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Khutell A, Grover T, Singh A, Seth A, Madan M, Yadav K. A Prospective Comparison of Insertion Characteristics of Laryngeal Mask Airway (LMA) ProSeal® Using Rotation Techniques vs Standard Techniques in Adults Undergoing Elective Surgery. Cureus 2023; 15:e37976. [PMID: 37223173 PMCID: PMC10202660 DOI: 10.7759/cureus.37976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Airway management is the most essential skill in Anesthesiology and the inability to secure the airway is one of the most common reasons for anesthesia-related morbidity and mortality. This study aimed to evaluate and compare the insertion characteristics of laryngeal mask airway (LMA) ProSeal insertion using the standard introducer technique, 90-degree rotation technique, and 180-degree rotation technique in adult patients undergoing elective surgery. MATERIAL AND METHOD This prospective, interventional, randomized, comparative study was carried out in the Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, after obtaining hospital ethical committee approval for 18 months of duration. Patients in the age group 18-65 years, of either gender, fulfilling American Society of Anesthesiologists grade I or II criteria, scheduled for elective surgery under general anesthesia with controlled ventilation using the LMA ProSeal were included in the study. The patients were randomized into three groups: Group I - Standard Introducer technique (n=40); Group NR - 90-degree rotation technique (n=40); Group RR - 180-degree rotation technique or back to front (airway) technique (n=40). RESULT In this study, the majority (73.3%) of the patients were females with 31 patients in group I, 29 patients in group NR, and 28 patients in group RR. A total of 26.67% of male patients were included in the study. No significant difference in the gender distribution of the three groups was seen in the study. There was no incidence of failure in ProSeal laryngeal mask airway (PLMA) insertion in the NR group, while it was 2.50% in group I and 7.50% in group RR but the difference was not statistically significant. A statistically significant difference was seen in the incidence of LMA ProSeal blood staining (p=0.013). In the post-anesthesia care unit at 1 hour, the incidence of sore throat was 10% in patients with the NR group, 30% in the I group, and 35.44% in the RR group which was statistically significant. CONCLUSION The study concluded that the 90-degree rotation technique was superior to both the 180-degree rotation and the introducer technique in adult patients in terms of insertion time, ease of insertion score, manipulation requirement, blood staining of PLMA, and post-op sore throat.
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Affiliation(s)
- Aadhar Khutell
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
- Critical Care, Royal Preston Hospital, Preston, GBR
| | - Tanvi Grover
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Apoorva Singh
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Anita Seth
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Mansha Madan
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Kulbhushan Yadav
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Baran Akkuş İ, Kavak Akelma F, Emlek M, Özkan D, Ergil J, Polat R. Comparison of the standard and triple airway maneuvering techniques for i-gel™ placement in patients undergoing elective surgery: a randomized controlled study. J Anesth 2020; 34:512-518. [PMID: 32367393 DOI: 10.1007/s00540-020-02780-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The i-gel is a supraglottic airway device with non-inflatable cuff which can suffer insertion failure if its standard placement technique is implemented. The aim of this study was to compare the placement technique proposed by the manufacturer of i-gel with the triple airway maneuver in terms of successful device insertion time and first-attempt success. METHODS After ethics committee approval, 103 ASA I-III patients were randomly allocated to the standard or triple airway maneuver groups. In the standard Group, the i-gel was inserted in the sniffing position while, in the triple group, it was inserted using the triple airway maneuver consisting of head tilt, jaw thrust, and open mouth. The time taken for successful insertion, first-attempt success rate, i-gel position, airway complications, and hemodynamic responses were assessed. RESULTS Between the two groups patient characteristics were similar. Time for successful insertion was significantly shorter in the triple group (20 ± 7 s) than with the standard technique (32 ± 11 s; p < 0.001). Successful insertion at the first attempt was 78% and 92% for the standard and triple group, respectively (p = 0.092). The i-gel position, airway complications, and hemodynamic responses were similar in both groups. CONCLUSION The triple airway maneuver required less i-gel insertion time as compared with the standard placement technique. First-attempt success rates were similar with both techniques, although the triple airway maneuver was superior to the standard method as a rescue technique in failed insertions. We therefore recommend use of the triple airway maneuver in i-gel insertion.
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Affiliation(s)
- İlkay Baran Akkuş
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey.
| | - Fatma Kavak Akelma
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey
| | - Merve Emlek
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey
| | - Derya Özkan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey
| | - Jülide Ergil
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey
| | - Reyhan Polat
- Department of Anesthesiology and Reanimation, University of Health Sciences, Diskapi Yildirim Beyazit Trainig and Research Hospital, Sehit Ömer Halisdemir Str, 06110, Dıskapı- Altındag, Ankara, Turkey
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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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Eglen M, Kuvaki B, Günenç F, Ozbilgin S, Küçükgüçlü S, Polat E, Pekel E. [Comparison of three different insertion techniques with LMA-Unique™ in adults: results of a randomized trial]. Rev Bras Anestesiol 2017; 67:521-526. [PMID: 28526466 DOI: 10.1016/j.bjan.2017.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/13/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-Unique™. METHODS One hundred and eighty ASA I-II patients aged 18-65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n=60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n=60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n=60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. RESULTS Successful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5-19]s) compared with the standard (11.78 [6-24]s) and rotational group (11.57 [5-31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. CONCLUSIONS Rotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations.
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Affiliation(s)
- Merih Eglen
- Malatya State Hospital, Department of Anesthesiology and Intensive Care, Malatya, Turquia
| | - Bahar Kuvaki
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Ferim Günenç
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Sule Ozbilgin
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia.
| | - Semih Küçükgüçlü
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Ebru Polat
- Samsun State Hospital, Department of Anesthesiology and Intensive Care, Samsun, Turquia
| | - Emel Pekel
- Florence Nighthingale Hospital, Department of Anesthesiology and Intensive Care, İstanbul, Turquia
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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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Krishna HM, Kamath S, Shenoy L. Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients. J Anaesthesiol Clin Pharmacol 2012; 28:481-5. [PMID: 23225929 PMCID: PMC3511946 DOI: 10.4103/0970-9185.101923] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique. Materials and Methods: This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed. Results: Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group). Conclusions: LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.
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Affiliation(s)
- Handattu M Krishna
- Department of Anesthesiology, Kasturba Medical College, Manipal, Manipal University, Manipal, India
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