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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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Castro-Gómez A, Delgado LA. Intubación orotraqueal en prono: otra manera para acceder a la vía aérea. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Castro-Gómez A, Delgado LA. Tracheal intubation in the prone position: Another way to access the airway. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sorimachi K, Ono Y, Kobayashi H, Watanabe K, Shinohara K, Otani K. Airway management in a patient with nuchal, interspinous, and flavum ligament rupture by a sickle: a case report. J Med Case Rep 2016; 10:172. [PMID: 27292101 PMCID: PMC4904364 DOI: 10.1186/s13256-016-0957-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penetrating neck injury is an important trauma subset but is relatively rare, especially when involving the posterior cervical column. Rupture of the neck restraints, including the interspinous and flavum ligaments, can create serious cervical instability that requires special consideration when managing the airway. However, no detailed information regarding airway management in patients with profound posterior neck muscle laceration and direct cervical ligament disruption by an edged weapon is yet available in the literature. CASE PRESENTATION A 63-year-old Japanese man attempted to cut off his head using a sickle after drinking a copious amount of alcohol. On admission, his posterior vertebral column was grossly exposed and the lacerated tissues were actively bleeding, resulting in severe hypovolemic shock. We used a rapid-sequence intubation technique with direct laryngoscopy while manual in-line stabilization of his head and neck was maintained by several people. Surgical exploration revealed nuchal, interspinous, and flavum ligament rupture between his fourth and fifth cervical vertebrae, but no injury to the great vessels was present. The major source of bleeding was a site of oozing from his trapezius and splenius muscles. After surgical hemostasis, wound repair, and subsequent intensive care, our patient was discharged home without any neurological sequelae. CONCLUSIONS Deficits of the neck restraints can cause cervical spine subluxation and dislocation secondary to neck movement. Thus, the key to successful airway management in such a scenario is minimization of neck movement to prevent further neurological impairment. We successfully managed an airway using a conventional but trusted endotracheal intubation strategy in a patient with multiple traumas and a suspected spinal cord injury. This case also illustrates that, even when great vessel injury is absent, severe hypovolemic shock may occur after profound neck muscle laceration, requiring immediate surgical intervention.
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Affiliation(s)
- Kotaro Sorimachi
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Hideo Kobayashi
- Department of Orthopedics Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kazuyuki Watanabe
- Department of Orthopedics Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Koji Otani
- Department of Orthopedics Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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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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Oh CH, Kim MS, Noh SH, Shin DA, Ji GY. Vertebral artery dissect injury with brown-séquard syndrome by a neural foramen penetrated electric screw driver bit : a case report. KOREAN JOURNAL OF SPINE 2013; 10:258-60. [PMID: 24891861 PMCID: PMC4040642 DOI: 10.14245/kjs.2013.10.4.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/19/2022]
Abstract
There are few reports in the literature of complete obstruction of the vertebral artery (VA) due to an electric screw driver bit penetration through the neural foramen into the spinal canal with Brown-Séquard syndrome (BSS). A 25-year-old man was admitted to the emergency department with a penetrated neck injury by an electric screw driver bit after a struggle. The patient presented the clinical features of BSS. Computed tomography scan revealed that the electric screw driver bit penetrated through the right neural foramen at the level of C3-4, and it caused an injury to the right half of the spinal cord. Emergent angiography revealed VA dissection, which was managed by immediate coil embolization at both proximal and distal ends of the injury site. After occlusion of the VA, the electric screw driver bit was extracted under general anesthesia. Bleeding was minimal and controlled without difficulties. No postoperative complications, such as wound dehiscence, CSF leakage, or infection, were noted. Endovascular approaches for occlusion of vertebral artery lesions are safe and effective methods of treatment.
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Affiliation(s)
- Chang Hyun Oh
- Department of Neurosurgery, Guro Teun Teun Hospital, Seoul, Korea
| | - Min Soo Kim
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Hyun Noh
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Gyu Yeul Ji
- Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Kumar V, Raina R. Airway rescue in the prone position with laryngeal mask airway in a case of lumbar spinal stenosis undergoing percutaneous posterior decompression using an inter-spinous spacer device. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rcae.2012.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kumar V, Raina R. Rescate de la vía aérea en posición prona con máscara laríngea en casos de estenosis de la columna lumbar y descompresión percutánea posterior por medio de un espaciador interespinoso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Airway rescue in the prone position with laryngeal mask airway in a case of lumbar spinal stenosis undergoing percutaneous posterior decompression using an inter-spinous spacer device☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341020-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND Tracheal intubation in the prone position has previously been reported only as a necessity in a very few emergency situations. It emerged at our clinic as a routine after invention of a test aimed at pinpointing a painful motion segment in patients with chronic low back pain who were candidates for lumbar fusion operation. MATERIAL AND METHODS During a 6-year period 247 consecutive patients were treated at our clinic, 91 men and 156 women, mean age 42.8 years, range 25.3-62.8. Classification of the pharyngeal structures according to Mallampati et al. was done the day before surgery, and grading of visualization of the glottis as described by Cormack and Lehane was done during intubation, with the aim of revealing factors of importance for the possibility of performing tracheal intubation in the prone position. RESULTS The large majority of patients classified preoperatively as Mallampati class 1 had Cormack and Lehane grade 1 at laryngoscopy, although some patients had grades 2, 3, and 4. Most problems with intubation in the prone position were anticipated among those classified preoperatively as Mallampati class 3, but tracheal intubation in the prone position was still possible in 21 of the 23 patients in this group. In all, tracheal intubation in the prone position was successful in 244 of the 247 patients (98.8%). CONCLUSION Routine tracheal intubation in the prone position can be performed effectively by experienced anaesthesiologists, but this requires continuous training and good support from the anaesthesiology staff.
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Affiliation(s)
- Klaus Baer
- Clinic of Spinal Surgery, Löt, 64594 Strängnäs, Sweden
| | - Bo Nyström
- Clinic of Spinal Surgery, Löt, 64594 Strängnäs, Sweden
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Rabiu TB, Fadare AE. A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury. Indian J Anaesth 2012; 56:162-4. [PMID: 22701208 PMCID: PMC3371492 DOI: 10.4103/0019-5049.96329] [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] [Indexed: 11/04/2022] Open
Abstract
Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.
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Affiliation(s)
- Taopheeq B Rabiu
- Department of Surgery, Division of Neurological Surgery, Federal Medical Centre, Ido-Ekiti, Nigeria
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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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Prasad MK, Sinha AK, Bhadani UK, Chabra B, Rani K, Srivastava B. Management of difficult airway in penetrating cervical spine injury. Indian J Anaesth 2011; 54:59-61. [PMID: 20532076 PMCID: PMC2876915 DOI: 10.4103/0019-5049.60501] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Management of airway in trauma victim with penetrating cervical/thoracic spine injury has always been a challenge to the anaesthesiologist. Stabilisation of spine during airway manipulation, to prevent any further neural damage, is of obvious concern to the anaesthesiologist. Most anaesthesiologists are not exposed to direct laryngoscopy and intubation in lateral position during their training period. Tracheal intubation in the lateral position may be unavoidable in some circumstances. Difficult airway in an uncooperative patient compounds the problem to secure airway in lateral position. We present a 46-year-old alcoholic, hypertensive, morbidly obese person who suffered a sharp instrument (screwdriver) spinal injury with anticipated difficult intubation; the case was managed successfully.
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Affiliation(s)
- Mukesh Kumar Prasad
- Department of Anaesthesiology, U.F.H.T. Medical College, Rampur Road, Haldwani, Nainital, Uttrakhand, India
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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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Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position. Can J Anaesth 2010; 57:1014-20. [DOI: 10.1007/s12630-010-9378-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022] Open
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Direct laryngoscopy and endotracheal intubation in the prone position following traumatic thoracic spine injury. J Anesth 2008; 22:170-2. [PMID: 18500616 DOI: 10.1007/s00540-007-0596-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
Abstract
Perioperative airway management in trauma victims presenting with penetrating thoracic spine injury poses a major challenge to the anesthesiologist. To avoid further neurological impairment it is essential to ensure maximal cervical and thoracic spine stability at the time of airway manipulation (e.g., direct laryngoscopy and endotracheal intubation). Airway management in the prone position additionally increases the incidence of cervical/thoracic spine injury, difficult ventilation, and difficult airway instrumentation. Although awake fiberoptic intubation of the trachea is considered the gold standard for airway instrumentation in patients with posterior thoracic/cervical trauma, this technique requires the patient's cooperation, special equipment, and extensive training, all of which might be difficult to accomplish in emergency situations. We herein present the first reported case of an adult trauma patient who underwent direct laryngoscopy and endotracheal intubation under general anesthesia in the prone position. Although the prone position is not the standard position for airway instrumentation with direct laryngoscopy and endotracheal intubation under general anesthesia, our experience indicates that this technique is possible (and relatively easy to perform) and might be considered in an emergency situation.
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García-Aguado R, Tornero F, Otero M, Sanchís R. [On inserting the ProSeal laryngeal mask in prone position]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:320-321. [PMID: 18661698 DOI: 10.1016/s0034-9356(08)70582-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Kumar V, Lalitha K, Lone T. Use of Laryngeal Mask Airway in Prone Position. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Abstract
Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.
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Affiliation(s)
- H Edgcombe
- Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK
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Kramer DC, Lo JC, Gilad R, Jenkins A. Fiberoptic Scope as a Rescue Device in an Anesthetized Patient in the Prone Position. Anesth Analg 2007; 105:890. [PMID: 17717273 DOI: 10.1213/01.ane.0000269690.05759.eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Agrawal S, Sharma JP, Jindal P, Sharma UC, Rajan M. Airway management in prone position with an intubating Laryngeal Mask Airway. J Clin Anesth 2007; 19:293-5. [PMID: 17572326 DOI: 10.1016/j.jclinane.2006.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 08/21/2006] [Accepted: 09/07/2006] [Indexed: 11/27/2022]
Abstract
The prone position impairs the ability for endotracheal intubation by direct laryngoscopy. We describe the airway management of a 25-year-old woman with an extensive open wound over her back and fractured pelvis. She was treated in the prone position and was scheduled for debridement of her wound with skin grafting during general anesthesia. Her trachea was successfully intubated on the first attempt using an intubating Laryngeal Mask Airway while she was in the prone position.
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Affiliation(s)
- Sanjay Agrawal
- Department of Anesthesia, Himalayan Institute of Medical Sciences, Dehradun 248140, India.
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Gernoth C, Jandewerth O, Contzen M, Hinkelbein J, Genzwürker H. Vergleich von zwei Larynxmaskenmodellen zur Atemwegssicherung bei Patienten mit Immobilisation der Halswirbelsäule. Anaesthesist 2006; 55:263-9. [PMID: 16328475 DOI: 10.1007/s00101-005-0921-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reduced cervical spine mobility can impair laryngoscopy and tracheal intubation. Supraglottic airway devices can be important alternatives for oxygenation under these circumstances. The Ambu laryngeal mask (ALM) and the LMA-Classic (LMA) are compared in patients with immobilization of the cervical spine. METHODS In 60 patients scheduled for elective ambulatory interventions, ALM or LMA were inserted after cervical immobilization with an extrication collar and assessment of laryngoscopic view. Insertion time (removal of facemask until first tidal volume), number of insertion attempts, airway leak pressure (cuff pressure 60 cm H(2)O), intraoperative complications and postoperative complaints were assessed. RESULTS Demographical data, insertion attempts, insertion time (ALM 15.6+/-4.4 s, LMA 15.5+/-4.9 s) and airway leak pressure (ALM 25.6+/-5.2 cm H(2)O, LMA 26.5+/-6.5 cm H(2)O) were comparable. Traces of blood were found in 6 LMAs and 3 ALMs after removal, mild trouble with swallowing (visual analogue scale, VAS 2-4) in the recovery room and after 24 h were complaints by 1 ALM and 2 LMA patients. CONCLUSIONS LMA-Classic and Ambu laryngeal masks are suitable for rapid and reliable airway management in patients with cervical immobilization.
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Affiliation(s)
- C Gernoth
- Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum, Mannheim. del berg.de
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Abstract
PURPOSE OF REVIEW To present recent advances in the role of the laryngeal mask airway (LMA) and its newer modifications in the management of difficult airway. RECENT FINDINGS The principles of management of a difficult airway remain the same, but the advent of the intubating LMA (ILMA) and Proseal LMA (PLMA) has provided a better choice in such situations. While fiberoptic intubation remains the preferred choice of many anaesthesiologists, the ILMA provides equal or better conditions for intubation when compared with the awake technique. The PLMA with its better safety profile is proving valuable in the emergency scenario. SUMMARY ILMA and PLMA have been shown to be effective in the management of difficult airway. We recommend that training in the use of these devices be made mandatory.
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Affiliation(s)
- Krishna Ramachandran
- Department of Anesthesia, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
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