1
|
Yoshimura S, Kiguchi T, Nishioka N, Ikeda N, Takegawa M, Miyamae N, Sumida Y, Kitamura T, Iwami T. Association of pre-hospital tracheal intubation with outcomes after out-of-hospital cardiac arrest by drowning comparing to supraglottic airway device: A nationwide propensity score-matched cohort study. Resuscitation 2024; 197:110129. [PMID: 38280506 DOI: 10.1016/j.resuscitation.2024.110129] [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: 11/06/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
AIM OF THE STUDY This study aimed to compare the survival outcomes of adult patients with out-of-hospital cardiac arrest (OHCA) by drowning who were treated with either endotracheal intubation (ETI) or a supraglottic airway (SGA) device. METHODS We compared the outcomes of patients with OHCA by drowning according to airway management using a Japanese nationwide population-based registry (All-Japan Utstein Registry). Adult patients with OHCA treated in 2014-2020 with advanced airway management (ETI or SGA) were included. Patients who received ETI during cardiopulmonary resuscitation were matched with those treated with SGA based on propensity scores in a 1:1 ratio with a 0.2 calliper width. The outcome measures were the return of spontaneous circulation (ROSC), survival at one month, and favourable neurological outcomes defined as a Cerebral Performance Category Scale score of 1 or 2. RESULTS Of the 11,703 eligible patients, 4,467 (38.2%) and 7,236 (61.8%) underwent ETI and SGA, respectively. A total of 3,566 patients in each cohort were matched. The ROSC rate was higher in those treated with ETI versus SGA (207/3,566 [5.8%] versus 167/3,566 [4.7%], respectively; adjusted odds ratio, 1.25; 95% confidence interval [CI], 1.02-1.55). There was no intergroup difference in one-month survival or favourable neurological outcome (32/3566 [0.90%] versus 34/3566 [0.95%]; odds ratio, 0.94; 95% CI, 0.58-1.53; and 9/3566 [0.25%] versus 8/3566 [0.22%]; odds ratio, 1.13; 95% CI, 0.43-2.92), respectively. CONCLUSIONS In this propensity score-matched study of adult OHCA by drowning, ETI compared to SGA was associated with ROSC but not associated with survival and favourable neurological outcomes at one month.
Collapse
Affiliation(s)
- Satoshi Yoshimura
- Department of Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan; Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Nobuhiro Ikeda
- Department of Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Masayasu Takegawa
- Department of Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Nobuhiro Miyamae
- Department of Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Yasuyuki Sumida
- Department of Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
| |
Collapse
|
2
|
Bollucuoğlu K, Baytar Ç, Küçükosman G, Ayoğlu H. The placement of four different supraglottic airway devices by medical students: a manikin study. Ann Med 2023; 55:2282746. [PMID: 37983542 PMCID: PMC10836238 DOI: 10.1080/07853890.2023.2282746] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although endotracheal intubation is the gold standard in airway management, this procedure requires both technical training and experience. Supraglottic airway devices are an alternative to endotracheal intubation and are simpler, less invazive, and require less time for placement compared with endotrakeal intubation. Aim of the study was to evaluate the success rates, ease of use, duration of application, and maneuver performance of different supraglottic airway devices (SADs) used by term-5 medical students on a manikin. MATERIALS AND METHODS This cross-sectional study was conducted in Zonguldak Bülent Ecevit University Hospital, Turkey, between April and June 2022. Term 5 Medical students (n = 111) were asked to place four different SAD [classical laryngeal mask, suprema laryngeal mask, ProSeal laryngeal mask (pLMA), I-gel] on an adult airway manikin. After the students were trained in the use of the devices, the ease of use for each, duration of successful application, success of application and use of optimization maneuvers were recorded. The participants were asked to distinguish the device they felt most confident to place and the most difficult to implement. RESULTS There was a significant difference between the groups in ease and duration of application (p < 0.001). The most difficult and longest application time was with pLMA and the easiest and shortest was with I-gel (p < 0.05). The number of application failure was also highest for pLMA (p < 0.001). It was found that the participants distinguished (41%) I-gel as the most confident device to use, (84%) pLMA as the most difficult device to use for airway control. CONCLUSIONS I-gel was found to be superior to others in terms of ease of use, duration and success of application.
Collapse
Affiliation(s)
- Keziban Bollucuoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Çağdaş Baytar
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Gamze Küçükosman
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Medicine Faculty, Zonguldak, Turkey
| |
Collapse
|
3
|
Lv Z, Huang X, Cai J, Zhou Z, Gao L, Wang W, Sun J, Pan Y. Effect of superior laryngeal nerve block in alleviating sore throat after application of i-gel supraglottic airway: a randomized controlled trial. BMC Anesthesiol 2023; 23:333. [PMID: 37798734 PMCID: PMC10552282 DOI: 10.1186/s12871-023-02287-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Postoperative sore throat (POST) is a common complaint after supraglottic airway device (SAD) application. Internal branch of the superior laryngeal nerve (iSLN) block has the potential to alleviate POST. The aim of this trial was to explore the effect of iSLN block in alleviating sore throat, as well as to identify the potential risk factors for POST after SAD insertion. METHODS One hundred thirty-four patients scheduled for elective gynecological surgery were randomized to either group T: tetracaine syrup (1%) for local lubrication on i-gel supraglottic device (n = 67) or group B: i-gel insertion with water based lubricant on it and followed by bilateral iSLN block (ropivacaine, 0.375%, 2 ml for each side) (n = 67). Under ultrasound guidance, iSLN was exposed below thyrohyoid membrane. The primary outcome was the intensity of sore throat at 6 h after surgery. In addition, POST score at 0.5 h and 24 h, the severity of postoperative swallowing discomfort, acoustic analysis and complications were measured. RESULTS Compared with tetracaine syrup for local lubrication, iSLN block resulted in a reduced intensity of POST at 0.5 h (P = 0.044, OR = 1.99, 95%CI 1.02 to 3.88) and 6 h (P < 0.001, OR = 5.07, 95%CI 2.53 to 10.14) after surgery, as well as less severity of swallowing discomfort (P < 0.001, OR = 2.21, 95%CI 1.63 to 2.99) and cough (P = 0.039, OR = 1.97, 95%CI 1.04 to 3.73). The patients after iSLN block presented lower jitter and shimmer value in acoustic analysis at 6 h after surgery (P < 0.001). CONCLUSIONS iSLN block was effective in alleviating POST, improving voice function, as well as reducing postoperative swallowing discomfort and coughing. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2000037974) on 8th Sept 2020.
Collapse
Affiliation(s)
- Zhu Lv
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyi Huang
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinxia Cai
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zijun Zhou
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linglin Gao
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weijian Wang
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jiehao Sun
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Yizhao Pan
- Department of Anesthesiology, 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
4
|
Güth J, Jung P, Schiele A, Urban B, Parsch A, Matsche B, Eich C, Becke-Jakob K, Landsleitner B, Russo SG, Bernhard M, Hossfeld B, Olivieri M, Hoffmann F. [Update 2022: interdisciplinary statement on airway management with supraglottic airway devices in pediatric emergency medicine-The laryngeal mask is and remains state of the art : Joint statement of the Institute for Emergency Medicine and Medicine Management (INM), the University Clinic Munich, LMU Munich, Germany, the Working Group for Pediatric Critical Care and Emergency Medicine of the German Interdisciplinary Society for Critical Care and Emergency Medicine (DIVI), the Medical Directors of Emergency Medical Services in Bavaria (ÄLRD), the Scientific Working Group for Pediatric Anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI), the Scientific Working Group for Emergency Medicine of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and the Society of Neonatology and Pediatric Critical Care Medicine (GNPI)]. Anaesthesiologie 2023:10.1007/s00101-023-01284-2. [PMID: 37222766 DOI: 10.1007/s00101-023-01284-2] [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] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors. RESULTS The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10 kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility. DISCUSSION Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application.
Collapse
Affiliation(s)
- J Güth
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - P Jung
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - A Schiele
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Urban
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, München, Deutschland
| | - A Parsch
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - B Matsche
- Ärztliche Leitung, Rettungsdienst Bayern (ÄLRD Bayern), München, Deutschland
| | - C Eich
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - K Becke-Jakob
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Landsleitner
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - S G Russo
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M Bernhard
- Wissenschaftlicher Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Hossfeld
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - M Olivieri
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - F Hoffmann
- Sektion Pädiatrische Intensiv- und Notfallmedizin, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland.
- Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI), Berlin, Deutschland.
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-Universität München, Lindwurmstr. 4, 80337, München, Deutschland.
| |
Collapse
|
5
|
Kim J, Lee S, Kim Y, Jeong JS. Remimazolam dose for successful insertion of a supraglottic airway device with opioids: a dose-determination study using Dixon's up-and-down method. Can J Anaesth 2023; 70:343-350. [PMID: 36536157 DOI: 10.1007/s12630-022-02379-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Remimazolam, an ultra-short-acting benzodiazepine, was recently approved in numerous jurisdictions as an induction drug for general anesthesia. We aimed to determine the doses of remimazolam that would allow placement of a supraglottic airway device (SGD) in 50% and 95% of nonparalyzed patients (ED50 and ED95). METHODS In this prospective study, 30 American Society of Anesthesiology Physical Status I-II grade female patients scheduled for hysteroscopic surgery were enrolled. Anesthesia was induced with 1 μg·kg-1 of fentanyl and continuous infusion of remimazolam without neuromuscular blockade. An i-gel® SGD was inserted 2.5 min after the start of remimazolam infusion. We used Dixon's up-and-down method and isotonic regression to determine the ED50 and ED95 of remimazolam for insertion of an SGD. RESULTS Twenty-eight patients were included in the final analysis. The ED50 and ED95 of remimazolam required for successful i-gel insertion were 8.8 mg·kg-1·hr-1 (95% confidence interval [CI], 6.3 to 10.6) and 10.7 mg·kg-1·hr-1 (95% CI, 10.6 to 11.7), respectively. A nonfully relaxed jaw was found in 7/13 patients (54%) in the success group and 14/15 patients (93%) in the failure group (difference in proportions, 40%; 95% CI, 7 to 65; P = 0.02). Bucking or other movements during SGD insertion only occurred in the failure group (11/15, 73%). CONCLUSION In 95% of nonparalyzed female patients undergoing hysteroscopy, 10.7 mg·kg-1·hr-1 of remimazolam with 1 μg·kg-1 of fentanyl facilitates i-gel insertion. Remimazolam showed a high incidence of poor jaw relaxation and bucking or other movements during SGD insertion. STUDY REGISTRATION Clinical Trial Registry of the Republic of Korea (KCT0006527, https://cris.nih.go.kr ; registered 1 September 2021; principal investigator: Ji Seon Jeong).
Collapse
Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Seungwon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Youyoung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| |
Collapse
|
6
|
Van Zundert AAJ, Gatt SP, Van Zundert TCRV, Kumar CM, Pandit JJ. Features of new vision-incorporated third-generation video laryngeal mask airways. J Clin Monit Comput 2021. [PMID: 34919170 DOI: 10.1007/s10877-021-00780-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. Both devices are made up of two interlocking components-the SAD and a videoscope. The 3rd generation, direct vision SADs allow vision-guided insertion, corrective manoeuvres, if needed, and correct placement in the hypopharynx and possess additional features which permit insertion of a gastric tube and endotracheal intubation should the need arise. This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLMTM, UE Medical®) and the SafeLM® Video Laryngeal Mask System (SafeLMTM VLMS, Magill Medical Technology®) consist of two parts: (a) a disposable 2nd generation SAD with a silicone cuff and an anatomically curved tube; and (b) a reusable patient-isolated videoscope and monitoring screen, with the flexible scope located into a specially-designed, blind-end channel terminating in the bowl of the SAD, preventing the videoscope from contacting patient body fluids in the SAD bowl. Third generation placement-under-direct-vision supraglottic airway devices possess several theoretical safety and ease of use advantages which now need to be validated in clinical use.
Collapse
|
7
|
Doss G, de Miguel Garcia C. African Pygmy Hedgehog (Atelerix albiventris) and Sugar Glider (Petaurus breviceps) Sedation and Anesthesia. Vet Clin North Am Exot Anim Pract 2021; 25:257-272. [PMID: 34823693 DOI: 10.1016/j.cvex.2021.08.005] [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: 10/19/2022]
Abstract
African pygmy hedgehogs and sugar gliders are common zoologic companion animals frequently presented to veterinarians for routine preventive care and illness. Given their small size, intravascular access, intubation, and monitoring can be challenging, and hypothermia is a common problem during chemical immobilization. Studied injectable sedation options are limited, but can provide an alternative to general anesthesia for minor procedures. Anesthetic induction and maintenance are most commonly performed with inhalant anesthetics, such as isoflurane or sevoflurane. Preparation of all necessary equipment and emergency drugs before chemical immobilization increases the chance of a successful procedure.
Collapse
Affiliation(s)
- Grayson Doss
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
| | - Cristina de Miguel Garcia
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 602 Tower Road, Ithaca, NY 14853, USA
| |
Collapse
|
8
|
Fukuda T, Ohashi-Fukuda N, Inokuchi R, Kondo Y, Sekiguchi H, Taira T, Kukita I. Association between time to advanced airway management and neurologically favourable survival during out-of-hospital cardiac arrest. Anaesth Crit Care Pain Med 2021; 40:100906. [PMID: 34147685 DOI: 10.1016/j.accpm.2021.100906] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/22/2021] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Advanced airway management (AAM) is commonly performed as part of advanced life support. However, there is controversy about the association between the timing of AAM and outcomes after out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether time to AAM is associated with outcomes after OHCA. METHODS This was a nationwide population-based observational study using the Japanese government-led registry of OHCA. Adults who experienced OHCA and received AAM by EMS personnel in the prehospital setting from 2014 to 2017 were included. Multivariable logistic regression models were used to assess the associations between time to AAM (defined as time in minutes from emergency call to the first successful AAM) and outcomes after OHCA. Then, associations between early (≤ 20 min) vs. delayed (> 20 min) AAM and outcomes after OHCA were examined using propensity score-matched analyses. The primary outcome was one-month neurologically favourable survival. RESULTS A total of 164,223 patients (median [IQR] age, 80 [69-86] years; 57.7% male) were included. The median time to AAM was 17 min (IQR, 14-22). Longer time to AAM was significantly associated with a decreased chance of one-month neurologically favourable survival (multivariable adjusted OR per minute delay, 0.90 [95% CI, 0.90-0.91]). In the propensity score-matched cohort, compared with early AAM, delayed AAM was associated with a decreased chance of one-month neurologically favourable survival (516 of 50,997 [1.0%] vs. 226 of 50,997 [0.4%]; RR, 0.44; 95% CI, 0.37-0.51; NNT, 176). CONCLUSIONS Delay in AAM was associated with a decreased chance of one-month neurologically favourable survival among patients with OHCA.
Collapse
Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Naoko Ohashi-Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Inokuchi
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Sekiguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takayuki Taira
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Anaesthesiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan; Department of Medical Engineering, University of the Ryukyus Hospital, Okinawa, Japan
| |
Collapse
|
9
|
Lønvik MP, Elden OE, Lunde MJ, Nordseth T, Bakkelund KE, Uleberg O. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 2021; 21:51. [PMID: 33879067 PMCID: PMC8056505 DOI: 10.1186/s12873-021-00444-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. Methods All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD’s. Results Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. Conclusions Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00444-0.
Collapse
Affiliation(s)
- Maja Pålsdatter Lønvik
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,Department of Internal Medicine, Nord-Trøndelag Hospital Trust, NO-7601, Levanger, Norway
| | - Odd Eirik Elden
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway.,Department of Pre-Hospital Services, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway.,Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway
| | - Mats Joakimsen Lunde
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, N-7600, Levanger, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St.Olav's University Hospital, NO-7030, Trondheim, Norway
| | - Karin Elvenes Bakkelund
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, NO-7030, Trondheim, Norway. .,Department of Research and Development, Norwegian Air Ambulance Foundation, NO-0103, Oslo, Norway.
| |
Collapse
|
10
|
Van Zundert AAJ, Kumar CM, Van Zundert TCRV, Gatt SP, Pandit JJ. The case for a 3rd generation supraglottic airway device facilitating direct vision placement. J Clin Monit Comput 2021; 35:217-24. [PMID: 32537697 DOI: 10.1007/s10877-020-00537-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, to visualise insertion of the device, enable immediate manoeuvres to optimise SAD position, verify whether correct 1st and 2nd seals are achieved and check whether size selected is appropriate. We do not provide technical details of such a '3rd generation' device, but rather present a theoretical analysis of its desirable properties, which are essential to overcome the remaining limitations of current 1st and 2nd generation devices. We also recommend that this further milestone improvement, i.e. ability to place the SAD accurately under direct vision, be eligible for the moniker '3rd generation'. Blind insertion of SADs should become the exception and we anticipate, as in other domains such as central venous cannulation and nerve block insertions, vision-guided placement becoming the gold standard.
Collapse
|
11
|
Park SY, Kim JK. Transtracheal ultrasonographic confirmation of endotracheal intubation using I-gel and an endotracheal tube introducer. Am J Emerg Med 2020; 38:2629-2633. [PMID: 33046321 DOI: 10.1016/j.ajem.2020.07.080] [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: 03/12/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy of transtracheal ultrasonography in confirming the placement of an endotracheal tube introducer during endotracheal intubation using the I-gel supraglottic airway as a guide. METHODS In this prospective study, endotracheal intubation using an endotracheal tube introducer through the I-gel was performed in patients with return of spontaneous circulation after I-gel insertion for out-of-hospital cardiac arrest. The introducer placement was assessed by the occurrence of hyperechoic artifacts within the trachea or esophagus in transtracheal ultrasonography. Results of ultrasonography were confirmed by waveform capnography in the case of tracheal artifacts and direct visualization by laryngoscopy in the case of esophageal artifacts. RESULTS One hundred and six patients were enrolled in this study. In transtracheal ultrasonography, artifacts of introducer in the trachea and esophagus were observed in 80 (75.5%) and 26 (24.5%) patients, respectively. Transtracheal ultrasonography in identifying the placement of introducers revealed a sensitivity of 100% (95% CI 95.4 to 100), specificity of 96.3% (95% CI 81.0 to 99.9), a PPV of 98.7% (95% CI 92.0 to 99.8), and a NPV of 100% (95% CI 94.8 to 99.9). CONCLUSION Transtracheal ultrasonography is an accurate method for identifying introducer placement during endotracheal intubation using an endotracheal tube introducer through the I-gel.
Collapse
Affiliation(s)
- Sin-Youl Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
| |
Collapse
|
12
|
Chae YJ, Lee H, Jun B, Yi IK. Conversion of I-gel to definitive airway in a cervical immobilized manikin: Aintree intubation catheter vs long endotracheal tube. BMC Anesthesiol 2020; 20:152. [PMID: 32552828 PMCID: PMC7302158 DOI: 10.1186/s12871-020-01069-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background After prehospital insertion of i-gel, a popular supraglottic airway (SGA), fiberoptic-guided intubation through i-gel is often required to switch the i-gel to a definitive airway for anticipated difficult airway. The Aintree intubation catheter (AIC) was developed for this purpose yet it requires many procedural steps during which maintenance of adequate ventilation is difficult. We custom-made a long endotracheal tube (LET) which may facilitate this procedure and compared the efficacy of the AIC and LET in a cervical immobilized manikin. Methods In this 2 × 2 crossover manikin-based trial, 20 anaesthesiologists and residents performed both methods in random order. Total intubation time, fiberoptic time, and procedure time were recorded. The ease of insertion, procedure failure rate, difficulty score, and participants’ preference were recorded. Results Total intubation time was significantly shorter for the LET than the AIC group (70.8 ± 16.4 s vs 94.0 ± 28.4 s, P = 0.001). The procedure time was significantly shorter in the LET group (51.9 ± 13.8 s vs 76.5 ± 25.4 s, P < 0.001). The ease of insertion score was lower, i.e., easier, in the AIC than the LET group (2.0 [1.0–2.75] vs 1.0 [1.0–1.0], P < 0.001). Fiberoptic time (19.0 ± 6.9 s vs 17.5 ± 12.3 s) and subjective difficulty (4.0 [3.0–6.0] vs 4.0 [3.0–5.75]) were similar between groups. Fourteen participants preferred the LET method (70%) due to its fewer procedural steps. Conclusions LET resulted in a shorter intubation time than the AIC during fiberoptic-guided intubation through the i-gel, possibly due to the less procedural steps compared to AIC. Trial registration NCT03645174 (ClinicalTrials.gov, Aug 22, 2018).
Collapse
Affiliation(s)
- Yun Jeong Chae
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Heirim Lee
- Office of Biostatics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Bokyeong Jun
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - In Kyong Yi
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
| |
Collapse
|
13
|
van Zundert AAJ, Wyssusek KH, Pelecanos A, Roets M, Kumar CM. A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®. J Clin Monit Comput 2020; 34:285-94. [PMID: 30953222 DOI: 10.1007/s10877-019-00301-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an 'insert-detect-correct-as-you-go' technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9 cm H2O) compared to the LMA-Supreme (27.7 ± 3.5 cm H2O) group (mean difference 4.0 cm H2O, 95% confidence interval (CI) 2.7-5.3 cm H2O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided.
Collapse
|
14
|
Schmutz A, Loeffler T, Schmidt A, Goebel U. LMA Gastro™ airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients: a single-center observational study. BMC Anesthesiol 2020; 20:40. [PMID: 32035477 PMCID: PMC7007643 DOI: 10.1186/s12871-020-0938-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/04/2019] [Accepted: 01/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background Nonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA Gastro™ is a new supraglottic airway device, developed specifically for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA Gastro™ in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures. Methods We analyzed data from 214 patients retrospectively who received anesthesia for gastroenterological interventions. Inclusion criteria were upper gastrointestinal endoscopic interventions, airway management with LMA Gastro™ and ASA status ≥3. The primary outcome measure was successful use of LMA Gastro™ for airway management and endoscopic intervention. Results Thirtyone patients with ASA physical status ≥3, undergoing complex and prolonged upper gastrointestinal endoscopic procedures were included. There were 7 endoscopic retrograde cholangiopancreatographies, 7 peroral endoscopic myotomies, 5 percutaneous endoscopic gastrostomies and 12 other complex procedures (e.g. endoscopic submucosal dissection, esophageal stent placement etc.). Of these, 27 patients were managed successfully using the LMA Gastro™. Placement of the LMA Gastro™ was reported as easy. Positive pressure ventilation was performed without difficulty. The feasibility of the LMA Gastro™ for endoscopic intervention was rated excellent by the endoscopists. In four patients, placement or ventilation with LMA Gastro™ was not possible. Conclusions We demonstrated the feasibility of the LMA Gastro™ during general anesthesia for advanced endoscopic procedures in high-risk patients. Trial registration German Clinical Trials Register (DRKS00017396) Date of registration: 23rd May 2019, retrospectively registered.
Collapse
Affiliation(s)
- Axel Schmutz
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany.
| | - Thomas Loeffler
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany
| | - Arthur Schmidt
- Department of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg University of Freiburg, Hugstetter Strasse 55, Freiburg im Breisgau, 79106, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany
| |
Collapse
|
15
|
Abstract
The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.
Collapse
Affiliation(s)
- Andrey Akopov
- 6/8 L/Tolstoy Street, Saint-Petersburg 197022, Russia.
| | | |
Collapse
|
16
|
Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Segafredo G, Blennow M, Trevisanuto D, Tylleskär T. Neonatal resuscitation using a supraglottic airway device for improved mortality and morbidity outcomes in a low-income country: study protocol for a randomized trial. Trials 2019; 20:444. [PMID: 31324213 PMCID: PMC6642595 DOI: 10.1186/s13063-019-3455-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/18/2018] [Accepted: 05/20/2019] [Indexed: 11/28/2022] Open
Abstract
Background Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. Methods A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. Discussion Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur. Trial registration ClinicalTrials.gov. Identifier: NCT03133572. Registered April 28, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3455-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicolas J Pejovic
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway. .,Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden. .,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Susanna Myrnerts Höök
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway.,Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Josaphat Byamugisha
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda.,Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Box 7072, Kampala, Uganda
| | - Tobias Alfvén
- Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Clare Lubulwa
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda
| | | | - Jolly Nankunda
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Box 7072, Kampala, Uganda
| | - Hege Ersdal
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4019, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Box 8600, 4036, Stavanger, Norway
| | - Giulia Segafredo
- Operational Research Unit, Doctors with Africa Cuamm, Via San Francesco 126, Padova, Italy
| | - Mats Blennow
- Department of Neonatal Medicine, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden.,Karolinska Institutet Department of Clinical Science, Technology and Intervention, Alfred Nobels alle 8, 141 52, Huddinge, Sweden
| | - Daniele Trevisanuto
- Department of Woman and Child Health, Padua University, Via Giustiniani, 3, 35128, Padua, Italy
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway
| |
Collapse
|
17
|
Kim TH, Hong KJ, Shin SD, Lee JC, Choi DS, Chang I, Joo YH, Ro YS, Song KJ. Effect of endotracheal intubation and supraglottic airway device placement during cardiopulmonary resuscitation on carotid blood flow over resuscitation time: An experimental porcine cardiac arrest study. Resuscitation 2019; 139:269-274. [PMID: 31009692 DOI: 10.1016/j.resuscitation.2019.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/05/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Supraglottic airway devices (SGDs) are widely used during the resuscitation of out-of-hospital cardiac arrest (OHCA). The effect of SGDs on carotid blood flow (CBF) as resuscitation time passes is controversial. We assessed the effects of endotracheal intubation (ETI) and 3 types of SGD placement on CBF over time in prolonged resuscitation through an experimental porcine cardiac arrest study. METHODS We conducted a randomized crossover study using 12 female pigs. After 4 min of untreated ventricular fibrillation, 3 pairs of ETI for 3 min and each type of SGD placement, including Combitube, I-gel, and laryngeal mask airway, for 3 min were conducted. The order of the 3 pairs of ETI and SGD were randomly assigned for each pig. We measured physiological parameters including CBF and mean arterial pressure (MAP). We compared CBF and MAP between the last 1 min of the insertion period for each of the 3 types of SGD and the preceding ETI period. Trends of CBF and MAP according to ETI and SGD transition were also plotted during the prolonged resuscitation duration. RESULTS CBF decreased after inserting I-gel and Combitube compared to ETI (mean difference (95% CI): -685 ml (-1052 to -318) for Combitube, -369 ml (-623 to -114) for I-gel). MAP subsequently decreased after transitioning airway devices as resuscitation was prolonged, regardless of the device type. The mean CBF during the transition from ETI to SGD decreased by -480 ml (95% CI: -675 to -286), but the decrease in CBF during the transition from SGD to ETI was only -4 ml (95% CI: -182 to 175). CONCLUSION SGD placement was associated with decreased carotid blood flow during cardiopulmonary resuscitation in an experimental porcine model. As time passed during prolonged resuscitation, reduction in CBF was aggravated after the transition to SGD placement compared to the reduction after the transition to ETI. This study was approved by the study institution IACUC 16-0140-S1A0.
Collapse
Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Dong Sun Choi
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Ikwan Chang
- Kangwon National University College of Medicine, Chuncheon, Gangwon-do, Republic of Korea.
| | - Yoo Ha Joo
- Interdisciplinary Program of Bioengineering, Seoul National University Graduate School, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
18
|
Jin H, Nishino T, Aoe T, Isono S. A simple and safe method for tracheal intubation using a supraglottic intubation-aid device in mice. Respir Physiol Neurobiol 2019; 263:9-13. [PMID: 30790746 DOI: 10.1016/j.resp.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/27/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
Although mice are a commonly used animal species in experimental medicine, airway management of this species is not easy due to their small size. In order to develop a new method of tracheal intubation in mice, we produced a supraglottic intubation-aid conduit (SIAC) for mice, and tested the efficacy of this device in spontaneously breathing mice anesthetized with sevoflurane inhalation. The success rate of tracheal intubation with the crude prototype of the SIAC was 50% and adverse effects on respiration and some trauma in the upper airway were occasionally observed. After refining the size and shape of the SIAC, the success rate of tracheal intubation with the refined prototype of the SIAC was 100% without any serious adverse effects. This study showed that it is possible to produce a supraglottic airway device to aid tracheal intubation in mice and that the shape and size of the SIAC play a crucial role in successful tracheal intubation in mice.
Collapse
Affiliation(s)
- Hisayo Jin
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Japan
| | - Takashi Nishino
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Japan.
| | - Tomohiko Aoe
- Department of Anesthesiology and Pain research, Teikyo Medical Center, Teikyo University, Japan
| | - Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
19
|
Hernández García I, Hidalgo I, Barragán L, Berenguer B, Lorca-García C, Mantilla I. Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. ACTA ACUST UNITED AC 2019; 66:222-225. [PMID: 30686492 DOI: 10.1016/j.redar.2018.10.007] [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] [Received: 06/26/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022]
Abstract
Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.
Collapse
Affiliation(s)
- I Hernández García
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - I Hidalgo
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Barragán
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - B Berenguer
- Departamento de Cirugía Plástica Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Lorca-García
- Departamento de Cirugía Plástica Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - I Mantilla
- Departamento de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| |
Collapse
|
20
|
Christ M, von Auenmüller KI, von den Benken T, Fessaras S, Dierschke W, Trappe HJ. [ Supraglottic airway devices and intraosseous access in the treatment of patients after out-of-hospital cardiac arrest : Do we use the wrong tool too often?]. Med Klin Intensivmed Notfmed 2018; 114:426-433. [PMID: 30353227 DOI: 10.1007/s00063-018-0502-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/21/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Only a little is known about the frequency of use of supraglottic airway devices (SADs) and intraosseous (IO) access in patients who have had out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS We analyzed data from all patients who had had OHCA admitted to our hospital between 1 January 2008 and 31 December 2017. RESULTS A total of 135 (33.8%) patients who had had OHCA were admitted with a SAD, 223 (55.8%) with an endotracheal tube, 3 (0.8%) with mask ventilation, and 32 (8.0%) breathed spontaneously on admission to hospital. Three hundred and twenty-eight patients (82.0%) were admitted with a peripheral intravenous line, one (0.3%) with a central venous catheter, one (0.3%) with a port catheter, and 32 (8.0%) with IO access. CONCLUSIONS Irrespective of an increasing number of studies that raise the question whether the airway management of patients who have had OHCA using an SGA might be inferior to that with endotracheal tubes, approximately one third of all patients who have had OHCA were admitted with an SAD in this study. On the other hand, IO access is significantly less frequently used, despite fewer critical study results overall.
Collapse
Affiliation(s)
- M Christ
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - K I von Auenmüller
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - T von den Benken
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - S Fessaras
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - W Dierschke
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - H-J Trappe
- Medizinische Klinik II, Schwerpunkt Kardiologie und Angiologie, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| |
Collapse
|
21
|
Ueshima H. RETRACTED: Successful case of perioperative management with i-gel during a case of wide-awake hand surgery. J Clin Anesth 2018; 49:73. [PMID: 29906762 DOI: 10.1016/j.jclinane.2018.06.017] [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: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief as it contains fabricated/falsified data. The Editor-in-Chief decision was based on the investigation by the Japanese Society of Anesthesiologists which concluded that no research was conducted and all the data including patient backgrounds were fabricated. The investigation report can be found here.
Collapse
Affiliation(s)
- Hironobu Ueshima
- Department of Anesthesiology, Showa University Hospital, Tokyo, Japan.
| |
Collapse
|
22
|
Heegeman DJ, Rosandick WD, Boehning-Anderson RH, Woltmann AR. Supraglottic airway device placement by respiratory therapists. Am J Emerg Med 2018; 36:1845-1848. [PMID: 30097274 DOI: 10.1016/j.ajem.2018.06.030] [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: 03/22/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. DESIGN A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice. METHODS RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement. RESULTS Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device. CONCLUSION We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.
Collapse
Affiliation(s)
- David J Heegeman
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA.
| | - William D Rosandick
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
| | | | - Andrew R Woltmann
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
| |
Collapse
|
23
|
Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Department of Anesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; Anesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, Spain; Spanish Difficult Airway Group (GEVAD).
| | - José María Calvo-Vecino
- Department of Anesthesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, Spain
| |
Collapse
|
24
|
Aleksandrowicz D, Gaszyński T. Intubation through 2 supraglottic airway device in cervical spine immobilization: a randomized trial of residents' use of the intubating laryngeal mask airway and the intubating laryngeal tube in manikins. Emergencias 2018; 30:186-189. [PMID: 29687674] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to compare the intubating laryngeal mask (iLM) airway and the new intubating laryngeal tube (iLTS-D) in use by residents with minimal previous intubation experience during simulated conditions of reduced cervical spine mobility. MATERIAL AND METHODS Thirty first-year residents in anesthesiology participated in the study (18 women). All participants had minimal intubation experience (fewer than 10 previously performed intubations) and were novices in the specialty. Both devices were used by each participant after random assignment of order. We recorded the time required to insert the device and start to ventilate through it (T1) and the time from insertion and intubation to successful ventilation (T2). Efficacy of intubation and each resident's assessment of ease of use were also assessed.Observational study using biomechanical inertial sensors to detect movement in the spinal column during removal of helmets. RESULTS The residents' mean (SD) T1 values were similar for the 2 devices (iLMA, 15.3 [5.5] seconds; iLTS-D, 15.4 [5.5] seconds; P=.938). T2 was shorter with the iLTS-D (25.4 [8.6] seconds vs 31.9 [8.8] seconds with the iLMA; P=.005). There were no failed intubation attempts with the iLTS-D. CONCLUSION The new iLTS-D may be a good alternative to the iLMA because a patient can be intubated and successfully ventilated in less time. The rate of successful intubation is also better with the iLTS-D.
Collapse
Affiliation(s)
- Dawid Aleksandrowicz
- London North West Healthcare NHS Trust, Anaesthetics Department, Northwick Park Hospital, Londres, Reino Unido
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Łódź, Polonia
| |
Collapse
|
25
|
Han MM, Xue FS, Kang F, Huang X, Li J. Male requires a higher median target effect-site concentration of propofol for I-gel placement when combined with dexmedetomidine. Anaesth Crit Care Pain Med 2018; 38:57-61. [PMID: 29452333 DOI: 10.1016/j.accpm.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/06/2017] [Revised: 12/10/2017] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The supraglottic airway device (SAD) can be used for airway management of spontaneous breathing patients, and propofol is commonly applied for the SAD placement. This study was designed to assess the effect of gender on median target effect-site concentration (Ce50) of propofol for I-gel placement when combined with dexmedetomidine. MATERIAL AND METHOD 19 males and 18 females, aged 18 to 59 and undergoing elective surgery, were enrolled. After intravenous infusion of dexmedetomidine 1.0μg/kg over 10min followed by continuous infusion of 0.4μg/kg/h, target-controlled infusion of propofol under Marsh model was started and the initial Ce of propofol was set at 4.79μg/mL and 4.35μg/mL in the male and female patients, respectively. The I-gel was inserted when the Ce of propofol reached the pre-set concentration and bispectral index value was less than 60. The Ce of propofol required for I-gel placement was determined by the Dixon up-and-down method. RESULTS The Ce50 (95% confidence interval) of propofol required for I-gel placement were 4.082μg/mL (3.798-4.332μg/mL) and 3.509μg/mL (3.266-3.749μg/mL) in male and female patients, respectively, with a significantly higher Ce50 in males. CONCLUSION When combined with dexmedetomidine, males require a higher Ce50 of propofol for I-gel placement compared to females.
Collapse
Affiliation(s)
- M-M Han
- Department of Anaesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
| | - F-S Xue
- Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - F Kang
- Department of Anaesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
| | - X Huang
- Department of Anaesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
| | - J Li
- Department of Anaesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
| |
Collapse
|
26
|
Wang H, Gao X, Wei W, Miao H, Meng H, Tian M. The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study. BMC Anesthesiol 2017; 17:156. [PMID: 29179689 PMCID: PMC5704385 DOI: 10.1186/s12871-017-0449-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/21/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Airway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia. METHODS Thirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon's up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient's response to supraglottic airway device insertion was classified as either 'movement' or 'no-movement'. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from 'movement' or 'no-movement' response. RESULTS The ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28-3.42) % and 4.03 (3.16-17.83) % for supraglottic airway device Blockbuster™ insertion, respectively. CONCLUSION We conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IPR-16009071 , Registered on 24 August 2016.
Collapse
Affiliation(s)
- Haixia Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Gao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huihui Miao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hua Meng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
27
|
Ono Y, Tanigawa K, Shinohara K, Yano T, Sorimachi K, Inokuchi R, Shimada J. Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study. Int J Emerg Med 2017; 10:28. [PMID: 28905252 PMCID: PMC5597568 DOI: 10.1186/s12245-017-0155-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 11/17/2016] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although human and equipment resources, proper training, and the verification of endotracheal intubation are vital elements of difficult airway management (DAM), their availability in Japanese emergency departments (EDs) has not been determined. How ED type and patient volume affect DAM preparation is also unclear. We conducted the present survey to address this knowledge gaps. METHODS This nationwide cross-sectional study was conducted from April to September 2016. All EDs received a mailed questionnaire regarding their DAM resources, airway training methods, and capnometry use for tube placement. Outcome measures were the availability of: (1) 24-h in-house back-up; (2) key DAM resources, including a supraglottic airway device (SGA), a dedicated DAM cart, surgical airway devices, and neuromuscular blocking agents; (3) anesthesiology rotation as part of an airway training program; and (4) the routine use of capnometry to verify tube placement. EDs were classified as academic, tertiary, high-volume (upper quartile of annual ambulance visits), and urban. RESULTS Of the 530 EDs, 324 (61.1%) returned completed questionnaires. The availability of in-house back-up coverage, surgical airway devices, and neuromuscular blocking agents was 69.4, 95.7, and 68.5%, respectively. SGAs and dedicated DAM carts were present in 51.5 and 49.7% of the EDs. The rates of routine capnometry use (47.8%) and the availability of an anesthesiology rotation (38.6%) were low. The availability of 24-h back-up coverage was significantly higher in academic EDs and tertiary EDs in both the crude and adjusted analysis. Similarly, neuromuscular blocking agents were more likely to be present in academic EDs, high-volume EDs, and tertiary EDs; and the rate of routine use of capnometry was significantly higher in tertiary EDs in both the crude and adjusted analysis. CONCLUSIONS In Japanese EDs, the rates of both the availability of SGAs and DAM carts and the use of routine capnometry to confirm tube placement were approximately 50%. These data demonstrate the lack of standard operating procedures for rescue ventilation and post-intubation care. Academic, tertiary, and high-volume EDs were likely to be well prepared for DAM.
Collapse
Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
| | - Koichi Tanigawa
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan.,Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Tetsuhiro Yano
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
| | - Kotaro Sorimachi
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Jiro Shimada
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, Fukushima, 960-1295, Japan
| |
Collapse
|
28
|
Kleine-Brueggeney M, Gottfried A, Nabecker S, Greif R, Book M, Theiler L. Pediatric supraglottic airway devices in clinical practice: A prospective observational study. BMC Anesthesiol 2017; 17:119. [PMID: 28865448 PMCID: PMC5581452 DOI: 10.1186/s12871-017-0403-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/22/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Supraglottic airway devices (SGA) are commonly used in pediatric anesthesia and serve as primary or back-up devices for difficult airway management. Most SGA are marketed without proper clinical evaluation. The purpose of this study was to evaluate the performance of the pediatric LMA Supreme™, Air-Q® and Ambu® Aura-i™. METHODS This prospective observational study was performed at Bern University Hospital, Switzerland. With ethics committee approval and a waiver for written informed consent 240 children undergoing elective surgery with an ASA class I-III and a weight of 5-30 kg were included. Three different pediatric supraglottic airway devices were assessed: The LMA Supreme™, Air-Q® and Ambu® Aura-i™. Primary outcome parameter was airway leak pressure. Secondary outcome parameters included first attempt and overall success rate, insertion time, fiberoptic view through the SGA, and adverse events. The primary hypothesis was that the mean airway leak pressure of each tested SGA was 20 cmH2O ± 10%. RESULTS None of the SGA showed a mean airway leak pressure of 20 cmH2O ± 10%, but mean airway leak pressures differed significantly between devices [LMA Supreme™ 18.0 (3.4) cmH2O, Air-Q® 15.9 (3.2) cmH2O, Ambu® Aura-i™ 17.3 (3.7) cmH2O, p < 0.001]. First attempt success rates (LMA Supreme™ 100%, Air-Q® 90%, Ambu® Aura-i™ 91%, p = 0.02) and overall success rates (LMA Supreme™ 100%, Air-Q® 91%, Ambu® Aura-i™ 95%, p = 0.02) also differed significantly. Insertion times ranged from 20 (7) seconds (Air-Q®) to 24 (6) seconds (LMA Supreme™, <p = 0.005). Insertion was rated easiest with the LMA Supreme™ (very easy in 97% vs. Air-Q® 70%, Ambu® Aura-i™ 72%, p < 0.001). Fiberoptic view was similar between the SGA. Adverse events were rare. CONCLUSIONS Airway leak pressures ranged from 16 to 18 cmH2O, enabling positive pressure ventilation with all successful SGA. The highest success rates were achieved by the LMA Supreme™, which was also rated easiest to insert. TRIALS REGISTRATION ClinicalTrials.gov , identifier NCT01625858 . Registered 31 May 2012.
Collapse
Affiliation(s)
- Maren Kleine-Brueggeney
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Present address: Department of Anaesthesia, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Anne Gottfried
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sabine Nabecker
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Malte Book
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.,Present address: Department of Anaesthesia, Klinikum Oldenburg AöR, 26133, Oldenburg, Germany
| | - Lorenz Theiler
- Department of Anaesthesiology and Pain Therapy, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| |
Collapse
|
29
|
Ueshima H, Ata A, Otake H. Clinical efficacy of a supraglottic airway device with a pressure gauge for robot-assisted surgery. J Clin Anesth 2017; 41:74-5. [PMID: 28802617 DOI: 10.1016/j.jclinane.2017.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/30/2017] [Indexed: 11/20/2022]
|
30
|
Eglen M, Kuvaki B, Günenç F, Ozbilgin S, Küçükgüçlü S, Polat E, Pekel E. [Comparison of three different insertion techniques with LMA-Unique™ in adults: results of a randomized trial]. Rev Bras Anestesiol 2017; 67:521-526. [PMID: 28526466 DOI: 10.1016/j.bjan.2017.04.007] [Citation(s) in RCA: 4] [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: 12/17/2015] [Accepted: 07/13/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-Unique™. METHODS One hundred and eighty ASA I-II patients aged 18-65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n=60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n=60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n=60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. RESULTS Successful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5-19]s) compared with the standard (11.78 [6-24]s) and rotational group (11.57 [5-31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. CONCLUSIONS Rotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations.
Collapse
Affiliation(s)
- Merih Eglen
- Malatya State Hospital, Department of Anesthesiology and Intensive Care, Malatya, Turquia
| | - Bahar Kuvaki
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Ferim Günenç
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Sule Ozbilgin
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia.
| | - Semih Küçükgüçlü
- Dokuz Eylül University, Medical Faculty, Department of Anesthesiology and Intensive Care, İzmir, Turquia
| | - Ebru Polat
- Samsun State Hospital, Department of Anesthesiology and Intensive Care, Samsun, Turquia
| | - Emel Pekel
- Florence Nighthingale Hospital, Department of Anesthesiology and Intensive Care, İstanbul, Turquia
| |
Collapse
|
31
|
Ono Y, Shimada J, Shinohara K. Possible additional role for nasal jet oxygen insufflation. J Anesth 2017; 31:797. [PMID: 28299454 DOI: 10.1007/s00540-017-2335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
|
32
|
Nellore SS, Waychal AD, Rustagi PS. Comparison of Dexmedetomidine-Propofol versus Fentanyl-Propofol on Insertion Conditions of Proseal Laryngeal Mask Airway. J Clin Diagn Res 2016; 10:UC06-UC09. [PMID: 28050480 DOI: 10.7860/jcdr/2016/23244.8934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/21/2016] [Accepted: 09/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Proseal Laryngeal Mask Airway (PLMA) is a newer supraglottic airway device that requires adequate depth of anaesthesia and suppression of upper airway reflexes thereby providing optimal insertion conditions. AIM To compare dexmedetomidine and fentanyl for co-induction with propofol with respect to PLMA insertion conditions, haemodynamic variation and the total dose requirement of propofol. MATERIALS AND METHODS This was a prospective randomized double-blinded study conducted in 60 cases of American Society of Anaesthesiologists (ASA) class I/II undergoing elective surgery under general anaesthesia. They were randomly divided into two equal groups, D and F, each receiving 1μg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of PLMA insertion was Young's Criteria and Modified scheme of Lund and Stovener. The haemodynamic parameters (mean heart rate, mean arterial pressure, Respiratory rate, SPO2) were monitored at: Baseline, Pre-medication, Pre PLMA, Post LMA (at insertion), 1, 3, 5, 10, 15 and 20 minutes. RESULTS PLMA insertion conditions and haemodynamics were comparable between the dexmedetomidine-propofol and fentanyl-propofol groups according to the Young's criteria and Modified scheme of Lund and Stovener. Total induction dose of propofol and its increments were significantly reduced in the dexmedetomidine group. CONCLUSION Dexmedetomidine and fentanyl when both used individually for co-induction with propofol for PLMA insertion give excellent overall insertion conditions with haemodynamic stability. Dexmedetomidine also significantly reduces the requirements of induction dose propofol for PLMA insertion.
Collapse
Affiliation(s)
- Shalaka Sandeep Nellore
- Associate Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical Hospital and College , Sion, Mumbai, Maharashtra, India
| | - Abhijeet Dattatray Waychal
- Senior Resident, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical Hospital and College , Sion, Mumbai, Maharashtra, India
| | - Preeti Sachin Rustagi
- Assistant Professor, Department of Anaesthesiology, Lokmanya Tilak Municipal Medical Hospital and College , Sion, Mumbai, Maharashtra, India
| |
Collapse
|
33
|
Keil J, Jung P, Schiele A, Urban B, Parsch A, Matsche B, Eich C, Becke K, Landsleitner B, Russo SG, Bernhard M, Nicolai T, Hoffmann F. [Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine: Laryngeal mask is state of the art]. Anaesthesist 2016; 65:57-66. [PMID: 26661389 DOI: 10.1007/s00101-015-0107-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS Literature search in the database PubMed and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine levels of evidence. RESULTS The evidence for successful application of the various types of LM is significantly higher than for LT application. Reports of smaller series of successful applications of LT are currently limited to selected research groups and centers. Insufficient evidence currently exists for the successful application of the LT especially for children below 10 kg body weight and, therefore, its routine use cannot currently be recommended. SGAs used for emergencies should have a possibility for gastric drainage. DISCUSSION Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.
Collapse
|
34
|
Taylor J, Black S, J Brett S, Kirby K, Nolan JP, Reeves BC, Robinson M, Rogers CA, Scott LJ, South A, Stokes EA, Thomas M, Voss S, Wordsworth S, Benger JR. Design and implementation of the AIRWAYS-2 trial: A multi-centre cluster randomised controlled trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest. Resuscitation 2016; 109:25-32. [PMID: 27697605 DOI: 10.1016/j.resuscitation.2016.09.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 05/23/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
Health outcomes after out of hospital cardiac arrest (OHCA) are extremely poor, with only 7-9% of patients in the United Kingdom (UK) surviving to hospital discharge. Currently emergency medical services (EMS) use either tracheal intubation or newer supraglottic airway devices (SGAs) to provide advanced airway management during OHCA. Equipoise between the two techniques has led to calls for a well-designed randomised controlled trial. The primary objective of the AIRWAYS-2 trial is to assess whether the clinical effectiveness of the i-gel, a second-generation SGA, is superior to tracheal intubation in the initial airway management of OHCA patients in the UK. Paramedics recruited to the AIRWAYS-2 trial are randomised to use either tracheal intubation or i-gel as their first advanced airway intervention. Adults who have had a non-traumatic OHCA and are attended by an AIRWAYS-2 paramedic are retrospectively assessed against eligibility criteria for inclusion. The primary outcome is the modified Rankin Scale score at hospital discharge. Secondary objectives are to: (i) estimate differences between groups in outcome measures relating to airway management, hospital stay and recovery at 3 and 6 months; (ii) estimate the cost effectiveness of the i-gel compared to tracheal intubation. Because OHCA patient needs immediate treatment there are several unusual features and challenges to the design and implementation of this trial; these include level of randomisation, the automatic enrolment model, enrolment of patients that lack capacity and minimisation of bias. Patient enrolment began in June 2015. The trial will enrol 9070 patients over two years. The results are expected to influence future resuscitation guidelines. Trial Registration ISRCTN: 08256118.
Collapse
Affiliation(s)
- Jodi Taylor
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Stephen J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
| | - Kim Kirby
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Jerry P Nolan
- School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Anaesthesia, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Maria Robinson
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Lauren J Scott
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Adrian South
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Matthew Thomas
- Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan R Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Academic Department of Emergency Care, The University Hospitals NHS Foundation Trust, Bristol, UK.
| |
Collapse
|
35
|
Metterlein T, Dintenfelder A, Plank C, Graf B, Roth G. A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation. Braz J Anesthesiol 2017; 67:166-71. [PMID: 28236864 DOI: 10.1016/j.bjane.2015.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. METHODS With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05). RESULTS Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. CONCLUSION None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices.
Collapse
|
36
|
Ono Y, Tanigawa K, Shinohara K, Yano T, Sorimachi K, Sato L, Inokuchi R, Shimada J, Tase C. Difficult airway management resources and capnography use in Japanese intensive care units: a nationwide cross-sectional study. J Anesth 2016; 30:644-52. [PMID: 27130212 PMCID: PMC4956707 DOI: 10.1007/s00540-016-2176-3] [Citation(s) in RCA: 6] [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: 02/17/2016] [Accepted: 04/16/2016] [Indexed: 12/05/2022]
Abstract
Purpose The availability of difficult airway management (DAM) resources and the extent of capnometry use in Japanese intensive care units (ICUs) remained unclear. The purpose of this study was to clarify whether: (1) DAM resources were adequate, and (2) capnometry was routinely applied in Japanese ICUs. Methods This nationwide cross-sectional study was conducted from September 2015 to February 2016. All ICUs received a mailed questionnaire about their DAM resources and use of capnometry. Outcome measures were availability of: (1) 24-h in-house backup coverage; (2) a supraglottic airway device (SGA); (3) a dedicated DAM cart; and (4) surgical airway devices, and (5) routine use of capnometry to verify tube placement and for continuous monitoring of ventilator-dependent patients. The association between these outcomes and ICU type (academic, high-volume, closed, surgical) was also analyzed. Results Of the 289 ICUs, 196 (67.8 %) returned completed questionnaires. In-house backup coverage and surgical airway devices were highly available (89.3 and 95.9 %), but SGAs and dedicated DAM carts were not (60.2 and 60.7 %). The routine use of capnometry to confirm tube placement was reported by 55.6 % of the ICUs and was highest in closed ICUs (67.2 %, p = 0.03). The rate of continuous capnography monitoring was also 55.6 % and was highest in academic ICUs (64.5 %, p = 0.04). Conclusion In Japanese ICUs, SGAs and dedicated DAM carts were less available, and capnometry was not universally applied either to confirm tube placement, or for continuous monitoring of ventilated patients. Our study revealed areas in need of improvement. Electronic supplementary material The online version of this article (doi:10.1007/s00540-016-2176-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
| | - Koichi Tanigawa
- Fukushima Medical University, Fukushima, Japan.,Fukushima Global Medical Science Center, Fukushima, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Tetsuhiro Yano
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kotaro Sorimachi
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Lubna Sato
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Jiro Shimada
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Choichiro Tase
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| |
Collapse
|
37
|
Abstract
There are innumerable tools and devices available to facilitate airway management and life-saving gas exchange of the patient's lungs. Over the years, various designs and generations of supraglottic airway devices have proven to be effective in accomplishing this function. Their application has grown beyond the original purpose of controlling the normal pediatric airway without tracheal intubation, and has been incorporated in the difficult airway management algorithms of anesthesia societies around the world based on clear evidence of efficacy. Older supraglottic airway devices since the 1980's have been validated in multiple clinical trials to be safe and effective in the pediatric population, however there is also sufficient evidence that the newer designs have features that help overcome some limitations. These newer designs and features are effective in managing both the normal and difficult pediatric airway, and will be discussed in this comprehensive review.
Collapse
Affiliation(s)
- Andrea S Huang
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - John Hajduk
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA
| | - Narasimhan Jagannathan
- a Department of Pediatric Anesthesia , Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago , IL , USA.,b Department of Anesthesiology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| |
Collapse
|
38
|
Ono Y, Shinohara K, Goto A, Yano T, Sato L, Miyazaki H, Shimada J, Tase C. Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan. J Anesth 2015; 30:205-14. [PMID: 26715428 PMCID: PMC4819484 DOI: 10.1007/s00540-015-2124-7] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/13/2015] [Indexed: 11/29/2022]
Abstract
Purpose
Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. Methods This nationwide cross-sectional study was conducted in May 2015. Base hospitals of HEMS were mailed a questionnaire about their airway management equipment and back-up personnel. Outcome measures were (1) call for help, (2) supraglottic airway device (SGA) insertion, (3) verification of tube placement using capnometry, and (4) the establishment of surgical airways, all of which have been endorsed in various airway management guidelines. The criteria defining feasibility were the availability of (1) more than one physician, (2) SGA, (3) capnometry, and (4) a surgical airway device in the prehospital setting. Results Of the 45 HEMS base hospitals questioned, 42 (93.3 %) returned completed questionnaires. A surgical airway was practicable by all HEMS. However, in the prehospital setting, back-up assistance was available in 14.3 %, SGA in 16.7 %, and capnometry in 66.7 %. No HEMS was capable of all four steps. Conclusion In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure. Electronic supplementary material The online version of this article (doi:10.1007/s00540-015-2124-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yuko Ono
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan.
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Aya Goto
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tetsuhiro Yano
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Lubna Sato
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiroyuki Miyazaki
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jiro Shimada
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Choichiro Tase
- Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| |
Collapse
|
39
|
Michalek P, Jindrova B, Kriz P, Stritesky M, Sedlar M. A pilot evaluation of the 3gLM-R - A new supraglottic airway device. Adv Med Sci 2015; 60:186-90. [PMID: 25827129 DOI: 10.1016/j.advms.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Revised: 01/08/2015] [Accepted: 02/03/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Supraglottic airway devices are designed for airway management during anaesthesia. The 3gLM is a novel device with a non-inflatable soft cuff and separate channels for gas delivery and drainage of gastric content. MATERIAL AND METHODS This prospective observational study of the 3gLM, version R, size 4 in 40 adult patients scheduled for elective surgery, evaluated the insertion success rate at the 1st attempt as the primary outcome. Secondary aims included insertion parameters, such as total success rate, insertion time, oropharyngeal seal pressures, postoperative complications and a comparison between males and females. RESULTS First attempt insertion success rate was 80% (70% in males, 90% in female patients, p=0.24), while total insertion success rate was 92.5% (85% in males, 100% in females, p=0.23). The oropharyngeal seal pressures were 27cmH2O, higher in females (29.4cmH2O) than in males (24.2cmH2O) - p=0.002. Postoperative complications were only temporary and included sore throat (24.3%), hoarseness (10.8%), pain on swallowing (10.8%) and minor tongue haematoma (2.5%). There was no difference in the incidence of postoperative complications between the genders apart from hoarseness. No aspiration of gastric contents or other long-term complications occurred in this cohort. CONCLUSIONS The 3gLM exhibited oropharyngeal seal pressures adequate for the controlled ventilation in most patients. Size 4 of the device showed higher pressures in females than in men.
Collapse
|
40
|
Maignan M, Koch FX, Kraemer M, Lehodey B, Viglino D, Monnet MF, Pham D, Roux C, Genty C, Rolland C, Bosson JL, Danel V, Debaty G. Impact of laryngeal tube use on chest compression fraction during out-of-hospital cardiac arrest. A prospective alternate month study. Resuscitation 2015; 93:113-7. [PMID: 26070831 DOI: 10.1016/j.resuscitation.2015.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 03/19/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/18/2022]
Abstract
AIM Supraglottic devices are thought to allow efficient ventilation and continuous chest compressions during cardiac arrest. Therefore, the use of supraglottic devices could increase the chest compression fraction (CCF), a critical determinant of patient survival. The aim of this study was to assess the CCF in out-of-hospital cardiac arrest (OHCA) patients ventilated with a supraglottic device. METHODS We conducted an open prospective multicenter study with temporal clusters. OHCA patients treated by emergency nurses received either intermittent chest compressions with bag-valve mask ventilations (30:2 rhythm; BVM group); or continuous chest compressions with asynchronous ventilations by laryngeal tube (LT group). The primary endpoint was the CCF assessed using an accelerometer connected to the defibrillator. We also investigated the ease of use of the laryngeal tube. RESULTS Eighty-two patients were included (41 in each group); 68% were male and the median age was 68 (54-80) years. Patients and cardiac arrest characteristics did not differ between groups. The CCF was 75% (68-79%) in the LT group and 59% (51-68%) in the BVM group (p<0.01). LT insertion failed in nine out of 40 cases (23%). The median time of LT insertion was 26s (11-56 s). CCF was significantly lower when LT insertion failed (58% (48-74%) vs. 76% (72-80%) when LT insertion succeeded; p=0.01). CONCLUSION The use of the LT during OHCA increases the CCF when compared to standard BVM ventilation. However, the impact of LT use on mortality remains unclear.
Collapse
Affiliation(s)
- Maxime Maignan
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France.
| | - François-Xavier Koch
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Marie Kraemer
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Bruno Lehodey
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Damien Viglino
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; INSERM U1042, HP2 Laboratory, University Grenoble Alps, Grenoble, France
| | | | | | | | - Céline Genty
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Carole Rolland
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Jean-Luc Bosson
- University Grenoble Alps - Center for Clinical Investigation, CHU Michallon, Grenoble, France
| | - Vincent Danel
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France
| | - Guillaume Debaty
- University Grenoble Alps - Emergency Department and Mobile Intensive Care Unit, CHU Michallon, Grenoble, France; University Grenoble Alps, CNRS UMR 5525, TIMC-IMAG Laboratory, Team PRETA, Grenoble, France
| |
Collapse
|
41
|
Sanuki T, Sugioka S, Komasawa N, Ueki R, Kaminoh Y, Kotani J. Comparison of insertion of the modified i-gel airway for oral surgery with the LMA Flexible: a manikin study. Anesth Prog 2014; 61:145-9. [PMID: 25517549 DOI: 10.2344/0003-3006-61.4.145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We previously modified the i-gel airway to enable its use in the field of oral and maxillofacial surgery and reported its fabrication methods. In general, the standard i-gel airway is quick to insert and has a high success rate, but the modified i-gel airway has yet to be assessed for these attributes. We, therefore, set out to compare the ease of insertion of the modified i-gel airway with the LMA Flexible to investigate the usefulness of the modified i-gel airway. The study participants, who included 20 new interns with no experience using either the LMA Flexible or the modified i-gel airway, inserted each device 3 times into an intubation practice manikin. The variables measured in this study were insertion time and rate of successful insertions. Mean insertion time over 3 attempts was significantly shorter for the modified i-gel™ airway (18.9 ± 4.7 seconds) than the LMA Flexible (24.9 ± 5.1 seconds, P < .001). The rate of successful insertions as a total of all 3 attempts was significantly higher for the modified i-gel airway (56/60 times, 93.3%) than the LMA Flexible (45/60 times, 75%; P = .012). When used by an inexperienced operator, the modified i-gel™ airway is faster and has a higher success rate than the LMA Flexible, suggesting that it can be easily manipulated during insertion.
Collapse
Affiliation(s)
- Takuro Sanuki
- Department of Anesthesiology, Osaka Dental University, Osaka, Japan
| | | | | | | | | | | |
Collapse
|
42
|
Kannaujia A, Srivastava U, Saraswat N, Mishra A, Kumar A, Saxena S. A preliminary study of I-gel: a new supraglottic airway device. Indian J Anaesth 2009; 53:52-6. [PMID: 20640078 PMCID: PMC2900034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2009] [Indexed: 11/23/2022] Open
Abstract
This preliminary study on I-gel (Intersurgical Ltd, Wokingham, U K) was conducted on 50 consecutive patients of ASA physical status I-III, to determine the ease of insertion, time to achieve effective airway, oropharyngeal seal pressure and airway stability on head and neck movement. After premedication with midazolam and fentanyl, induction was done with propofol and I-gel was inserted according to manufacturer's instruction. An effective airway was confirmed by bilateral chest movement, square wave on capnograph and SpO(2)>95%. The success rate at first attempt was 90% with a median insertion time of 11 sec (range 8-45sec). Five patients (10%) needed second attempt while none needed 3(rd) attempt. The manipulation needed to achieve effective airway were increasing the depth of insertion of I-gel in 4 (8%) cases, jaw thrust or chin lift in 2(4%) cases. Oropharyngeal seal pressure was 20 cm of H(2)O (16-40 cm of H(2)O). Gastric tube placement was done in 50% of the cases; it was easy and successful in all the cases. No significant adverse event was noted in any of the patient in perioperative period. Our initial experience showed that I-gel is a simple, easy to use supraglottic airway device with a high success rate at first time insertion.
Collapse
Affiliation(s)
- Ashish Kannaujia
- Lecturer, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra,Correspondence to: Ashish Kannaujia, Department of anaesthesia and critical care. S.N. Medical College Agra, E-mail:
| | - Uma Srivastava
- Professor, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra
| | - Namita Saraswat
- PG Students, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra
| | - Abhijeet Mishra
- PG Students, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra
| | - Aditya Kumar
- Professor, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra
| | - Surekha Saxena
- Professor, Department of Anaesthesiology & Critical Care, S N. Medical College, Agra
| |
Collapse
|