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Tan Y, Jiang J, Wang R. Contrast of oropharyngeal leak pressure and clinical performance of I-gel™ and LMA ProSeal™ in patients: A meta-analysis. PLoS One 2022; 17:e0278871. [PMID: 36520843 PMCID: PMC9754199 DOI: 10.1371/journal.pone.0278871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Conflicting outcomes have been reported for the i-gel™ and laryngeal mask airway (LMA) ProSeal™ in children and adults during general anesthesia. Randomized controlled trials (RCTs) that yielded wide contrast outcomes between i-gel™ and LMA ProSeal™ were included in this meta-analysis. METHODS Two authors independently identified RCTs that compared i-gel™ with LMA ProSeal™ among patients receiving general anesthesia by performing searches in EMBASE, Cochrane, PubMed, and ScienceDirect. Discussion was adopted to resolve disagreements. Data were counted with Review Manger 5.3 and pooled by applying weighted mean difference (MD) and rlsk ratio (RR), and related 95% confidence intervals. RESULTS A total of 33 RCTs with 2605 patients were included in the meta-analysis. I-gel™ provided a considerably lower oropharyngeal leak pressure [weighted average diversity (MD) = -1.53 (-2.89, -0.17), P = 0.03], incidence of blood staining on the supraglottic airway devices [RR = 0.44, (0.28, 0.69), P = 0.0003], sore throat [RR = 0.31 (0.18, 0.52), P<0.0001], and a short insertion time [MD = -5.61 (-7.71, -3.51), P<0.00001] than LMA ProSeal™. Compared with LMA ProSeal™, i-gel™ offered a significantly higher first-insertion success rate [RR = 1.03 (1.00, 1.06), P = 0.03] and ease of insertion [RR = 1.06 (1.01, 1.11), P = 0.03]. The gastric-tube-placement first insertion rate [RR = 1.04 (0.99, 1.10), P = 0.11], laryngospasm [RR = 0.76 (0.17, 3.31), P = 0.72], and cough [RR = 1.30 (0.49, 3.44), P = 0.60] between the two devices were similar. CONCLUSIONS Both devices could achieve a good seal to provide adequate ventilation. Compared with the used LMA ProSeal™, the i-gel™ was found to have fewer complications (blood stainning, sore throat) and offers certain advantages (short insertion time, higher first-insertion success rate and ease of insertion) in patients under general anesthesia.
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Affiliation(s)
- Yuan Tan
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jingyao Jiang
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rurong Wang
- Departments of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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Schmucker Agudelo E, Farré Pinilla M, Andreu Riobello E, Franco Castanys T, Villaverde Castillo I, Monclus Diaz E, Aragonés Panadés N, Muñoz Luz A. An update in paediatric airway management. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:472-486. [PMID: 36096882 DOI: 10.1016/j.redare.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/25/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Schmucker Agudelo
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain.
| | | | - E Andreu Riobello
- Hospital Universitario Vall d'Hebrón, Área Materno Infantil, Barcelona, Spain
| | | | | | | | | | - A Muñoz Luz
- Hospital Universitario Dr. Josep Trueta, Girona, Spain
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Comparison of Proseal LMA with i-Gel in children under controlled ventilation: a prospective randomised clinical study. Braz J Anesthesiol 2021; 72:247-252. [PMID: 33823205 PMCID: PMC9373209 DOI: 10.1016/j.bjane.2021.02.042] [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: 03/27/2020] [Revised: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Supraglottic airway device is presently the most common modality of airway management in children for short surgical procedures. The i-gel is one such novel supraglottic airway device with a non-inflatable cuff. The objective of the present study was to evaluate the efficiency of i-gel compared to LMA Proseal regarding oropharyngeal leak pressure, insertion time, ease of insertion, and fibreoptic view of larynx. Methods After obtaining ethical clearance and parental consent, 70 children aged 2–10 years, weighing 10–30 kg were randomised to receive LMA Proseal or i-gel for airway management. Data with respect to oropharyngeal leak pressure, insertion time, ease of insertion, number of attempts, and fibreoptic score were collected. The primary outcome was the oropharyngeal leak pressure with the two supraglottic airway devices measured by manometric stability. Results Demographic data were comparable between the two groups. The oropharyngeal leak pressure (LMA Proseal vs. i-gel, 20.51 ± 4.71 cmH2O vs. 19.57 ± 5.71 cmH2O), ease of insertion, number of attempts, and fibreoptic view score was similar between the two groups. The insertion time was faster with i-gel (22.63 ± 5.79 s) compared to LMA Proseal (43.26 ± 7.85 s). Conclusion I-gel was similar to LMA Proseal with respect to oropharyngeal leak pressure in children under controlled ventilation.
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Rodrigues JPBB, Bacci SLLDS, Pereira JM, Johnston C, Azevedo VMGDO. Frequency and characterization of the use of cuffed tracheal tubes in neonatal and pediatric intensive care units in Brazil. Rev Bras Ter Intensiva 2020; 32:235-243. [PMID: 32667452 PMCID: PMC7405737 DOI: 10.5935/0103-507x.20200038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/26/2019] [Indexed: 01/23/2023] Open
Abstract
Objective To identify the neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil that use cuffed tracheal tubes in clinical practice and to describe the characteristics related to the use of protocols and monitoring. Methods To identify the intensive care units in Brazil, the Ministry of Health’s National Registry of Health Facilities was accessed, and information was collected on 693 registered intensive care units. This was an analytical cross-sectional survey conducted through electronic questionnaires sent to 298 neonatal, pediatric and mixed intensive care units in Brazil. Results This study analyzed 146 questionnaires (49.3% from neonatal intensive care units, 35.6% from pediatric intensive care units and 15.1% from mixed pediatric intensive care units). Most of the participating units (78/146) used cuffed tracheal tubes, with a predominance of use in pediatric intensive care units (52/78). Most of the units that used cuffed tracheal tubes applied a cuff pressure monitoring protocol (45/78). The use of cuff monitoring protocols was observed in intensive care units with a physical therapy service exclusive to the unit (38/61) and in those with a physical therapist present 24 hours/day (25/45). The most frequent cause of extubation failure related to the use of cuffed tracheal tubes in pediatric intensive care units was upper airway obstruction. Conclusion In this survey, the use of cuffed tracheal tubes and the application of a cuff pressure monitoring protocol was predominant in pediatric intensive care units. The use of a monitoring protocol was more common in intensive care units that had a physical therapist who was exclusive to the unit and was present 24 hours/day.
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Affiliation(s)
- João Paulo Berti Buzzi Rodrigues
- Programa de Residência em Área Profissional da Saúde (Uni e Multiprofissional), Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Suzi Laine Longo Dos Santos Bacci
- Programa de Residência em Área Profissional da Saúde (Uni e Multiprofissional), Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Janser Moura Pereira
- Faculdade de Matemática, Universidade Federal de Uberlândia, Uberlândia, MG, Brasil
| | - Cíntia Johnston
- Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Abstract
Airway devices were first used in children since 1940 and thereafter an increasingly large number of paediatric airway devices have come into our armamentarium. To control and protect the airway in children during anaesthesia, in intensive care unit or in emergency department either tracheal intubation is performed under direct or indirect visualization of vocal cords with the help of laryngoscopes or video-laryngoscopes respectively or it can be done blindly or by using special instruments such as fiberoptic laryngoscope, lighted stylet or Bullard laryngoscope to name a few. Airway also can be maintained with the help of Laryngeal mask airways, oropharyngeal and nasopharyngeal airways. Updating our information and knowledge regarding these developments is pivotal to our practice of paediatric anaesthesia. With a thorough search of books, MEDLINE, MEDNET, clinical trials.gov.in, this article aims at focusing and understanding a brief basis of paediatric devices and their use.
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Affiliation(s)
- Sarbari Swaika
- Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sujata Ghosh
- Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Chiranjib Bhattacharyya
- Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Chand R, Roy Chowdhury S, Rupert E, Mandal CK, Narayan P. Benefits of Using High-Volume-Low-Pressure Tracheal Tube in Children Undergoing Congenital Cardiac Surgery: Evidence From a Prospective Randomized Study. Semin Cardiothorac Vasc Anesth 2018; 22:300-305. [PMID: 29320927 DOI: 10.1177/1089253217750753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the past 2 decades, usage of high-volume-low-pressure microcuffed tracheal tubes in smaller children has increased. However, there is paucity of evidence of its usage in smaller children undergoing congenital cardiac surgery. The aim of this study was to assess if microcuff endotracheal tubes in neonates and younger children undergoing congenital cardiac surgery is associated with better outcomes than uncuffed tubes. METHODS We carried out this single-center, prospective, randomized study between June and November 2016. Eighty patients were randomized into those receiving microcuff tracheal tubes and conventional uncuffed tubes. Primary outcome was stridor postextubation. Secondary outcomes measured included number of tube changes, volume of anesthetic gases required, and cost incurred. RESULTS The 2 groups were comparable in terms of baseline characteristics and duration of intubation. Incidence of stridor was significantly higher in conventional uncuffed tubes (12 [30%] vs 4 [10%]; P = .04) and so was the number of tube changes required (17/40 [42.5%] vs 2/40 [5%]; P ≤ .001). Tube change was associated with more than 3-fold risk of stridor (odds ratio = 3.92; 95% confidence interval = 1.23-12.43). Isoflurane (29.14 ± 7.01 mL vs19.2 ± 4.81 mL; P < .0001) and oxygen flow requirement ( P < .0001) and the resultant cost (7.46 ± 1.4 vs 5.77 ± 1.2 US$; P < .0001) were all significantly higher in the conventional uncuffed group. CONCLUSION Microcuff pediatric tracheal tube is associated with significantly lower incidence of stridor, tube changes, and anesthetic gas requirement. This leads to significant cost reduction that offsets the higher costs associated with usage of a microcuff tracheal tube.
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Affiliation(s)
- Rakesh Chand
- 1 NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Saibal Roy Chowdhury
- 1 NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Emmanuel Rupert
- 1 NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Chandan Kumar Mandal
- 1 NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Pradeep Narayan
- 1 NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Mukhopadhyay S, Mukhopadhyay S, Bhattacharya D, Bandyopadhyay BK, Mukherjee M, Ganguly R. Clinical performance of cuffed versus uncuffed preformed endotracheal tube in pediatric patients undergoing cleft palate surgery. Saudi J Anaesth 2016; 10:202-7. [PMID: 27051374 PMCID: PMC4799615 DOI: 10.4103/1658-354x.168842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Uncuffed endotracheal tubes are commonly used in children but due to several decade preferred in paediatric oral surgery. Due to lack of conclusive evidences in this regard, we have conducted this study to compare post-operative morbidity following use of cuffed and uncuffed endotracheal tubes in paediatric patients undergoing cleft lip-palate surgery. Methods: This randomised controlled trial was conducted on children aged 2 to 12 years.110 patients were allocated in two parallel groups using computer generated list of random numbers. Post operative extubation stridor, sore throat, time to first oral intake and regaining of normal voice were compared between two groups. Results: The incidence of sore throat was significantly more (P value > 0.005) in patients of uncuffed group compared to cuffed group. The time to first oral intake and time to regain normal voice were significantly earlier in cuffed group compared to the other. Conclusion: With standard care, preformed cuffed ET tube has shown reduced incidence of post operative sore throat. Cuffed group has earlier oral intake and normal voice regain compared to uncuffed group.
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Affiliation(s)
- S Mukhopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - S Mukhopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - D Bhattacharya
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - B K Bandyopadhyay
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - M Mukherjee
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - R Ganguly
- Department of Anaesthesiology and Critical Care, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
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JENSEN LL, BARATT‐DUE A, ENGLUND PN, HARJU JA, SIGURÐSSON TS, LIBERG J. Paediatric ventilation treatment of acute lung injury in Nordic intensive care units. Acta Anaesthesiol Scand 2015; 59:568-75. [PMID: 25762113 PMCID: PMC6681019 DOI: 10.1111/aas.12500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 12/14/2022]
Abstract
Background Treatment of acute respiratory distress syndrome (ARDS) in children is largely based on extrapolated knowledge obtained from adults and which varies between different hospitals. This study explores ventilation treatment strategies for children with ARDS in the Nordic countries, and compares these with international practice. Methods In October 2012, a questionnaire covering ventilation treatment strategies for children aged 1 month to 6 years of age with ARDS was sent to 21 large Nordic intensive care units that treat children with ARDS. Pre‐terms and children with congenital conditions were excluded. Results Eighteen of the 21 (86%) targeted intensive care units responded to the questionnaire. Fifty per cent of these facilities were paediatric intensive care units. Written guidelines existed in 44% of the units. Fifty per cent of the units frequently used cuffed endotracheal tubes. Ventilation was achieved by pressure control for 89% vs. volume control for 11% of units. Bronchodilators were used by all units, whereas steroids usage was 83% and surfactant 39%. Inhaled nitric oxide and high frequency oscillation were available in 94% of the units. Neurally adjusted ventilator assist was used by 44% of the units. Extracorporeal membrane oxygenation could be started in 44% of the units. Conclusion Ventilation treatment strategies for paediatric ARDS in the Nordic countries are relatively uniform and largely in accordance with international practice. The use of steroids and surfactant is more frequent than shown in other studies.
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Affiliation(s)
- L. L. JENSEN
- Department of Anaesthesia and Intensive Care Aarhus University Hospital Aarhus Denmark
| | - A. BARATT‐DUE
- Department of Paediatric Anaesthesia and Intensive Care Oslo University Hospital Rikshospitalet Norway
| | - P. N. ENGLUND
- Department of Paediatric Anaesthesia and Intensive Care Drottning Silvias University Hospital Gothenburg Sweden
| | - J. A. HARJU
- Department of Anaesthesia and Intensive Care Tampere University Hospital Tampere Finland
| | - T. S. SIGURÐSSON
- Department of Paediatric Anaesthesia and Intensive Care Skåne University Hospital Lund Sweden
| | - J.‐P. LIBERG
- Department of Anaesthesia and Intensive Care St. Olavs Hospital Trondheim University Hospital Trondheim Norway
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Singh P, Anand S. Endotracheal intubation challenges to oral cavity - prevention strategy. J Surg Tech Case Rep 2014; 6:70. [PMID: 25598948 PMCID: PMC4290045 DOI: 10.4103/2006-8808.147265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Preetinder Singh
- Department of Periodontology and Oral Implantology, SDD Hospital and Dental College, Barwala, Haryana, India. E-mail:
| | - Samir Anand
- Rayat and Bahra Dental College, Kharar, Mohali, chandigarh, Punjab, India
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Mathew S, Chaudhuri S, Arun Kumar H, Joseph TT. Airway management in Escobar syndrome: A formidable challenge. Indian J Anaesth 2014; 57:603-5. [PMID: 24403623 PMCID: PMC3883398 DOI: 10.4103/0019-5049.123336] [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
Escobar syndrome is a rare autosomal recessive disorder characterized by flexion joint and digit contractures, skin webbing, cleft palate, deformity of spine and cervical spine fusion. Associated difficult airway is mainly due to micrognathia, retrognathia, webbing of neck and limitation of the mouth opening and neck extension. We report a case of a 1 year old child with Escobar syndrome posted for bilateral hamstrings to quadriceps transfer. The child had adequate mouth opening with no evidence of cervical spine fusion, yet we faced difficulty in intubation which was ultimately overcome by securing a proseal laryngeal mask airway (PLMA) and then by intubating with an endotracheal tube railroaded over a paediatric fibreoptic bronchoscope passed through the lumen of a PLMA.
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Affiliation(s)
- Shaji Mathew
- Department of Anaesthesia, Kasturba Medical College, Manipal, Karnataka, India
| | - Souvik Chaudhuri
- Department of Anaesthesia, Kasturba Medical College, Manipal, Karnataka, India
| | - Hd Arun Kumar
- Department of Anaesthesia, Kasturba Medical College, Manipal, Karnataka, India
| | - Tim Thomas Joseph
- Department of Anaesthesia, Kasturba Medical College, Manipal, Karnataka, India
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Gómez-Ríos MÁ, Gómez-Ríos D. New airway devices in paediatric anesthesia. Indian J Anaesth 2013; 57:310-1. [PMID: 23983299 PMCID: PMC3748695 DOI: 10.4103/0019-5049.115582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manuel Á. Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, Galicia, Spain,Address for correspondence: Dr. Manuel A. Gómez-Ríos, Xubias de arriba, 84, 15006, Spain. E-mail:
| | - David Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, Galicia, Spain
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