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Arime H, Asai T, Saito T, Okuda Y. Remimazolam: a randomized controlled study of its suitability for insertion of a supraglottic airway. J Anesth 2023; 37:762-768. [PMID: 37491669 DOI: 10.1007/s00540-023-03231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/15/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Loss of motor response to thrusting the jaw forward is a useful indicator for uncomplicated insertion of a supraglottic airway. The aim of this study was to assess the suitability of remimazolam for insertion of a supraglottic airway assessed by loss of response to jaw thrusting. METHODS Seventy patients, who were scheduled for elective surgeries under general anesthesia, were allocated randomly to one of two groups. In one group (remimazolam group), remimazolam was infused 12 mg kg-1 h-1 (50 mg maximum), and in the other (propofol group), propofol was infused at 120 mg kg-1 h-1 (500 mg maximum). Once the eyelash reflex disappeared, response to jaw thrusting was assessed. Primary outcome measure was the proportion of patients with loss of response to jaw thrusting before reaching the maximum dose of the test drug. We planned an interim analysis (of one time) after 40 patients, using the Pocock adjustment method. RESULTS From the interim analysis results, the study was stopped after recruitment of 40 patients. Loss of response to jaw thrusting was observed in all of 21 patients (100%) in the propofol group, and in 9 of 19 patients (47%) in the remimazolam group. There was a significant difference in the proportion between the groups (P = 0.0001, 95% CI for difference 30-75%). CONCLUSION Remimazolam frequently does not inhibit response to jaw thrusting, and thus remimazolam is not a suitable induction agent for uncomplicated insertion of a supraglottic airway unless either a neuromuscular blocking agent or an opioid is co-administered.
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Affiliation(s)
- Hayato Arime
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, 343-8555, Japan.
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, 343-8555, Japan
| | - Tomoyuki Saito
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, 343-8555, Japan
| | - Yasuhisa Okuda
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, 343-8555, Japan
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2
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Jung H. A comprehensive review of difficult airway management strategies for patient safety. Anesth Pain Med (Seoul) 2023; 18:331-339. [PMID: 37919917 PMCID: PMC10635845 DOI: 10.17085/apm.23123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
Difficult airway management is critical to ensuring patient safety. It involves addressing the challenges and failures that can occur, even with skilled healthcare providers, during face mask ventilation, intubation, supraglottic airway placement, invasive airway procedures, or extubation. Although the incidence of the most critical situation in airway management, "cannot intubate, cannot oxygenate," is low at 0.0019-0.04%, its occurrence can have severe consequences, including dental injury, airway injury, hypoxic brain damage, and even death. This study aimed to offer healthcare providers a comprehensive and evidence-based approach for difficult airway management by reviewing recent guidelines and incorporating the latest evidence-based practices to improve their preparedness and competence in difficult airway management, and thus ultimately contribute to improved patient safety.
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Affiliation(s)
- Hoon Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Palisch AC. Airway Management of the Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:543-558. [PMID: 37391249 DOI: 10.1016/j.emc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Appropriate airway management is critical to successful cardiac arrest resuscitation. However, the timing and method of airway management during cardiac arrest have traditionally been guided by expert and consensus opinion informed by observational data. In the last 5 years, recent studies, including several randomized controlled trials (RCTs), have provided additional clarity to help guide airway management. This article will review both current data and guidelines for airway management in cardiac arrest, a stepwise approach to airway management, the utility of various airway adjuncts, and best practices for oxygenation and ventilation in the peri-arrest period.
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Affiliation(s)
- Anthony Chase Palisch
- Department of Emergency Medicine, Vanderbilt University, 1211 Medical Center Drive, Nashville, TN 37232, USA.
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Scholz SS, Linder S, Latka E, Bartnick T, Karla D, Thaemel D, Wolff M, Sauzet O, Rehberg SW, Thies KC, Jansen G. Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest - a randomised manikin study. BMC Emerg Med 2023; 23:48. [PMID: 37189061 PMCID: PMC10184619 DOI: 10.1186/s12873-023-00820-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/05/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Although airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes. METHODS In this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants' subjective assessment of aerosol release using a Likert-scale (0 = no release-10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3. RESULTS A total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8). CONCLUSIONS COVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.
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Affiliation(s)
- Sean S Scholz
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Sissy Linder
- Skillslab, Medical School East Westphalia-Lippe, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Eugen Latka
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany
| | - Tobias Bartnick
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany
| | - Daniel Karla
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany
| | - Daniel Thaemel
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany
| | - Marlena Wolff
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany
| | - Odile Sauzet
- Epidemiology and International Public Health, Bielefeld School of Public Health & Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Karl-Christian Thies
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, University Hospital OWL, Protestant Hospital of the Bethel Foundation, University of Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Gerrit Jansen
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Remterweg 44, D-33617, Bielefeld, Germany.
- Medical School, Bielefeld University, University Medical Center East Westphalia-Lippe, Universitätsstraße 25, 33615, Bielefeld, Germany.
- University Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, Ruhr University Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany.
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Ishibashi H, Wakejima R, Kurihara Y, Seto K, Baba S, Asakawa A, Toyama S, Uchida T, Okubo K. Extubation by supraglottic airway after lobectomy prevents cough associated air leaks and prolonged coughing or sore throat. Eur J Cardiothorac Surg 2023; 63:7133743. [PMID: 37079745 DOI: 10.1093/ejcts/ezad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Double-lumen endobronchial tubes are essential for differential lung ventilation during pulmonary lobectomy, but they are more rigid, longer, larger in diameter, and irritable. Coughing at extubation sometimes causes airway and lung injury, which causes severe air leaks, prolonged cough, and sore throat. We examined the prevalence of cough associated air leaks at extubation and postoperative cough or sore throat after lobectomy, and evaluated the efficacy of supraglottic airway in preventing these complications. METHODS Patient characteristics, and operative and postoperative factors data were collected from patients who underwent pulmonary lobectomy between January 2013 and March 2022. After propensity score matching, these data were compared between the supraglottic airway and double-lumen endobronchial tubes groups. RESULTS 1069 patients with lung cancer (supraglottic airway, 641; double-lumen endobronchial tubes, 428) were enrolled and coughing at extubation occurred in 100 (23.4%) patients in the double-lumen endobronchial tubes group, 65 (65.0%) showed increased cough associated air leaks at extubation and 20 (30.8%) showed prolonged air leaks. Coughing at extubation occurred in 6 (0.9%) in the supraglottic airway group. In 193 patients from each group after propensity score matching, coughing at extubation and the associated air leak increase were significantly lower in the supraglottic airway group. Visual analogue scale of postoperative cough and sore throat on postoperative days 2, 7, and 30 were significantly lower in the supraglottic airway group. CONCLUSIONS Supraglottic airway is effective and safe for preventing cough associated air leaks and prolonged postoperative cough or sore throat at extubation following pulmonary lobectomy.
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Affiliation(s)
- Hironori Ishibashi
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ryo Wakejima
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasuyuki Kurihara
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Katsutoshi Seto
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shunichi Baba
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ayaka Asakawa
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Satoshi Toyama
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tokujiro Uchida
- Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kenichi Okubo
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Ní Eochagáin A, Athanassoglou V, Cumberworth A, Morris O, Corbett S, Jefferson H, O'Sullivan EP, Pandit JJ. Assessing a novel second generation laryngeal mask airway using the 'ADEPT' approach: results from the LMA® Protector™ observational study. J Clin Monit Comput 2023; 37:517-524. [PMID: 36063277 PMCID: PMC9441326 DOI: 10.1007/s10877-022-00910-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
To address the problem of lack of clinical evidence for airway devices introduced to the market, the Difficult Airway Society (UK) developed an approach (termed ADEPT; Airway Device Evaluation Project Team) to standardise the model for device evaluation. Under this framework we assessed the LMA Protector, a second generation laryngeal mask airway. A total of 111 sequential adult patients were recruited and the LMA Protector inserted after induction of general anaesthesia. Effective insertion was confirmed by resistance to further distal movement, manual ventilation, and listening for gas leakage at the mouth. The breathing circuit was connected to the airway channel and airway patency confirmed with manual test ventilation at 20 cm H20 (water) pressure for 3 s. Data was collected in relation to the time for placement, intraoperative performance and postoperative performance of the airway device. Additionally, investigators rated the ease of insertion and adequacy of lung ventilation on a 5-point scale. The median (interquartile range [range]) time taken to insertion of the device was 31 (26-40[14-780]) s with the ability to ventilate after device insertion 100 (95% CI 96.7- 100)%. Secondary endpoints included one or more manoeuvres 60.3 (95% CI 50.6-69.5)% cases requiring to assist insertion; a median ease of insertion score of 4 (2-5[3-5]), and a median adequacy of ventilation score of 5 (5-5[4-5]). However, the first time insertion rate failure was 9.9% (95% CI 5.1-17.0%). There were no episodes of patient harm recorded, particularly desaturation. The LMA Protector appears suitable for clinical use, but an accompanying article discusses our reflections on the ADEPT approach to studying airway devices from a strategic perspective.
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Affiliation(s)
- A Ní Eochagáin
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - V Athanassoglou
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Cumberworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - O Morris
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - S Corbett
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - H Jefferson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E P O'Sullivan
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - J J Pandit
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- University of Oxford, Oxford, UK.
- St John's College, Oxford, OX1 3JP, UK.
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Lv J, Ding X, Zhao J, Zhang H, He J, Ma L, Lv J. A combination of supraglottic airway and bronchial blocker for one-lung ventilation in infants undergoing thoracoscopic surgery. Heliyon 2023; 9:e13576. [PMID: 36846679 PMCID: PMC9950831 DOI: 10.1016/j.heliyon.2023.e13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Objectives One-lung ventilation (OLV) for children under the age of two years is difficult. The authors hypothesize that a combination of a supraglottic airway (SGA) device and intraluminal placement of a bronchial blocker (BB) may provide an appropriate choice. Design A prospective method-comparison study. Setting Second Affiliated Hospital of Xi'an Jiaotong University, China. Participants 120 patients under the age of two years undergoing thoracoscopic surgery with OLV. Interventions Participants were randomly assigned to receive intraluminal placement of BB with SGA (n = 60) or extraluminal placement of BB with endotracheal tube (ETT) (n = 60) for OLV. Measurements and main results The primary outcome was the length of postoperative hospitalization stay. The secondary outcomes were the basic parameters of OLV and investigator-defined severe adverse events. The postoperative hospitalization stay was 6 days (interquartile range, IQR 4-9) in SGA plus BB group compared with 9 days (IQR 6-13) in ETT plus BB group (P = 0.034). The placement and positioning duration of SGA plus BB was 64 s (IQR 51-75) compared with 132 s (IQR 117-152) of ETT plus BB (P = 0.001). The values of leukocyte (WBC) and C-reactive protein (CRP) of SGA plus BB group on the first day of post-operation were 9.8 × 109/L (IQR 7.4-14.5) and 15.1 mg/L (IQR 12.5-17.3) compared with 13.6 × 109/L (IQR 10.8-17.1) and 19.6 mg/L (IQR 15.0-23.5) of ETT plus BB group (P = 0.022 and P = 0.014). Conclusion There were few if any significant adverse events in the intervention group (SGA plus BB) for OLV in children under the age of two years, and this method seems worthy of clinical application. Meanwhile, the mechanism for this novel technique to shorten the length of postoperative hospitalization stay needs to be further explored.
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Affiliation(s)
- Junlin Lv
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoying Ding
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Zhao
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huijuan Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiaojiao He
- Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lei Ma
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China,Corresponding author. Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shaanxi, China.
| | - Jianrui Lv
- Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China,Corresponding author. Department of Anesthesiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shaanxi, China.
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Lyra JC, Guinsburg R, de Almeida MFB, Variane GFT, Souza Rugolo LMSD. Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey. Resusc Plus 2022; 13:100336. [PMID: 36582476 PMCID: PMC9792880 DOI: 10.1016/j.resplu.2022.100336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals' familiarity in using LMA in Brazil, this study aimed to describe the health professionals' knowledge and practice of using LMA, who provide neonatal care in the country. Methods An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room. Results We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use. Conclusion This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
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Affiliation(s)
- João Cesar Lyra
- Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Brazil,Corresponding author at: Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Distrito de Rubiao Junior – Av. Prof, Mario Rubens Guimaraes Montenegro s/n; Botucatu, Sao Paulo 18618-687, Brazil.
| | - Ruth Guinsburg
- Division of Neonatal Medicine - Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil
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Sato T, Mimuro S, Kurita T, Kobayashi M, Doi M, Katoh T, Nakajima Y. Recall of extubation after remimazolam anesthesia with flumazenil antagonism during emergence: a retrospective clinical study. J Anesth 2022. [PMID: 36076100 DOI: 10.1007/s00540-022-03093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/30/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This study was performed to examine and compare the incidence of extubation recall in surgical patients who underwent remimazolam anesthesia with flumazenil antagonism during emergence and in those who underwent propofol anesthesia. METHODS One hundred sixty-three patients who underwent surgery using general endotracheal or supraglottic airway anesthesia with propofol (n = 97) or remimazolam (n = 66) were retrospectively analyzed. Remimazolam was antagonized by flumazenil after discontinuation of remimazolam at the end of surgery. The endotracheal tube or supraglottic airway was removed after surgery was complete, and consciousness and adequate spontaneous breathing were confirmed. The incidence of extubation recall was compared between the remimazolam and propofol anesthesia groups using propensity score matching. RESULTS Extubation recall was observed in 28 patients (17%). After propensity score matching, the incidence of extubation recall did not significantly differ between the remimazolam and propofol anesthesia groups (15.6% vs. 18.8%; p = 1.000). CONCLUSION The incidence of extubation recall after remimazolam anesthesia with flumazenil antagonism during emergence did not significantly differ from that after propofol anesthesia.
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Abstract
Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.
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Affiliation(s)
- Megan J Cobb
- University of Maryland School of Medicine, Department of Emergency Medicine; Maryland Emergency Medicine Network, Upper Chesapeake Emergency Medicine, 500 Upper Chesapeake Dr, Bel Air, MD 21014, USA.
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Benoit JL, Stolz U, McMullan JT, Wang HE. Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2021; 160:59-65. [PMID: 33482266 DOI: 10.1016/j.resuscitation.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) studies have focused on the benefits and harms of placing an intra-arrest advanced airway, but few studies have evaluated the benefits and harms after successful placement. We hypothesize that increased time in the tumultuous prehospital environment after intra-arrest advanced airway placement results in reduced patient survival. METHODS This was a secondary analysis of adult, non-traumatic, OHCA patients with an advanced airway placed in the PRIMED trial. The exposure variable was the time interval between successful advanced airway placement and Emergency Department (ED) arrival. The outcome was cerebral performance category (CPC) 1 or 2 at hospital discharge. Multivariable logistic regression, adjusted for Utstein variables and resuscitation-associated time intervals, was used to estimate adjusted odds ratios (aOR). RESULTS The cohort of complete cases included 4779 patients. The median time exposed to a prehospital advanced airway was 27 min (IQR 20-35). The total prehospital time was 39.4 min (IQR 32.3-48.1). An advanced airway was placed intra-arrest in 3830 cases (80.1%) and post-return of spontaneous circulation (post-ROSC) in 949 cases (19.9%). Overall, 486 (10.2%) of the cohort achieved the CPC outcome, but this was higher in the post-ROSC (21.7%) versus intra-arrest (7.5%) cohort. CPC was not associated with the time interval from advanced airway placement to ED arrival in the intra-arrest airway cohort (aOR 0.98, 95%CI 0.94-1.01). CONCLUSIONS In OHCA patients who receive an intra-arrest advanced airway, longer time intervals exposed to a prehospital advanced airway are not associated with reduced patient survival.
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Affiliation(s)
- Justin L Benoit
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Uwe Stolz
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason T McMullan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
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12
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Abstract
Airway management during cardiac arrest has undergone several advancements. Endotracheal intubation (ETI) often is considered the gold standard for airway management in cardiac arrest; however, other options exist. Recent prospective randomized trials have compared outcomes in bag-valve mask ventilation and supraglottic airways to ETI in out-of-hospital cardiac arrest. ETI, if performed early in resuscitation, is associated with worse patient outcomes and has been de-emphasized so as not to interfere with other aspects of the resuscitation. Hyperventilation has multiple theoretic harms during cardiac arrest, and methods, such as compression-adjusted ventilation, may be utilized to help reduce the incidence of hyperventilation.
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Affiliation(s)
- Jestin N Carlson
- Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, 232 West 25th Street, Erie, PA 16544, USA.
| | - Henry E Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, 64312 Fannin Street, JJL 434, Houston, TX 77030, USA
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13
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Abstract
Purpose of Review This review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios. Recent Findings Based on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events. Some strategies to manage the extubation of the challenging/difficult airway have been described. Summary Extubating the challenging/difficult airway is a high-risk situation. However, it is fundamental to keep in mind that intended extubation is always an elective procedure. As such, it is imperative to adhere to principles of careful patient and context assessment, planning, and execution only when optimal conditions have been secured.
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Affiliation(s)
- Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON M5G 1E2 Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, EN 429 - 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON Canada
| | - Richard M Cooper
- Department of Anesthesiology and Pain Medicine, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON M5G 1E2 Canada
| | - Elizabeth C Behringer
- Division of CardioVascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, 1526 N Edgemont, Los Angeles, CA 90027 USA
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14
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Affiliation(s)
- Wan Yen Lim
- Division of anaesthesiology and perioperative sciences, Sengkang general hospital, Singapore general hospital, Singapore, Singapore; Duke-NUS medical school, Singapore, Singapore
| | - Patrick Wong
- Duke-NUS medical school, Singapore, Singapore; Yong Loo Lin school of medicine, National university of Singapore, Singapore; Division of anaesthesiology and perioperative sciences, FRCA, Sengkang general hospital, Singapore general hospital, Singapore, Singapore.
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15
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Calheiros J, Charco-Mora P. Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:316-324. [PMID: 32143822 DOI: 10.1016/j.redar.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.
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Affiliation(s)
- J Calheiros
- Departamento de Anestesia, Unidade Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal.
| | - P Charco-Mora
- Departamento de Anestesiología y Cuidados Intensivos, Hospital Clínico Universitario de Valencia, Valencia, España
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16
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Seet E, Zhang J, Macachor J, Kumar CM. Choosing the best supraglottic airway for ophthalmic general anaesthesia: a manikin study. J Clin Monit Comput 2020; 35:443-447. [PMID: 32274646 PMCID: PMC7223643 DOI: 10.1007/s10877-020-00507-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022]
Abstract
General anaesthesia is sometimes favoured over regional anaesthesia in ophthalmic surgery. The use of supraglottic airway (SGA) or laryngeal mask airway (LMA) as the primary airway device is increasing due to numerous advantages over tracheal intubation. Compared with 1st generation SGAs, 2nd generation SGAs have an added benefit of isolating the airway from the alimentary tract. However, the vertical profile of SGAs may encroach into the surgical field and hence interfere with surgery. We investigated the vertical projections of 1st generation SGAs (LMA Classic, Ambu AuraFlex) and commonly used 2nd generation SGAs in our institution (LMA ProSeal, LMA Supreme, LMA Protector, Ambu AuraGain and I-gel) in a manikin model. Each device was connected to a corrugated catheter mount or angled connector following insertion as per usual clinical practice in our institutions. Vertical projections of all devices were measured from the chin using a centimetre ruler. Securing of airway device to the chin with an adhesive tape was possible for the LMA Classic and Ambu AuraFlex with straight corrugated connector, whereas the stiffer 2nd generations SGAs required the addition of an angled connector or straight corrugated tubing to direct the airway tube caudally, away from the surgical field. The LMA ProSeal had the lowest vertical projection amongst the 2nd generation SGAs and may be the suitable choice for ophthalmic surgery. We also describe a novel technique of utilising a 1st generation SGA with placement of an orogastric tube, although with some reservations. This study has several limitations and transferability of our findings into clinical practice is questionable as the use of a manikin may not fully imitate the real condition of the patient. Our study is the first study comparing vertical projected height of different SGAs in manikin, but future studies should investigate the use of SGA in the clinical setting during ophthalmic surgery.
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Affiliation(s)
- Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore
| | - Jinbin Zhang
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Joselo Macachor
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore, 768828, Singapore.
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17
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Holley J, Moore JC, Jacobs M, Rojas-Salvador C, Lick C, Salverda BJ, Lick MC, Frascone RJ, Youngquist ST, Lurie KG. Supraglottic airway devices variably develop negative intrathoracic pressures: A prospective cross-over study of cardiopulmonary resuscitation in human cadavers. Resuscitation 2020; 148:32-38. [PMID: 31962176 DOI: 10.1016/j.resuscitation.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/14/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
AIM OF THE STUDY Negative intrathoracic pressure (ITP) during the decompression phase of cardiopulmonary resuscitation (CPR) is essential to refill the heart, increase cardiac output, maintain cerebral and coronary perfusion pressures, and improve survival. In order to generate negative ITP, an airway seal is necessary. We tested the hypothesis that some supraglottic airway (SGA) devices do not seal the airway as well the standard endotracheal tube (ETT). METHODS Airway pressures (AP) were measured as a surrogate for ITP in seven recently deceased human cadavers of varying body habitus. Conventional manual, automated, and active compression-decompression CPR were performed with and without an impedance threshold device (ITD) in supine and Head Up positions. Positive pressure ventilation was delivered by an ETT and 5 SGA devices tested in a randomized order in this prospective cross-over designed study. The primary outcome was comparisons of decompression AP between all groups. RESULTS An ITD was required to generate significantly lower negative ITP during the decompression phase of all methods of CPR. SGAs varied in their ability to support negative ITP. CONCLUSION In a human cadaver model, the ability to generate negative intrathoracic pressures varied with different SGAs and an ITD regardless of the body position or CPR method. Differences in SGAs devices should be strongly considered when trying to optimize cardiac arrest outcomes, as some SGAs do not consistently develop a seal or negative intrathoracic pressure with multiple different CPR methods and devices.
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Affiliation(s)
- Joe Holley
- Department of Emergency Medicine, University of Tennessee, Memphis Fire Department and State of Tennessee, Memphis, USA.
| | - Johanna C Moore
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Michael Jacobs
- Alameda County Emergency Medical Services, Health Care Services Agency, San Leandro, CA, USA
| | - Carolina Rojas-Salvador
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Charles Lick
- Allina Health Emergency Medical Services, St. Paul, MN, USA
| | - Bayert J Salverda
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Michael C Lick
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Ralph J Frascone
- Department of Emergency Medicine, Regions Hospital, St. Paul, MN, USA
| | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City Fire Department, Salt Lake City, UT, USA
| | - Keith G Lurie
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA; Hennepin Healthcare Research Institute, Minneapolis, MN, USA; Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
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18
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Abstract
A secure and patent airway is a prerequisite to safe interhospital transfer and this has traditionally been via endotracheal tubes. Neonatal intubation success rates are falling as there is declining opportunities amongst paediatric junior doctors and consultants, therefore being able to successfully intubate an infant before or during a transfer, especially if they have an airway anomaly, may be very challenging. The use of supraglottic airways is increasingly popular in neonatology as an alternative to facemask ventilation or endotracheal intubation. This review considers the role of supraglottic airway devices during the stabilisation and transfer of neonates.
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Affiliation(s)
- Stacy Wightman
- Royal Hospital for Children, Glasgow, 1345 Govan Road, Glasgow G51 4TFE, United Kingdom of Great Britain and Northern Ireland.
| | - Cliodhna Godden
- Royal Hospital for Children, Glasgow, 1345 Govan Road, Glasgow G51 4TFE, United Kingdom of Great Britain and Northern Ireland.
| | - Joyce O'Shea
- Royal Hospital for Children, Glasgow, 1345 Govan Road, Glasgow G51 4TFE, United Kingdom of Great Britain and Northern Ireland; Scotstar Neonatal Transport Service, Glasgow, United Kingdom of Great Britain and Northern Ireland. joyce.o'
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19
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Behrens KM, Galgon RE. Supraglottic airway versus endotracheal tube during interventional pulmonary procedures - a retrospective study. BMC Anesthesiol 2019; 19:196. [PMID: 31672120 PMCID: PMC6823941 DOI: 10.1186/s12871-019-0872-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/21/2019] [Indexed: 02/08/2023] Open
Abstract
Background As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.
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Affiliation(s)
- Kyle M Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Richard E Galgon
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave., B6/319, Madison, WI, 53792, USA
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20
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Gaddam M, Sethi S, Jain A, Saini V. Comparison of Air-QⓇ insertion techniques in pediatric patients with fiber-optic bronchoscopic assessment: a prospective randomized control trial. Korean J Anesthesiol 2019; 72:570-575. [PMID: 31159533 PMCID: PMC6900414 DOI: 10.4097/kja.d.18.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques. Methods This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied. Results FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups. Conclusions The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.
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Affiliation(s)
- Manasa Gaddam
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Sameer Sethi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Aditi Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
| | - Vikas Saini
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Nehru Hospital, Chandigarh, India
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21
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Eismann H, Sieg L, Otten O, Leffler A, Palmaers T. Impact of the laryngeal tube as supraglottic airway device on blood flow of the internal carotid artery in patients undergoing general anaesthesia. Resuscitation 2019; 138:141-145. [PMID: 30885823 DOI: 10.1016/j.resuscitation.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Laryngeal tubes (LT) are supraglottic airway devices routinely used in emergency airway management. During cardiac arrest in a swine model, the carotid artery blood flow is reduced after insertion of a LT. A compression of the internal carotid (ICA) artery by the inflated cuff was shown. Up to now there is no information if the LT has similar effects in humans with possible negative implications for use of the LT in case of cardiac arrest. OBJECTIVE We hypothesized that the use of a LT in humans significantly reduces the blood flow in the ICA compared facemask ventilation. A significant reduction was defined as a 25% reduction from baseline values. MATERIAL AND METHODS After induction of general anaesthesia and reaching a haemodynamic steady state (stable heart rate >50/min and mean arterial pressure >60 mmHg), blood flow within the ICA was measured via doppler sonography during pressure-controlled ventilation with facemask-, laryngeal tube- and laryngeal mask. RESULTS We found no differences in the carotid blood flow. Neither between the facemask ventilation (right side 419 ± 159 ml min-1, left side 355 ± 120 ml min-1) and the laryngeal tube ventilation (right side 400 ± 131 ml min-1, left side 384 ± 124 ml min-1. p = 0.86 and p = 0.12), nor the facemask-ventilation and the laryngeal mask ventilation (right ICA 415 ± 150 ml min-1, left ICA 485 ± 274 ml min-1, p = 0.49 and 0.26). CONCLUSIONS In humans the LT does not impair blood flow of the internal carotid artery during ventilation in general anaesthesia. Further studies are needed to confirm our findings under the conditions of cardiac arrest.
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Affiliation(s)
- Hendrik Eismann
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Lion Sieg
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Oliver Otten
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Andreas Leffler
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thomas Palmaers
- Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Özkan D, Altınsoy S, Sayın M, Dolgun H, Ergil J, Dönmez A. Comparison of cervical spine motion during intubation with a C‑MAC D‑Blade® and an LMA Fastrach®. Anaesthesist 2019; 68:90-96. [PMID: 30627738 DOI: 10.1007/s00101-018-0533-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND This prospective randomized study compared cervical motion during intubation with a C‑MAC D‑Blade® and with a laryngeal mask airway LMA Fastrach®. MATERIAL AND METHODS The participants in this study were 52 ASA I-III patients aged 18-70 years and assigned for elective cervical discectomy. The patients were randomly selected for intubation with a C‑MAC D‑Blade® (group V) or an LMA Fastrach® laryngeal airway (group F). Both groups received the same induction of anaesthesia. The first lateral view was X‑rayed while the head and neck were in a neutral supine position and the second exposure was taken during the passage of the endotracheal tube through the vocal cords for group V and during the advance of the endotracheal tube for group F. The occiput-C1 (C0-C1), C1-C2 and C2-5 angles were measured. The angle formed by the line between the occipital protuberance and anterior process of the foramen magnum and the line between the central point of C1 spinous process and the anterior process of the foramen magnum was defined as angle A. The differences between the angles were calculated. Overall intubation success and first-pass success (success at the first attempt) were recorded. RESULTS The change in angulations between C0-C1 during intubation was significantly lower in group F than in group V (2.780 ± 2.10 vs. 6.040 ± 4.10, p = 0.007). Before intubation, angle A was 14.40 ± 3.90 in group V and 13.80 ± 3.70 in group F (p = 0.627). During intubation, angle A was significantly smaller for group V than for group F (9.10 ± 2.40 vs. 10.70 ± 2.90, p = 0.04). The number of successful intubations were significantly higher in group V (100% of intubations were successful on the first attempt for group V, vs. 80% for group F, p = 0.023). CONCLUSION Intubation with both a C‑MAC D‑Blade and a Fastrach LMA resulted in cervical motion but within safe ranges. Intubation with a C-mac D blade might be preferred because the Fastrach LMA may result in more failed intubation attempts in patients with cervical spine disorders.
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Affiliation(s)
- D Özkan
- Department of Anesthesiology and Reanimation, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. .,, Koru M Kavakli S No: 4/44, 06810, Cayyolu Ankara, Turkey.
| | - S Altınsoy
- Department of Anesthesiology and Reanimation, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - M Sayın
- Department of Anesthesiology and Reanimation, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - H Dolgun
- Department of Neurosurgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - J Ergil
- Department of Anesthesiology and Reanimation, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - A Dönmez
- Department of Anesthesiology and Reanimation, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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23
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Foo LL, Shariffuddin II, Chaw SH, Lee PK, Lee CE, Chen YS, Chan L. Randomized comparison of the Baska FESS mask and the LMA Supreme in different head and neck positions. Expert Rev Med Devices 2018; 15:597-603. [PMID: 30095289 DOI: 10.1080/17434440.2018.1506329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Baska functional endoscopic sinus surgery (FESS) mask is a new supraglottic airway designed for head and neck procedures. This prospective, randomized controlled trial compared the oropharyngeal leak pressure (OLP) of the Baska FESS mask with the laryngeal mask airway (LMA) Supreme in different head and neck positions. METHODS One hundred patients undergoing elective surgery were recruited. OLP was compared in supine position, 45° lateral rotation, 45° neck extension, and 30° neck flexion. Glottic view, insertion time, ease of insertion, number of attempts, ease and time of insertion of gastric tube, and complications were also compared. RESULTS The OLP of the Baska FESS was higher than the LMA Supreme in all head and neck positions studied (p < 0.001). Glottic views were better in the Baska FESS in supine and lateral rotation. LMA Supreme was easier (p = 0.046) and faster (p < 0.001) to insert. First attempt insertion success rates were 91.8% for Baska FESS and 98% for LMA Supreme. Gastric drain was easier and faster to insert (p < 0.001) in the LMA Supreme. CONCLUSIONS The Baska FESS provides a superior airway seal with higher mean OLP than the LMA Supreme in all head and neck positions studied. However, LMA Supreme was superior in terms of ease and speed of insertion.
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Affiliation(s)
- Li Lian Foo
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Ina Ismiarti Shariffuddin
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Sook Hui Chaw
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Pui Kuan Lee
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Chong En Lee
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Yi Shang Chen
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Lucy Chan
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
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Trimmel H, Beywinkler C, Hornung S, Kreutziger J, Voelckel WG. Success rates of pre-hospital difficult airway management: a quality control study evaluating an in-hospital training program. Int J Emerg Med 2018; 11:19. [PMID: 29549460 PMCID: PMC5856681 DOI: 10.1186/s12245-018-0178-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Competence in emergency airway management is key in order to improve patient safety and outcome. The scope of compulsory training for emergency physicians or paramedics is quite limited, especially in Austria. The purpose of this study was to review the difficult airway management performance of an emergency medical service (EMS) in a region that has implemented a more thorough training program than current regulations require, comprising 3 months of initial training and supervised emergency practice and 3 days/month of on-going in-hospital training as previously reported. METHODS This is a subgroup analysis of pre-hospital airway interventions performed by non-anesthesiologist EMS physicians between 2006 and 2016. The dataset is part of a retrospective quality control study performed in the ground EMS system of Wiener Neustadt, Austria. Difficult airway missions recorded in the electronic database were matched with the hospital information system and analyzed. RESULTS Nine hundred thirty-three of 23060 ground EMS patients (4%) required an airway intervention. In 48 cases, transient bag-mask-valve ventilation was sufficient, and 5 patients needed repositioning of a pre-existing tracheostomy cannula. Eight hundred thirty-six of 877 patients (95.3%) were successfully intubated within two attempts; in 3 patients, a supraglottic airway device was employed first line. Management of 41 patients with failed tracheal intubation comprised laryngeal tubes (n = 21), intubating laryngeal mask (n = 11), ongoing bag-mask-valve ventilation (n = 8), and crico-thyrotomy (n = 1). There was no cannot intubate/cannot ventilate situation. Blood gas analysis at admission revealed hypoxemia in 2 and/or hypercapnia in 11 cases. CONCLUSION During the 11-year study period, difficult airways were encountered in 5% but sufficiently managed in all patients. Thus, the training regime presented might be a feasible and beneficial model for training of non-anesthesiologist emergency physicians as well as paramedics.
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Affiliation(s)
- Helmut Trimmel
- Department of Anaesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700 Wiener Neustadt, Austria
- Medical University, Vienna, Austria
| | - Christoph Beywinkler
- Department of Anaesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700 Wiener Neustadt, Austria
| | - Sonja Hornung
- Department of Anaesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700 Wiener Neustadt, Austria
| | - Janett Kreutziger
- Department of Anaesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria
| | - Wolfgang G. Voelckel
- University of Stavanger, Stavanger, Norway
- Paracelsus Medical University, Salzburg, Austria
- Department of Anaesthesiology and Critical Care Medicine, AUVA Trauma Center Salzburg, Salzburg, Austria
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Hernandez MC, Antiel RM, Balakrishnan K, Zielinski MD, Klinkner DB. Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma. J Pediatr Surg 2018; 53:352-356. [PMID: 29096887 DOI: 10.1016/j.jpedsurg.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). METHODS We reviewed pediatric multisystem trauma patients (2005-2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS). RESULTS Ninety patients were included (SGA, n=17 and BVM, n=73). SGA patients displayed increased median head AIS (5 [4-5] vs 2 [0-4], p=0.001) and facial AIS (1 [0-2] vs 0 [0-0], p=0.03). SGA indications were multiple failed intubation attempts (n=12) and multiple failed attempts with poor visualization (n=5). Median intubation attempts were 2 [1-3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p<0.05). CONCLUSIONS Escalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA.
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Affiliation(s)
- Matthew C Hernandez
- Department of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN.
| | - Ryan M Antiel
- Department of Pediatric Surgery, Mayo Clinic, Rochester, MN.
| | | | - Martin D Zielinski
- Department of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN.
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Kulnig J, Füreder L, Harrison N, Frass M, Robak O. Performance and skill retention of five supraglottic airway devices for the pediatric difficult airway in a manikin. Eur J Pediatr 2018; 177:871-8. [PMID: 29619557 DOI: 10.1007/s00431-018-3134-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/05/2022]
Abstract
UNLABELLED Supraglottic airway devices (SADs) have been introduced to assist medical professionals in emergency situations with limited experience in securing airways via conventional endotracheal intubation (ETI). Literature on the use of SADs for securing an airway during pediatric critical settings is scarce, and there is a lack of studies comparing different SADs to each other and to conventional ETI. We conducted a study comparing five different SADs to ETI with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions in 41 pediatricians of varying clinical experience and training. Only the AirQ, AuraG, and laryngeal tube (LT) were inserted within 30 s correctly by all participants under physiologic conditions. In tongue edema (TE), AirQ and LT had the highest success rate. In limited mobility of the cervical spine (CS), AirQ, AuraG, and LT again all were inserted within 30 s. In a multivariate analysis, factors influencing the success were experience with the respective device and level of medical education. Under TE conditions, there were significantly longer insertion times for the ETI, laryngeal mask airway (LMA), and EzT. Under CS conditions, there were significantly longer insertion times for the ETI, LMA, LT, and EzT. A multivariate analysis showed experience with the respective device to be the only factor of influence on time to first ventilation. CONCLUSION LT, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians. What is Known: • Supraglottic airway devices have been introduced for medical professionals who lack experience for managing difficult airway situations. • A variety of these devices have been developed so far, but not compared to each other yet. What is New: • We compared five different supraglottic airway devices with regard to success rate, time to first ventilation, and personal rating in a pediatric manikin under simulated physiologic and pathologic airway conditions. • Laryngeal tube, AuraG, and AirQ were superior in providing fast and effective ventilation during simulated difficult airway situations in pediatricians with varying clinical experience.
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Dodd KW, Driver BE, Reardon RF. Trauma patients presenting with a King laryngeal tube™ in place can be safely intubated in the emergency department. Am J Emerg Med 2018; 36:503-4. [PMID: 29321115 DOI: 10.1016/j.ajem.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/21/2022] Open
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Nagahisa Y, Hashida K, Matsumoto R, Kawashima R, Okabe M, Kawamoto K. A randomized clinical study on postoperative pain comparing between the supraglottic airway device and endotracheal tubing in transabdominal preperitoneal repair (TAPP). Hernia 2017; 21:391-396. [PMID: 28194529 DOI: 10.1007/s10029-017-1586-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transabdominal preperitoneal (TAPP) repair is the most widely used laparoscopic technique for the treatment of inguinal hernia in Japan. Many studies have shown that in comparison with open hernia repair, laparoscopic repair results in less pain and a shorter convalescence. However, postoperative pain remains a concern. One possible cause of postoperative pain in the early postoperative phase is strain or cough on removal of the endotracheal tube. Use of a supraglottic airway (SGA) device helps to avoid such complaints. We evaluated postoperative pain after TAPP repair using the SGA for general anesthesia. METHODS We evaluated the postoperative pain in 146 patients with inguinal hernia repaired by TAPP in our hospital between May 2013 and May 2016. A total of 144 adult patients of American Society of Anesthesiologists physical status I and II who underwent needlescopic TAPP surgery were randomly allocated to one of two groups of 72 patients: group A (SGA), in which the patient's airway was secured with an appropriately sized I-gel, and group B (endotracheal tube), in which the airway was secured under laryngoscopy. RESULTS There was no significant difference between the groups regarding patient background, postoperative hospital stay, and operation time, and TAPP was performed safely in all cases. In the analysis of postoperative pain, the mean Numerical Rating Scale score of peak pain in group A was significantly less than that of group B (2.10 ± 2.05 vs 2.90 ± 2.65; p = 0.043). In group A, the percentage of patients who had an NRS score of 0 was 51.4% 30 min after surgery, 62.5% after 6 h and 68.1% at POD1, and compared to group B, the NRS scores were significantly higher at POD1 (p = 0.003), and the level of postoperative pain in group A tended to decrease earlier than that in group B. CONCLUSIONS The results of this study are the first to show that an SGA device can reduce postoperative pain after laparoscopic surgery.
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Affiliation(s)
- Y Nagahisa
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan.
| | - K Hashida
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan
| | - R Matsumoto
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan
| | - R Kawashima
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan
| | - M Okabe
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan
| | - K Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki City, Okayama, Japan
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Maitra S, Baidya DK, Arora MK, Bhattacharjee S, Khanna P. Laryngeal mask airway ProSeal provides higher oropharyngeal leak pressure than i-gel in adult patients under general anesthesia: a meta-analysis. J Clin Anesth 2016; 33:298-305. [PMID: 27555181 DOI: 10.1016/j.jclinane.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/17/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE i-gel is a single-use supraglottic airway device that has a gastric drain tube similar to laryngeal mask airway (LMA) ProSeal. Randomized trials, when compared i-gel with LMA ProSeal, reported a differing results. Primary objective of this study is to compare LMA ProSeal and i-gel in terms of oropharyngeal leak pressure. DESIGN Meta-analysis of randomized controlled trials where i-gel has been compared to LMA ProSeal in adult airway management during general anesthesia. SETTING Teaching institutions. MEASUREMENTS PubMed, PubMed Central, and Cochrane databases were searched with search words "i-gel," "i-gel laryngeal mask airway," "i-gel ProSeal," and "i-gel LMA ProSeal" to find out the randomized controlled trials that compared i-gel with LMA ProSeal in terms of safety and efficacy. A total of 10 prospective randomized trials have been included in this meta-analysis. MAIN RESULTS LMA ProSeal provides higher oropharyngeal leak pressure than i-gel (mean difference, 3.37 cm H2O; 95% confidence interval, 1.80-4.95 cm H2O; P< .0001). Time to insert the device, first insertion success rate, and ease of gastric tube insertion are similar with both the devices, but i-gel may be easier to insert. Although the reported complications are not frequent and not very serious, a significantly higher blood staining on the mask has been noted with LMA ProSeal (odds ratio, 0.27; 95% confidence interval, 0.13-0.56; P= .0004). CONCLUSION LMA ProSeal may still remain the supraglottic device of choice over i-gel in adult patients during general anesthesia as it provided better seal against leak pressure with comparable device insertion characteristics.
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Affiliation(s)
- Souvik Maitra
- Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Dalim K Baidya
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Mahesh K Arora
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Puneet Khanna
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
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Kurz MC, Prince DK, Christenson J, Carlson J, Stub D, Cheskes S, Lin S, Aziz M, Austin M, Vaillancourt C, Colvin J, Wang HE. Association of advanced airway device with chest compression fraction during out-of-hospital cardiopulmonary arrest. Resuscitation 2015; 98:35-40. [PMID: 26520783 DOI: 10.1016/j.resuscitation.2015.10.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Select Emergency Medical Services (EMS) practitioners substitute endotracheal intubation (ETI) with supraglottic airway (SGA) insertion to minimize CPR chest compression interruptions, but the resulting effects upon chest compression fraction (CCF) are unknown. We sought to determine the differences in CCF between adult out-of-hospital cardiac arrest (OHCA) receiving ETI and those receiving SGA. METHODS We studied adult, non-traumatic OHCA patients enrolled in the Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation using an Impedance valve and an Early vs. Delayed analysis (PRIMED) trial. Chest compressions were measured using compression or thoracic impedance sensors. We limited the analysis to those receiving ETI or SGA (Combitube, King Laryngeal Tube, or Laryngeal Mask Airway) and >2min of chest compression data before and after airway insertion. We compared CCF between ETI and SGA before and after airway insertion, adjusting for age, sex, witnessed arrest, bystander CPR, shockable initial rhythm, public location, PRIMED trial arm, and regional ROC center. We also compared the change in CCF for each airway technique. RESULTS Of 14,955 patients enrolled in the ROC PRIMED trial, we analyzed 2767 cases, including 2051 ETI, 671 SGA, and 45 both. Among subjects in this investigation the mean age was 66.4 years with a male predominace, 46% with witnessed event, 37% receiving bystander CPR, and 22% presenting with an initially shockable rhythm. Pre- and post-airway CCF was higher for SGA than ETI (SGA pre-airway CCF 73.2% [95%CI: 71.6-74.7%] vs. ETI 70.6% [95%CI: 69.7-71.5%]; post-airway 76.7% [95%CI: 75.2-78.1%] vs. 72.4% [95%CI: 71.5-73.3%]). After adjusting for potential confounders, these significant changes persisted (pre-airway difference 2.2% favoring SGA, p-value=0.046; post-airway 3.4% favoring SGA, p=0.001). CONCLUSION In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.
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Affiliation(s)
| | - David K Prince
- The Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - James Christenson
- Department of Emergency Medicine, University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jestin Carlson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Emergency Medicine, Allegheny Health Network, Saint Vincent Hospital, Erie, PA, USA
| | - Dion Stub
- Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne Australia
| | - Sheldon Cheskes
- Sunnybrook Center for Prehospital Medicine, Department of Family and Community Medicine, Divison of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Steve Lin
- Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michael Austin
- The Ottawa Hospital, Department of Emergency Medicine, University of Ottawa Ottawa, ON, Canada
| | - Christian Vaillancourt
- The Ottawa Hospital, Department of Emergency Medicine, University of Ottawa Ottawa, ON, Canada
| | | | - Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
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Toman H, Erbas M, Sahin H, Kiraz HA, Uzun M, Ovali MA. Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia. J Clin Monit Comput 2015; 29:727-32. [PMID: 25637244 DOI: 10.1007/s10877-015-9659-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED In this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). CONCLUSION In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.
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Abstract
In this article, recent literature related to airway management in the ambulatory surgery setting is reviewed. Practical pointers to improve clinical success and avoid complications of newer airway management techniques are provided.
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Affiliation(s)
- Jennifer Anderson
- Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Avenue, MC-4028, Chicago, IL 60637, USA.
| | - P Allan Klock
- Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Avenue, MC-4028, Chicago, IL 60637, USA
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Ye YA, Machuzak MS, Doyle DJ. Endoscopic removal of a self-expanding metallic airway stent: A case report. World J Anesthesiol 2014; 3:129-133. [DOI: 10.5313/wja.v3.i1.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/19/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-year-old man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure (ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external (wearable) cardiac defibrillator (Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion (total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 iGel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.
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Choi YM, Cha SM, Kang H, Baek CW, Jung YH, Woo YC, Kim JY, Koo GH, Park SG. The clinical effectiveness of the streamlined liner of pharyngeal airway (SLIPA) compared with the laryngeal mask airway ProSeal during general anesthesia. Korean J Anesthesiol 2010; 58:450-7. [PMID: 20532053 PMCID: PMC2881520 DOI: 10.4097/kjae.2010.58.5.450] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 03/03/2010] [Accepted: 03/12/2010] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal™ (PLMA) during general anesthesia. Methods Sixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications. Results First attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA. Conclusions The SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia.
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Affiliation(s)
- Yun Mi Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
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