5 µg/kg [Group R1.5] or 2.0 µg/kg [Group R2]) of remifentanil. Arterial blood pressure and heart rate were recorded at preanesthetic baseline, preinserton, and every one minute during the initial 3 minutes period after insertion. Results A Probit model of remifentanil concentration was predictive of successful insertion of SLIPA without the development of hypertension. The ED95 of remifentanil needed to suppress haemodynamic response from SLIPA insertion was 1.39 µg/kg (95% confidence interval, 1.06-2.61 µg/kg). Conclusions A single administration of remifentanil can effectively suppress haemodynamic changes due to the insertion of SLIPA.
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Affiliation(s)
| | | | | | | | | | | | | | - JY In
- Dongguk University College of Medicine, Department of Anesthesiology and Pain Medicine, Ilsan Hospital, 814, Siksa-dong, Ilsan-gu, Goyang 411-773, Korea
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Higginson R. The benefits of disposable surgical equipment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:690-691. [PMID: 24151706 DOI: 10.12968/bjon.2013.22.12.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ray Higginson
- Faculty of Health, Sport & Science, University of South Wales
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Goyal M, Dutt A, Khan Joad AS. Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison. F1000Res 2013; 2:123. [PMID: 24358868 PMCID: PMC3790608 DOI: 10.12688/f1000research.2-123.v1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/23/2022] Open
Abstract
We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity were assessed in both study groups. On statistical analysis, both groups were comparable in all respects. From our study it can be concluded that thumb insertion is an effective insertion technique for the LMA Classic™.
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Affiliation(s)
- Monica Goyal
- Department of Anesthesiology, O.P. Jindal Hospital, Hisar, 125005, India
| | - Akanksha Dutt
- Department of Anesthesiology, Sawai ManSingh Medical College, Jaipur, 302004, India
| | - Anjum S Khan Joad
- Department of Anesthesiology, Bhagawan Mahavir Medical Research Center, Jaipur, 302017, India
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Galgon RE, Schroeder KM, Han S, Andrei A, Joffe AM. The air-Q(®) intubating laryngeal airway vs the LMA-ProSeal(TM) : a prospective, randomised trial of airway seal pressure. Anaesthesia 2011; 66:1093-100. [PMID: 21880031 DOI: 10.1111/j.1365-2044.2011.06863.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We performed a prospective, open-label, randomised controlled trial comparing the air-Q(®) against the LMA-ProSeal™ in adults undergoing general anaesthesia. One hundred subjects (American Society of Anesthesiologists physical status 1-3) presenting for elective, outpatient surgery were randomly assigned to 52 air-Q(®) and 48 ProSeal devices. The primary study endpoint was airway seal pressure. Oropharyngolaryngeal morbidity was assessed secondarily. Mean (SD) airway seal pressures for the air-Q(®) and ProSeal were 30 (7) cmH (2) O and 30 (6) cmH(2) O, respectively (p = 0.47). Postoperative sore throat was more common with the air-Q(®) (46% vs 38%, p = 0.03) as was pain on swallowing (30% vs 5%, p = 0.01). In conclusion, the air-Q(®) performs well as a primary airway during the maintenance of general anaesthesia with an airway seal pressure similar to that of the ProSeal, but with a higher incidence of postoperative oropharyngolaryngeal complaints.
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Affiliation(s)
- R E Galgon
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
Supraglottic airway devices (SGAs) offer certain advantages over endotracheal intubation, making them particularly well suited for the specific demands of outpatient anesthesia. Patients may tolerate the placement and maintenance of an SGA at a lower dose of anesthetic than that needed for an endotracheal tube; neuromuscular blocking agents are rarely necessary for airway management with an SGA; the incidence of airway morbidity is lower with SGAs than with endotracheal tubes; and SGAs may facilitate faster recovery and earlier discharge of patients. Two limitations of SGAs are incomplete protection against aspiration of gastric contents and inadequate delivery of positive pressure ventilation. Newer variants of the original laryngeal mask airway, the LMA Classic (LMA North America, Inc), as well as an array of other recently developed SGAs, aim to address these limitations. Their utility and safety in specific patient populations (eg, the morbidly obese) and during certain procedures (eg, laparoscopic surgery) remain to be determined.
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Affiliation(s)
- Katarzyna Luba
- Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago Medical Center, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Parotto M, Micaglio M, Ori C, Trevisanuto D. Pharyngo-laryngeal discomfort after breast surgery: Comparison between orotracheal intubation and laryngeal mask. Breast 2009; 18:1. [DOI: 10.1016/j.breast.2008.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022] Open
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A clinical evaluation of four disposable laryngeal masks in adult patients. J Clin Anesth 2008; 20:514-20. [DOI: 10.1016/j.jclinane.2008.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 05/16/2008] [Accepted: 05/16/2008] [Indexed: 12/24/2022]
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Kuvaki B, Küçükgüçlü S, Iyilikçi L, Tuncali BE, Cinar O. The Soft Seal disposable laryngeal mask airway in adults: comparison of two insertion techniques without intra-oral manipulation. Anaesthesia 2008; 63:1131-4. [PMID: 18647291 DOI: 10.1111/j.1365-2044.2008.05566.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated whether insertion of the disposable Soft Seal laryngeal mask airway (SSLM) was successful without intra-oral digital manipulation. One hundred patients undergoing anaesthesia using the SSLM were randomly assigned into two groups. Insertion was performed by either a direct or a rotational technique, both without intra-oral digital manipulation. The primary outcome measure was successful insertion at first attempt. Other outcomes included insertion time, fibreoptic assessment of the airway view and airway morbidity. The first attempt success rate was higher (98%) with the direct technique than with the rotational technique (75%; p = 0.002) but insertion time was faster with the latter method (mean [range] 15 [8-50] s) than with the direct method (20 [8-56] s; p = 0.035). Fibreoptic assessment and airway morbidity were similar in both groups. We conclude that the SSLM can be successfully inserted without intra-oral digital manipulation.
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Affiliation(s)
- B Kuvaki
- Department of Anaesthesiology and Reanimation, Dokuz Eylul University, Izmir, Turkey.
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Wilkes AR, Hodzovic I, Latto IP. Introducing new anaesthetic equipment into clinical practice. Anaesthesia 2008; 63:571-5. [DOI: 10.1111/j.1365-2044.2008.05583.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sudhir G, Redfern D, Hall JE, Wilkes AR, Cann C. A comparison of the disposable Ambu�AuraOnce?Laryngeal Mask with the reusable LMA Classic?laryngeal mask airway. Anaesthesia 2007; 62:719-22. [PMID: 17567349 DOI: 10.1111/j.1365-2044.2007.05067.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Single-use supraglottic airway devices are now available and are intended to be comparable with the reusable LMA Classic laryngeal mask airway. We performed a randomised cross-over study comparing the Ambu AuraOnce Laryngeal Mask with the LMA Classic. Fifty patients participated in the trial. Success rates for insertion at the first attempt were similar (92% with the Ambu and 84% with the LMA Classic; p = 0.22). The volumes of air required to inflate the cuff to produce a seal were similar, but the cuff pressure was lower for the Ambu Laryngeal Mask (median (IQR [range]) 18 (10-31 [0-100] cmH(2)O) than the LMA Classic 27 (17-50 [4-90] cmH(2)O; p = 0.007). Visual analogue scores for ease of insertion were 87 (73-93 [26-97]) mm for the Ambu and 84 (60-89 [18-96]) for the LMA Classic (p = 0.017). Complications were similar in both groups. We suggest that the disposable Ambu Laryngeal Mask is an acceptable alternative to the reusable LMA Classic.
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Affiliation(s)
- G Sudhir
- Department of Anaesthestics and Intensive Care Medicine, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
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Lange M, Smul T, Zimmermann P, Kohlenberger R, Roewer N, Kehl F. The effectiveness and patient comfort of the novel streamlined pharynx airway liner (SLIPA) compared with the conventional laryngeal mask airway in ophthalmic surgery. Anesth Analg 2007; 104:431-4. [PMID: 17242104 DOI: 10.1213/01.ane.0000252460.94046.7c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The novel, disposable streamlined pharynx airway liner (SLIPA) has recently been introduced into clinical practice. It has no inflatable cuff, because the shape of the SLIPA closely resembles the anatomy of the pharynx. METHODS We compared the SLIPA with the conventional laryngeal mask airway (LMA) regarding handling, safety, sealing of the pharynx, and patient comfort in 124 adult patients (ASA I-III) undergoing ophthalmic surgery under general anesthesia. RESULTS Insertion of the SLIPA was straightforward in 88%, slightly difficult in 10%, and obviously difficult in 0% of cases. The SLIPA could not be inserted in 2% of patients. In the LMA group, insertion was straightforward in 90%, slightly difficult in 8%, obviously difficult in 2%, and a failure in 0% of patients. Maximum seal pressure was 24 +/- 6 mm H2O with the SLIPA and 24 +/- 4 mm H2O with the LMA. Gastric air insufflation was noticed in 19% of patients in the SLIPA group and 3% in the LMA group (P < 0.05). No regurgitation of gastric contents was observed. Removal of the airway was uneventful in all cases. Blood traces were noted on the surface of the device in 20% in the SLIPA versus 11% (n.s.) in the LMA group. Complaints of a sore throat were recorded in 2% vs. 14% in the SLIPA and the LMA group, respectively. CONCLUSION The SLIPA is a useful alternative to the conventional LMA in patients undergoing minor surgery. However, it is associated with a higher incidence of gastric air insufflation, which may increase the risk of aspiration.
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Affiliation(s)
- Markus Lange
- Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany
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Francksen H, Bein B, Cavus E, Renner J, Scholz J, Steinfath M, Tonner PH, Doerges V. Comparison of LMA Unique, Ambu laryngeal mask and Soft Seal laryngeal mask during routine surgical procedures. Eur J Anaesthesiol 2007; 24:134-40. [PMID: 16895620 DOI: 10.1017/s0265021506001219] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2006] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE This study was performed to compare three disposable airway devices, the LMA Unique (LMA-U), the Ambu laryngeal mask (Ambu LM) and the Soft Seal laryngeal mask (Soft Seal LM) for elective general anaesthesia during controlled ventilation in non-paralysed patients. METHODS One hundred and twenty ASA I-III patients scheduled for routine minor obstetric surgery were randomly allocated to the LMA-U (n = 40), Ambu LM (n = 40) or Soft Seal LM (n = 40) groups, respectively. Patients were comparable with respect to weight and airway characteristics. A size 4 LMA was used in all patients and inserted by a single experienced anaesthesiologist. Oxygenation, overall success rate, insertion time, cuff pressure and resulting airway leak pressure were determined as well as a subjective assessment of handling and the incidence of sore throat, dysphagia and hoarseness. RESULTS Time of insertion was shortest with the Ambu LM, while failure rates were comparable with the LMA-U, the Ambu LM and the Soft Seal LM (median 19 s; range 8-57 s; success rate 100% vs. 14; 8-35; 97% vs. 20; 12-46; 95%). Insertion was judged 'excellent' in 75% of patients in the LMA-U group, in 70% of patients in Ambu LM group and in 65% of patients in the Soft Seal LM group. There was no difference between devices with respect to postoperative airway morbidity at 6 h or 24 h following surgery. CONCLUSIONS All three disposable devices were clinically suitable with respect to insertion times, success rates, oxygenation, airway and leak pressures, as well as to subjective handling and postoperative airway morbidity.
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Affiliation(s)
- H Francksen
- University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Schwanenweg 21, D-24105 Kiel, Germany
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Soulias M, Martin L, Garnier N, Juniot A, Aho LS, Freysz M. Masques laryngés à usage unique vs réutilisable : une étude de minimisation de coûts. ACTA ACUST UNITED AC 2006; 25:811-4. [PMID: 16603333 DOI: 10.1016/j.annfar.2006.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 03/08/2006] [Indexed: 11/18/2022]
Abstract
JUSTIFICATION According to French regulations concerning the risk of Creutzfeldt-Jakob disease transmission, traceability procedures of all sterile medical devices which need to be reused are mandatory. Despite sterilization processes, the reusable laryngeal mask airway (LMA) prion disease transmission remains possible. As a result, the disposable LMA has been introduced. OBJECTIVE Assuming clinical equivalence was achieved, the cost of disposable vs reusable LMA was studied in a university hospital. STUDY DESIGN A Cost-minimization analysis of disposable vs reusable laryngeal mask airway was realised. METHODS Disposable LMA cost was calculated as the sum of product cost and elimination cost. Reusable LMA were autoclaved after hospital purchasing in two separate sterilizing processing units of the same hospital. Reusable LMA cost was determined combining materiel and labor costs. RESULTS The reusable LMA cost depended on the sterilizing processing unit concerned and varied between 9.59 Euros and 9.69 vs 8.38 Euros for the single-use LMA. CONCLUSION With the cost savings made possible by use of disposable LMA in both labor and consumables, this practice should be considered.
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Affiliation(s)
- M Soulias
- Service de Pharmacie-Stérilisation Centrale, CHU de Dijon, 3, rue du Faubourg-Raines, 21033 Dijon cedex, France
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