Supraglottic airway devices in short gynecological procedures: A randomized, clinical study comparing the Baska® mask and I-Gel® device

Efficacy of Baska mask as an alternative airway device to endotracheal tube in patients undergoing laparoscopic surgeries under controlled ventilation

BACKGROUND AND AIMS

Newer supraglottic devices with an additional gastric channel offer greater protection from aspiration and avoidance of laryngoscopy for their insertion would result in attenuated hemodynamic responses.The primary objective was to assess hemodynamic responses to insertion of Baska mask as compared to tracheal intubation. The time and attempts taken to secure airway and evidence of regurgitation and pulmonary aspiration of gastric contents were also assessed.

MATERIAL AND METHODS

This prospective, randomized study was conducted in 80 patients undergoing laparoscopic cholecystectomy. All patients received standardized anaesthesia protocol. Baska mask was used to secure airway in Group B, while tracheal intubation was done in group T. Methylene blue was injected through Ryle's tube into stomach in both groups. At end of surgery, fibreoptic bronchoscopy was performed to detect bluish staining of trachea and/or main bronchi as evidence of aspiration of gastric contents and bluish staining in oropharynx as evidence of regurgitation. Chi-square test and Independent sample t-test were applied.

RESULTS

The time taken to secure airway was significantly longer in Group B as compared to Group T (45.3 ± 12.6 vs. 24.3 ± 9.1 sec) Percentage of patients who had oropharyngeal blue stain was comparable in both groups. No patient in both groups had tracheal blue stain. Group T had significantly higher HR and MAP after intubation till 10 min later.

CONCLUSION

Baska mask insertion was associated with attenuated hemodynamic responses, though more time and attempts were required for securing the airway. It could be considered as an alternative to tracheal intubation during laparoscopic surgeries.

An unanticipated case of laryngeal mask failure due to hypopharyngeal mass: a case report

Supraglottic airway devices (SAD) have got popularity in the anesthetic practice owing to easy insertion, rapid airway access and lower incidence of complications. Igel® is a second generation SAD with a non‐inflatable cuff and gastric drainage channel. Despite ease of insertion, there are still cases of failure of Igel® insertion to secure airway. We are hereby presenting a case of unanticipated difficulty in Igel® insertion in a 35-years-old female due to a hypopharyngeal growth. This article aims to send a reminder that despite anticipated easy airway, definitive plan for securing airway should always be ready.

Baska mask versus endotracheal tube in laparoscopic cholecystectomy surgery: a prospective randomized trial

Background: Supraglottic airway devices have increasingly been used as the airway technique of choice in laparoscopic surgeries. This study compared the efficacy and safety of the Baska Mask with endotracheal tube (ETT) in patients undergoing elective laparoscopic cholecystectomy.Research design and methods: This single-center, prospective, randomized controlled trial recruited 60 patients aged 18-75 years with American Society of Anesthesiologists' classifications I to III. The time taken to achieve effective airway, number of attempts, ease of insertion, ventilation parameters, hemodynamics data, and pharyngolaryngeal complications were recorded.Results: The time taken to achieve effective airway was shorter for the Baska group (26.6 ± 4.7 vs. 47.2 ± 11.8 s; p < 0.001), although the first-time insertion success rate was ≥90% for both groups. The ETT group experienced more pharyngolaryngeal complications, including cough, trauma, spasm, dysphonia, and sore throat, during device insertion and removal and had higher systolic and diastolic blood pressures during intubation (p = 0.001). The Baska Mask achieved significantly lower peak airway pressure (p = 0.024) with stable oropharyngeal leak pressure ≥33 cmH₂O throughout the surgery.Conclusions: The Baska Mask is a suitable alternative to endotracheal intubation in selected patients undergoing laparoscopic cholecystectomy, with shorter insertion times, fewer perioperative complications, and improved ventilatory performance and hemodynamic response.Trial registration: The trial is registered at ClinicalTrials.gov (NCT03045835), 8 February 2017.

A multicenter and observational study of the Ambu™ AuraGain™ laryngeal mask in adult patients

PURPOSE

The main objective of this study was to evaluate the performance of the Ambu™ AuraGain™ device by determining its main parameters of use and complications.

METHODS

A total of 250 adult ASA physical status i to iii patients from five hospitals in Spain who received general anaesthesia with a supraglottic airway (SGA) device were enrolled in this study.

RESULTS

The primary outcome was analysed for 244 patients and a median OLP of 32 cm H2O (IQR 28-36 cm H2O) was obtained. Insertion was achieved at first attempt in 85% of cases, and overall in 98% of cases, in a median time of 15 s (12-22.5). We applied manoeuvres in 61% of patients to facilitate the process. Ventilation was effective in 97.2% of the interventions (95% CI 0.99-0.94) throughout the procedure. Insertion of the gastric tube was easily performed in 99.6% of the patients, and the vocal cords were viewed by fibrobronchoscopy in 96.3% of cases. Logistic regression analysis identified the use of sizes smaller than those recommended as a risk factor for low OLP (< 25 cm H2O). The main complication recorded was the presence of blood when withdrawing the SGA device (15%).

CONCLUSIONS

Our results confirm that the use of AuraGain allows airway management in a reliable and effective way achieving high OLP and low incidence of associated complications, establishing it as a useful alternative in the routine clinical setting of anaesthesiologists. AuraGain performance was consistent in all five centres.

Effectiveness of the Baska mask versus the i-gel device in adult patients under general anesthesia: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the ease of use, effectiveness of airway management, and incidence of perioperative complications of the Baska mask compared to the i-gel device in adult patients undergoing elective procedures with general anesthesia.

INTRODUCTION

Supraglottic airway devices have been widely used for airway management in patients undergoing various surgical procedures under general anesthesia. The Baska mask and the i-gel device are two commonly used second-generation supraglottic airway devices that offer a noninvasive alternative to the endotracheal tube given the ease of insertion, rapidity, low risk of postoperative complications, and reduced autonomic imbalance during insertion. However, there is a dearth of studies comparing the clinical performance of these two devices.

INCLUSION CRITERIA

This review will consider studies with adults aged 18 years or older who underwent elective surgical procedures under general anesthesia and received ventilation with the Baska mask or i-gel. Only randomized controlled trials comparing the two devices will be considered.

METHODS

MEDLINE, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, OpenGrey, and ProQuest Dissertations and Theses will be searched to identify both published and unpublished studies. Titles and abstracts will be screened to identify potentially relevant papers. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. Data will be synthesized using statistical meta-analysis with heterogeneity of data being assessed using the standard chi-squared and I2 tests, if possible.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020168774.

Incidence and Severity of Postoperative Pharyngolaryngeal Complications following Use of Baska Mask versus Endotracheal Intubation

Background:

Use of Baska Mask, since a supraglottic airway device, could result in low incidence of postoperative pharyngolaryngeal complications.

Aims:

The objectives were to compare the effect of Baska Mask versus endotracheal intubation on the incidence and severity of postoperative sore throat (POST), postoperative hoarseness of voice (POHV), and postoperative cough (POC).

Settings and Design:

This prospective randomized study was conducted in a tertiary care teaching institute in 120 patients undergoing short laparoscopic surgeries.

Subjects and Methods:

Airway was secured using with low-pressure, high-volume cuffed endotracheal tube in Group T and with Baska Mask in Group B. POST, POC, and POHV were assessed at 2, 6, 12, and 24 h after surgery. Those with Grade III score throat were managed by gargling with dispersible aspirin 75 mg.

Statistical Analysis Used:

Pearson's Chi-square test, Fisher's exact test, and independent sample t-test were used as applicable.

Results:

Group B patients required significantly more attempts at securing airway. Incidence of POST was significantly higher in Group T as compared to that Group B at 2, 6, 12, and 24 h after surgery. POC was significantly more in Group T at 2, 6, and 12 h. No patient in Group B had POC at 12 and 24 h. POHV showed significantly higher incidence in Group T at 2 and 6 h. No patient in Group B had hoarseness at 6, 12, and 24 h.

Conclusion:

Use of Baska Mask as compared to endotracheal intubation significantly reduces the incidence and severity of pharyngolaryngeal complications such as POST, POC, and POHV in patients undergoing short laparoscopic surgeries.