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Herrera K, Tufail B, Osborn I. Innovative (and Safe) Techniques With Supraglottic Airways. Int Anesthesiol Clin 2024; 62:91-100. [PMID: 39233575 DOI: 10.1097/aia.0000000000000457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
ABSTRACT Supraglottic airways have been utilized as an alternative to facemask ventilation and endotracheal intubation and thus have been essential to airway management since their introduction in the late 1980s. This chapter describes basic considerations in their use and an update on current clinical practice, with an emphasis on safe management. The devices have evolved to meet today's clinical airway challenges, and they provide benefits for patients and practitioners.
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Affiliation(s)
- Katherine Herrera
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Bilal Tufail
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Irene Osborn
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Castillo-Monzón CG, Gaszyński T, Marroquín-Valz HA, Orozco-Montes J, Ratajczyk P. Supraglottic Airway Devices with Vision Guided Systems: Third Generation of Supraglottic Airway Devices. J Clin Med 2023; 12:5197. [PMID: 37629238 PMCID: PMC10455808 DOI: 10.3390/jcm12165197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Supraglottic airway devices are currently widely used for airway management both for anaesthesia and emergency medicine. First-generation SADs only had a ventilation channel and did not provide protection from possible aspiration of gastric content if regurgitation occurred. Second-generation SADs are equipped with a gastric channel to allow the insertion of a gastric catheter and suctioning of gastric content. Additionally, the seal was improved by a change in the shape of the cuff. Some second-generation SADs were also designed to allow for intubation through the lumen using fiberscopes. Although the safety and efficacy of use of SADs are very high, there are still some issues in terms of providing an adequate seal and protection from possible complications related to misplacement of SAD. New SADs which allow users to choose the insertion scope and control the position of SAD can overcome those problems. Additionally, the Video Laryngeal Mask Airway may serve as an endotracheal intubation device, offering a good alternative to fibre-optic intubation through second-generation SADs. In this narrative review, we provide knowledge of the use of video laryngeal mask airways and the possible advantages of introducing them into daily clinical practice.
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Affiliation(s)
- Caridad G. Castillo-Monzón
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | | | - Javier Orozco-Montes
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
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Godinho P, Charco-Mora P. The use of supraglottic airways in the prone position for elective surgeries – A systematic review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Yan CL, Chen Y, Sun P, Qv ZY, Zuo MZ. Preliminary evaluation of SaCoVLM™ video laryngeal mask airway in airway management for general anesthesia. BMC Anesthesiol 2022; 22:3. [PMID: 34979936 PMCID: PMC8722220 DOI: 10.1186/s12871-021-01541-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background To preliminary evaluate the application of SaCoVLM™ video laryngeal mask airway in airway management of general anesthesia. Methods We recruited 100 adult patients (ages 18–78 years, male 19, female 81, weight 48–90 kg) with normal predicted airway (Mallampati I ~ II, unrestricted mouth opening, normal head and neck mobility) and ASA I-II who required general anaesthesia. The SaCoVLM™ was inserted after anesthesia induction and connected with the anesthesia machine for ventilation. Our primary outcome was glottic visualization grades. Secondary outcomes included seal pressure, success rate of insertion, intraoperative findings (gastric reflux and contraposition), gastric drainage and 24-h complications after operation. Results The laryngeal inlet was exposed in all the patients and shown on the video after SaCoVLM™ insertion. The status of glottic visualization was classified: grade 1 in 55 cases, grade 2 in 23 cases, grade 3 in 14 cases and grade 4 in 8 cases. The first-time success rate of SaCoVLM™ insertion was 95% (95% CI = 0.887 to 0.984), and the total success rate was 96% (95% CI = 0.901 to 0.989). The sealing pressure of SaCoVLM™ was 34.1 ± 6.2 cmH2O and the gastric drainage were smooth. Only a small number of patients developed mild complications after SaCoVLM™ was removed (such as blood stains on SaCoVLM™ and sore throat). Conclusions The SaCoVLM™ can visualize partial or whole laryngeal inlets during the surgery, with a high success rate, a high sealing pressure and smooth gastroesophageal drainage. SaCoVLM™ could be a promise new effective supraglottic device to airway management during general anesthesia. Trial registration ChiCTR,ChiCTR2000028802.Registered 4 January 2020.
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Affiliation(s)
- Chun-Ling Yan
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Ying Chen
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Pei Sun
- Peking University First Hospital, Xishiku Street, Xicheng District, Beijing, PR China
| | - Zong-Yang Qv
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Ming-Zhang Zuo
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Laryngeal Mask Ventilation During Lumbar Spine Neurosurgery in Knee-Chest Position is Feasible. J Neurosurg Anesthesiol 2018; 29:317-321. [PMID: 26807696 DOI: 10.1097/ana.0000000000000277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study describes our experience with laryngeal mask (LM) inserted after anesthetic induction in patients already in knee-chest position for lumbar neurosurgery. METHODS Airway management (need for LM repositioning, orotracheal intubation because of failed LM insertion), anticipated difficult airway, and airway complications were registered. Statistics were compared between groups with the t test or the χ test, as appropriate. RESULTS A total of 358 cases were reviewed from 2008 to 2013. Tracheal intubation was performed in 108 patients and LM was chosen for 250 patients (69.8%). Intubated patients had a higher mean age and rate of anticipated difficult airway; duration of surgery was longer (P<0.001, all comparisons). LM insertion and anesthetic induction proved effective in 97.2% of the LM-ventilated patients; 7 patients (2.8%) were intubated because of persistent leakage. Incidences with airway management were resolved without compromising patient safety. CONCLUSION LM airway management during lumbar neurosurgery in knee-chest position is feasible for selected patients when the anesthetist is experienced.
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McNarry A, Patel A. The evolution of airway management – new concepts and conflicts with traditional practice. Br J Anaesth 2017; 119:i154-i166. [DOI: 10.1093/bja/aex385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Weng M, Ding M, Xu Y, Yang X, Li L, Zhong J, Miao C. An Evaluation of Thyromental Distance-based Method or Weight-based Method in Determining the Size of the Laryngeal Mask Airway Supreme: A Randomized Controlled Study. Medicine (Baltimore) 2016; 95:e2902. [PMID: 26945383 PMCID: PMC4782867 DOI: 10.1097/md.0000000000002902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The successful placement of Laryngeal Mask Airway (LMA) Supreme in adults largely depends on right selection of its size. Most anesthesiologists determine the size of LMA according to patients' body weight, which does not always work well. An alternative method should be established to guarantee higher efficacy of ventilation through LMA Supreme placement. This controlled study was designed to compare the efficacy of LMA Supreme placement, when the size of it is determined by body weight or by thyromental distance. Eighty healthy individuals with American Society of Anesthesiologists physical status 1 to 2 scheduled for elective ambulatory surgery were randomly allocated into 2 groups: thyromental distance-based group (n = 40) and weight-based group (n = 40). Efficacy of controlled ventilation through LMA, easy of device placement, and pharyngeal sealing were evaluated between the groups. The tidal volume under 10 cm H2O pressure-controlled ventilation in thyromental distance-based group was significantly higher than that in weight-based group (523.9 ± 135.4 vs 477.1 ± 185.6; P = 0.031). The number of patients who achieved "excellent" tidal volume (>8 mL/kg) were significantly more in the thyromental distance-based group (24/40 vs 13/40; P = 0.019). Among overweight patients (body mass index >23), those who achieved "excellent" tidal volume (>8 mL/kg) under 10 cm H2O pressure-controlled ventilation were also more in thyromental distanced-based group than in weight-based group (11/24 vs 2/24; P = 0.031). The time taken for successful insertion was shorter with the thyromental distance-based group compared with the weight-based group (54.6 ± 33.6 vs 87.8 ± 98.9; P = 0.021). Oropharyngeal leak pressure was pretty close between the 2 groups (26.4 ± 5.1 vs 25.0 ± 5.7 cm H2O; P = 0.180). In terms of guaranteeing better positive pressure ventilation, facilitating device placement, and reliable pharyngeal sealing, thyromental distance-based method can be a better option compared with the weight-based method for LMA Supreme size selection.
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Affiliation(s)
- Meilin Weng
- From the Department of Anaesthesiology, Fudan University Shanghai Cancer Centre; Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China (MLW, YJX, XJY, LHL, JZ, CHM); and Department of Anaesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (MD)
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Comparison of the I-gel laryngeal mask airway with the LMA-supreme for airway management in patients undergoing elective lumbar vertebral surgery. J Neurosurg Anesthesiol 2016; 27:37-41. [PMID: 24978063 DOI: 10.1097/ana.0000000000000088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The single-use supreme-laryngeal mask airway (LMA) [corrected] has been reported to be suitable for airway management in the prone position. However, there are a limited number of cases using the I-gel in the prone position. In this study, we compared the clinical use of the 2 devices in adult patients undergoing elective lumbar vertebral surgery in the prone position. MATERIALS AND METHODS Two hundred and sixty-four consecutive patients scheduled for lumbar surgery in the prone position were randomized to receive either the I-gel or the LMA [corrected] for airway management. All I-gels and LMAs [corrected] were inserted in the supine position by experienced anesthesiologists using standard techniques. Time and number of attempts needed for insertion, quality of ventilation, airway peak pressure, airway seal pressure, fiberoptic view, and complications were compared between the 2 groups. RESULTS No differences were observed in insertion time between groups. The I-gel required significantly more attempts at insertion (P<0.001). Airway seal pressure was lower in prone than in supine position in both groups (P<0.001). The I-gels provided a higher airway seal pressure ([28.4±5.4] vs. [24.8±4.6] cm H2O; P<0.001) in the prone position. There was no difference observed in fiberoptic view of the vocal cords between the 2 groups. The complication rate was low and was similar between the groups. There was little fluid in the mask of both the I-gel and the LMA [corrected] and the pH value was 6.8±0.7 versus 6.6±0.9, respectively. CONCLUSIONS The I-gel laryngeal mask airway can also be used safely in airway management of patients undergoing lumbar surgery in the prone position as well as the LMA [corrected].
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Taxak S, Gopinath A, Saini S, Bansal T, Ahlawat MS, Bala M. A prospective study to evaluate and compare laryngeal mask airway ProSeal and i-gel airway in the prone position. Saudi J Anaesth 2015; 9:446-50. [PMID: 26543466 PMCID: PMC4610093 DOI: 10.4103/1658-354x.159473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Prone position is commonly used to provide surgical access to a variety of surgeries. In view of the advantages of induction of anesthesia in the prone position, we conducted a randomized study to evaluate and compare ProSeal laryngeal mask airway (LMA) and i-gel in the prone position. Materials and Methods: Totally, 40 patients of either sex as per American Society of Anesthesiologists physical status I or II, between 16 and 60 years of age, scheduled to undergo surgery in prone position were included in the study. After the patients positioned themselves prone on the operating table, anesthesia was induced by the standard technique. LMA ProSeal was used as an airway conduit in group 1 while i-gel was used in group 2. At the end of surgery, the airway device was removed in the same position. Results: Insertion of airway device was successful in first attempt in 16, and 17 cases in ProSeal laryngeal mask airway (PLMA) and i-gel groups, respectively. A second attempt was required to secure the airway in 4 and 3 patients in PLMA and i-gel groups, respectively. The mean insertion time was 21.8 ± 2.70 s for group 1 and 13.1 ± 2.24 s for group 2, the difference being statistically significant (P < 0.05). The mean seal pressure in group 1 was 36 ± 6.22 cm H2 O and in group 2 was 25.4 ± 3.21 cm H2 O. The difference was statistically significant (P < 0.05). 13 patients in group 1 had fiberoptic bronchoscopy (FOB) grade 1 while it was 6 for group 2. The remaining patients in both groups had FOB grade 2. Conclusion: Insertion of supraglottic airways and conduct of anesthesia with them is feasible in the prone position. The PLMA has a better seal while insertion is easier with i-gel.
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Affiliation(s)
- Susheela Taxak
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Ajith Gopinath
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Savita Saini
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Teena Bansal
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Mangal Singh Ahlawat
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Manju Bala
- Department of Anesthesiology and Critical Care, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Abstract
PURPOSE OF REVIEW For patients requiring surgery in the prone position, an alternative to a traditional supine induction is allowing the patient to position themselves comfortably prone and inducing anesthesia in that position. The purpose of this review is to examine the current literature and evaluate the safety of induction of anesthesia in the prone position. RECENT FINDINGS The first randomized trial comparing induction in the supine vs. prone position for patients requiring spinal surgery was published earlier this year and reported a time-saving benefit. Multiple case series report the feasibility of this approach; however, the potential benefits of prone induction, namely a reduction in pressure injuries and avoidance of complications of the turn itself, remain unproven. Increased familiarity with prone insertion of supraglottic airways is a useful tool in case of accidental intraoperative extubation in a patient who is already prone. Potential disadvantages include loss of the airway during induction, reduced ability to manage adverse hemodynamic consequences of induction and restriction to use of a supraglottic airway. SUMMARY The reviewed literature shows that elective prone induction of anesthesia using supraglottic airways, in select patients, is feasible and associated with very low complication rates; however, there is insufficient evidence to suggest that this should be done routinely.
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Sharma B, Sood J, Sehgal R, Sahai C, Gera A. ProSeal laryngeal mask airway™ insertion in the prone position: Optimal utilization of operation theatre personnel and time? J Anaesthesiol Clin Pharmacol 2014; 30:177-82. [PMID: 24803753 PMCID: PMC4009635 DOI: 10.4103/0970-9185.130005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Positioning an anesthetized patient prone is challenging with regard to manpower requirement, time to surgical readiness and airway management. The ProSeal laryngeal mask airway™ (PLMA) is emerging as a suitable alternative, both as a primary and a rescue airway device to the tracheal tube (TT) for patients undergoing surgery in the prone position. MATERIALS AND METHODS In this prospective randomized study, 70 patients scheduled to undergo pilonidal sinus excision in prone position were allocated to two groups of 35 patients each, depending on the position of the patient at induction and device placement: Group S (device placed while supine) and Group P (device placed while prone). We compared the manpower requirement, time to surgical readiness, efficacy and safety of the PLMA for airway management in the two groups. RESULTS The number of personnel [5 (4-6) vs. 3 (3-3); P < 0.001] required for positioning the patient and surgical readiness time (22.1 ± 3 vs. 5.9 ± 0.9 min; P < 0.001) was higher in group S. There was no difference between the two groups with regard to efficacy and safety of the PLMA. Incidence of blood on the PLMA cuff and sore throat was comparable in the two groups (P = 1.000). CONCLUSION We conclude that induction and placing the PLMA in the prone position by experienced users require fewer personnel and reduces surgical readiness time.
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Affiliation(s)
- Bimla Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raminder Sehgal
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Sahai
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Anjali Gera
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Self-positioning followed by induction of anaesthesia and insertion of a laryngeal mask airway versus endotracheal intubation and subsequent positioning for spinal surgery in the prone position. Eur J Anaesthesiol 2014; 31:259-65. [DOI: 10.1097/eja.0000000000000004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of head rotation on cerebral blood velocity in the prone position. Anesthesiol Res Pract 2012; 2012:647258. [PMID: 22988456 PMCID: PMC3440850 DOI: 10.1155/2012/647258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/03/2012] [Accepted: 07/25/2012] [Indexed: 01/15/2023] Open
Abstract
Background. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cerebral blood flow. We tested in healthy subjects the hypothesis that rotating the head in the prone position reduces cerebral blood flow. Methods. Mean arterial blood pressure (MAP), stroke volume (SV), and CO were determined, together with the middle cerebral artery mean blood velocity (MCA Vmean) and jugular vein diameters bilaterally in 22 healthy subjects in the prone position with the head centered, respectively, rotated sideways, with and without positive pressure breathing (10 cmH2O). Results. The prone position reduced SV (by 5.4 ± 1.5%; P < 0.05) and CO (by 2.3 ± 1.9
%), and slightly increased MAP (from 78 ± 3
to 80 ± 2 mmHg) as well as bilateral jugular vein diameters, leaving MCA Vmean unchanged. Positive pressure breathing in the prone position increased MAP (by 3.6 ± 0.8 mmHg) but further reduced SV and CO (by 9.3 ± 1.3
% and 7.2 ± 2.4
% below baseline) while MCA Vmean was maintained. The head-rotated prone position with positive pressure breathing augmented MAP further (87 ± 2 mmHg) but not CO, narrowed both jugular vein diameters, and reduced MCA Vmean (by 8.6 ± 3.2
%). Conclusion. During positive pressure breathing the prone position with sideways rotated head reduces MCA Vmean ~10% in spite of an elevated MAP. Prone positioning with rotated head affects both CBF and cerebrovenous drainage indicating that optimal brain perfusion requires head centering.
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Yao WY, Li SY, Sng BL, Lim Y, Sia ATH. The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study. Can J Anaesth 2012; 59:648-54. [PMID: 22556005 DOI: 10.1007/s12630-012-9718-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 04/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The LMA Supreme™ (SLMA) is a single-use supraglottic device that provides a good seal for positive pressure ventilation. It has a double aperture design that facilitates the introduction of an orogastric tube to aspirate gastric contents. This observational study evaluated the role of the SLMA in parturients undergoing Cesarean delivery under general anesthesia. METHODS Non-obese parturients with at least four hours of fasting and antacid prophylaxis scheduled for uncomplicated Cesarean delivery were recruited from June 2009 through May 2010 at the Quanzhou Women's and Children's Hospital, China. We recorded the number of SLMA insertion attempts, the time to effective ventilation, the incidence of aspiration, and other anesthetic and obstetric outcomes. Postoperatively, we noted the presence of blood on the SLMA, postoperative sore throat, and patient satisfaction. Analysis included comparison of results between parturients having elective and urgent Cesarean delivery. RESULTS We recruited 700 parturients (576 elective, 124 urgent). Mean (standard deviation) body mass index was 25.6 (2.5) kg·m(-2). All SLMA insertions were successful, with 686 (98%) inserted on first attempt and a time to effective airway of 19.5 (3.9) sec. We maintained ventilation and oxygenation in all parturients with a good seal and there was no evidence of aspiration. Eighteen parturients (2.6%) had blood on the SLMA upon removal, 24 (3.4%) had sore throat, and patient satisfaction was 85 (7)%. These results were similar in elective and urgent cases. CONCLUSIONS In a carefully selected group of parturients, the SLMA is a useful alternative to tracheal intubation for Cesarean delivery, providing effective ventilation and a low incidence of side effects or complications.
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Affiliation(s)
- Wei Yu Yao
- Department of Anesthesia, Quanzhou Women's and Children's Hospital, Fujian, China
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López AM, Valero R. Use of supraglottic airway devices in patients positioned other than supine. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brief review: The LMA Supreme™ supraglottic airway. Can J Anaesth 2012; 59:483-93. [DOI: 10.1007/s12630-012-9673-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022] Open
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Residual Neuromuscular Block. Anesth Analg 2012. [DOI: 10.1213/ane.0b013e318248a9f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hurtado P, Valero R, Tercero J, Carrero E, de Riva N, López AM, Enseñat J, Ubré M, Lushchenkov D, Fàbregas N. [Experience with the proseal laryngeal mask in ventriculoperitoneal shunting]. ACTA ACUST UNITED AC 2011; 58:362-4. [PMID: 21797086 DOI: 10.1016/s0034-9356(11)70085-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use, utility, safety, and effectiveness of the Proseal laryngeal mask for airway management in patients undergoing ventriculoperitonea shunting. PATIENTS AND METHODS We retrospectively reviewed the records of all patients in whom the Proseal laryngeal mask was used during ventriculoperitoneal shunting between January 2006 and October 2009. Patient demographic characteristics, airway assessments, type of anesthesia, quality of ventilation, and perioperative complications were recorded. RESULTS Of the 43 patients included, 8 (18.6%) had at least 1 difficult airway criterion. We were able to insert the Proseal laryngeal mask in all patients. Ventilation was optimal in 39 (91%) patients, with maintenance of end-expiratory carbon dioxide pressures between 35 and 40 mm Hg and airway pressures above 25 cm H2O throughout the procedures. Air leaks developed in 3 cases (7%) when the patient was placed in a lateral-cervical position for surgery; these patients required orotracheal intubation before surgery could begin. Mean duration of surgery was 53 minutes. Awakening occurred without incident in all cases. CONCLUSIONS The Proseal laryngeal mask is useful for airway management in patients undergoing ventriculoperitoneal shunting. Due to the forced position of the neck, however, it may be necessary to reposition the mask or even proceed to orotracheal intubation in some cases. As is the case for other advanced uses, experience with the device is necessary. Material for managing a difficult airway should be on hand.
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Affiliation(s)
- P Hurtado
- Servicio de Anestesiologia, Reanimación y Terapéutica del Dolor, Hospital Clinicá de Barcelona
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López AM, Valero R, Hurtado P, Gambús P, Pons M, Anglada T. Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position. Br J Anaesth 2011; 107:265-71. [PMID: 21576096 DOI: 10.1093/bja/aer104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position. METHODS One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared. RESULTS There were no differences between groups in insertion time or first attempt success (100% vs. 98%). The PLMA required fewer manipulations (3% vs. 15%; P=0.02) to achieve effective ventilation and provided a higher seal pressure (mean [sd] 31 [4] vs. 27 [4] cm H2O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs. 8% and sore throat in 3% vs. 5% of patients with the PLMA and SLMA, respectively. CONCLUSIONS Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.
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Affiliation(s)
- A M López
- Department of Anaesthesiology, Hospital Clínic de Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Sharma V, Verghese C, McKenna P. Prospective audit on the use of the LMA-Supreme™ for airway management of adult patients undergoing elective orthopaedic surgery in prone position. Br J Anaesth 2010; 105:228-32. [DOI: 10.1093/bja/aeq118] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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