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Becker CE, Lorenz W, de Abreu MG, Koch T, Kiss T. Airway management and pulmonary aspiration during surgical interventions in pregnant women in the 2nd/3rd trimester and immediate postpartum - a retrospective study in a tertiary care university hospital. BMC Anesthesiol 2024; 24:166. [PMID: 38702641 PMCID: PMC11067247 DOI: 10.1186/s12871-024-02551-4] [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: 08/21/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Pregnancy is associated with an increased risk of pulmonary aspiration during general anaesthesia, but the incidence of this complication is not well defined. METHODS We performed a retrospective database review in a tertiary care university hospital to determine the incidence of pulmonary aspiration in pregnant patients undergoing endotracheal intubation, with and without Rapid Sequence Induction (RSI), as well as face-mask ventilation and supraglottic airway devices. We included Patients in the 2nd or 3rd trimester of pregnancy and immediate postpartum undergoing surgical procedures. The primary endpoint was the occurrence of pulmonary aspiration. RESULTS Data from 2,390 patients undergoing general anaesthesia for cerclage of cervix uteri, manual removal of retained placenta, repair of obstetric laceration, or postpartum bleeding were retrospectively evaluated. A supraglottic airway device or face-mask ventilation was used in 1,425/2,390 (60%) of patients, while 638/2,390 (27%) were intubated. RSI was used in 522/638 (82%) of patients undergoing tracheal intubation, or 522/2,390 (22%) of the entire cohort. In-depth review of the charts, including 54 patients who had been initially classified as "possible pulmonary aspiration" by anaesthetists, revealed that this adverse event did not occur in the cohort. CONCLUSIONS In conclusion, in this obstetric surgery patient population at risk for pulmonary aspiration, supraglottic airway devices were used in approximately 60% of cases. Yet, no aspiration event was detected with either a supraglottic airway or endotracheal intubation.
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Affiliation(s)
- Charlotte E Becker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Wolfram Lorenz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Division of Intensive Care and Resuscitation, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
- Outcomes Research Consortium, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Kiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- Department of Anesthesiology, Intensive-, Pain- and Palliative Care Medicine, Radebeul Hospital, Academic Hospital of the Technische Universität Dresden, Heinrich-Zille-Straße 13, 01445, Radebeul, Germany.
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Song ES, Jeon GW. Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks. Clin Exp Pediatr 2024; 67:240-246. [PMID: 37448129 PMCID: PMC11065637 DOI: 10.3345/cep.2023.00619] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation. Furthermore, face mask ventilation is compromised during chest compressions. Endotracheal intubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation. In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods. Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway). In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers. Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.
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Affiliation(s)
- Eun Song Song
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Zhao D, Liu W, Zhang Z, Li Y, Luo J, Zheng W, Sun R. Timing of general anesthesia for pediatric patients recovering from COVID-19: a prospective cohort study. BMC Anesthesiol 2024; 24:11. [PMID: 38166732 PMCID: PMC10759690 DOI: 10.1186/s12871-023-02390-9] [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: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To explore the timing of general anesthesia for pediatric patients who have recovered from novel coronavirus infection and summarize anesthesia-related complications. METHODS We summarized the perioperative management of children under 14 years of age who underwent general anesthesia in our hospital according to national epidemic prevention and control requirements. We compared the incidence of postoperative pulmonary complications within 2 weeks (Group A), 3-4 weeks (Group B), and 5-6 weeks (Group C) after COVID-19 recovery. RESULTS There were differences among the three groups in terms of decreased blood oxygen saturation (< 94%), secretions, and coughing during the PACU period. The risk of low blood oxygen saturation during PACU decreased as the time of COVID-19 recovery extended in the three groups. Compared to Group A, the risk of low blood oxygen saturation was lower in Group B. The presence of respiratory symptoms and a body temperature above 40℃ increased the risk of decreased blood oxygen saturation. The proportion of children aged 11-14 years and children with high fever experiencing decreased blood oxygen saturation during PACU was higher in Groups A and B. Among the three groups, children with respiratory symptoms and longer illness duration had a higher proportion of decreased blood oxygen saturation during PACU. CONCLUSION Pediatric patients who have recovered from COVID-19 for more than 2 weeks have a lower risk of postoperative complications after general anesthesia. For children with respiratory system symptoms or high fever, there is a higher risk of transient blood oxygen saturation decrease during PACU. For older children, those with high fever, respiratory system symptoms, or longer illness duration, it is recommended to appropriately extend the time from COVID-19 recovery to surgery.
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Affiliation(s)
- Dinghuan Zhao
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Wei Liu
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Zhao Zhang
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Yuting Li
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Jun Luo
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Weiqiang Zheng
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Ruiqiang Sun
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China.
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Dhiman S, Bhalotra AR, Sharma KR. Safety of removal of ProSeal laryngeal mask airway in children in the supine versus lateral position in a deep plane of anesthesia: A randomized controlled trial. Pediatr Investig 2023; 7:233-238. [PMID: 38050534 PMCID: PMC10693662 DOI: 10.1002/ped4.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 12/06/2023] Open
Abstract
Importance When a ProSeal laryngeal mask airway (PLMA) is removed with the child in a deep plane of anesthesia, the upper airway muscle tone and protective upper airway reflexes may be obtunded. Objective To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications. Methods This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020. Forty children of the American Society of Anesthesiologists class I/II of ages 1-12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited. Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position. The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications. Results The incidence of airway complications was 30% in the supine group and 20% in the lateral group (P = 0.6641). Incidence of laryngospasm, immediate stridor, and excessive secretions were similar. Early stridor and oxygen desaturation were higher in the supine group (P = 0.0374, P = 0.0183 respectively). Interpretation The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children. The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.
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Affiliation(s)
- Shweta Dhiman
- Department of Anaesthesiology and Intensive CareMaulana Azad Medical College and Associated HospitalsNew DelhiIndia
| | - Anju R. Bhalotra
- Department of Anaesthesiology and Intensive CareMaulana Azad Medical College and Associated HospitalsNew DelhiIndia
| | - Kavita R. Sharma
- Department of AnaesthesiologyVardhaman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
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Roberts CT, O'Shea JE. Alternatives to neonatal intubation. Semin Fetal Neonatal Med 2023; 28:101488. [PMID: 38000926 DOI: 10.1016/j.siny.2023.101488] [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] [Indexed: 11/26/2023]
Abstract
Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. In term and near-term infants, supraglottic airways may be the most effective initial approach to resuscitation. Use of supraglottic airways during resuscitation can be taught to a range of providers, and may reduce need for intubation. While face mask ventilation is an important skill, it is challenging to perform effectively. Identification of the best approach to training the use of these devices during neonatal resuscitation remains an important priority.
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Affiliation(s)
- Calum T Roberts
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.
| | - Joyce E O'Shea
- Department of Paediatrics, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
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Maheshwari C, Kaur H, Aggarwal V. Comparison of Intubation Success Rate using Airtraq Laryngoscope and Intubating Laryngeal Mask Airway in Novice Users with Prior Airway Management Experience: A Prospective Randomised Study. Rom J Anaesth Intensive Care 2022; 29:16-21. [PMID: 36844960 DOI: 10.2478/rjaic-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Background and Aims Securing the airway without morbidity is of prime importance. The difficult airway cart should have some advanced airway aids if not all. In this study we evaluated Airtraq laryngoscope and Intubating Laryngeal Mask Airway (ILMA) as intubating devices in novice users who were well accomplished in intubation using direct laryngoscope with Macintosh blade. Both the devices were used because of relatively lesser cost, portability and all in one compact design not requiring any setup. Methods: 60 consenting American Society of Anaesthesiology (ASA) Grade I and II patients, weighing 50 to 70 were randomly assigned to be intubated by Airtraq or ILMA. Primary Aim was to compare success rate and intubation time. Comparison of ease of intubation and postoperative pharyngeal morbidity were the secondary end points. Results Success rate of intubation was higher in ILMA group (100%) than Airtraq (80%) [P = 0.0237]. However, in successful intubations the time for intubation was significantly less with Airtraq (Group A = 45.37 ± 27.55, Group I = 77.6 ± 31.85; P = 0.0003). No significant difference was noted in ease of intubation, number of optimizing manoeuvres to facilitate intubation and postoperative pharyngeal morbidity. Conclusion In Clinicians who are well versed with laryngoscopy using Macintosh blade but new to Airtraq and ILMA, success rate of intubation is higher with ILMA. Prolonged intubation time in ILMA should not deter its use in difficult airway scenarios because of the ability to ventilate through it.
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Kolay F, Vahapoğlu A, Güvenç A, Türkmen ÜA. The Comparison Between Inhalation and Total Intravenous Anesthesia Effect on Voice With Supraglottic Airway Devices for Short-term Anesthesia. J Voice 2022:S0892-1997(22)00315-0. [PMID: 36494245 DOI: 10.1016/j.jvoice.2022.10.009] [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: 07/13/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Supraglottic airway devices (SADs) are a good alternative to endotracheal intubation (ETI) in short-term anesthesia applications since they have advantages including easy application, lower cost, enabling spontaneous ventilation. Total intravenous anesthesia (TIVA) and desflurane anesthesia allowing rapid recovery are anesthesia methods to be selected. Inhalation anesthesia by desflurane may cause adverse effects on airway mucosa and vocal cord functions. The aim of the present study was to compare the effect of the chosen anesthesia method on voice in gynecological patients who underwent short-term anesthesia with SADs. MATERIAL AND METHOD Seventy four patients whom short-term surgical procedure was planned in the Gynecology and Obstetrics Clinic were randomized into two groups for desflurane anesthesia (group D) and TIVA (group T). Voice recording was performed through larynx examination before anesthesia. Perioperative hemodynamic parameters, airway complications and postoperative airway complications were recorded. Laryngeal examination and voice recording were performed for the second time after 24 hours following the anesthesia procedure. Acoustic voice analysis of the patients was evaluated through the Praat program. The conditions including sore throat, dysphagia, and hoarseness were investigated after the anesthesia. Acoustic and aerodynamic properties of the voice, airway complications and pharyngolaryngeal complaints related to the use of SADs were compared in the patients. RESULT There was not any significant difference between the groups for demographic data. The SADs type and size have similar characteristics. No significant difference was detected between Group T and Group D for anesthesia duration (P = 0.964). Both anesthesia methods cause similar effects on pharyngolaryngeal functions and voice. No significant difference was found between Group T and Group D in parameters other than the shimmer value of acoustic analysis. A statistically significant increase was observed in the Shimmer variable of group D (P < 0.05). When group T and group D were compared, there was not any significant difference in terms of airway complications, sore throat, dysphagia, and hoarseness. CONCLUSION The TIVA and desflurane anesthesia presented similar clinical effects on voice and pharyngolaryngeal morbidity in the short-term gynecological operations through SADs. The increased shimmer value of acoustic voice analysis in Group D suggests that desflurane anesthesia may cause clinically insignificant deterioration on the voice. Further comprehensive studies are needed in order to demonstrate the effect of anesthetic agents on larynx functions in patients whom SADs is used.
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Affiliation(s)
- Feyzullah Kolay
- Department of Anesthesiology and Reanimation, University of Health Sciences Gaziosmanpasa Training Research Hospital, Istanbul, Turkey.
| | - Ayşe Vahapoğlu
- Department of Anesthesiology and Reanimation, University of Health Sciences Gaziosmanpasa Training Research Hospital, Istanbul, Turkey
| | - Ahmet Güvenç
- Otolaryngology Department, University of Health Sciences Gaziosmanpaşa Taksim Education and Research Hospital, Istanbul, Turkey
| | - Ülkü Aygen Türkmen
- Department of Anesthesiology and Reanimation, University of Health Sciences Gaziosmanpasa Training Research Hospital, Istanbul, Turkey
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Wang T, Wang J, Lu Y, Liu X, Chen S. Efficacy of using an intravenous catheter to repair damaged expansion lines of endotracheal tubes and laryngeal masks. BMC Anesthesiol 2022; 22:238. [PMID: 35883053 PMCID: PMC9316419 DOI: 10.1186/s12871-022-01776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background In perioperative care or intensive care units, the expansion lines of endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) may be accidentally cut off during medical procedures. We designed a simple method for repairing damaged ETT and LMA expansion lines. Methods In this in vitro study, ETT (n = 20) or LMA (n = 20) models were each categorized into experimental (n = 10) and control (n = 10) groups. In the experimental groups, the expansion lines were cut in the middle, and a 22G intravenous catheter was inserted into the broken end of each expansion line. The time taken to repair the expansion lines was recorded in both experimental groups. The repaired expansion lines in both groups were tested for visible underwater air leakage with cuffs under high pressure (120 cm H2O). After 15 h, the cuff pressure and tensile strength of the expansion lines were measured. Results The overall time required to repair the expansion line was 27.8 ± 1.5 s in the ETT group and 20.4 ± 1.1 s in the LMA group. When the cuff pressure was increased to 120 cmH2O, no air leakage was observed in the experimental LMA and ETT groups. The mean difference in the cuff pressures of the control and experimental groups was insignificant for both, ETT (9.50 ± 1.29 vs. 9.50 ± 1.08 cmH2O, 95% CI = − 1.11 to 1.11 cmH2O, P = 1.00) and LMA (34.1 ± 1.10 cmH2O vs. 34.5 ± 0.97 cmH2O, 95% CI = − 0.57 to 1.37 cmH2O, P = 0.40) groups, The tensile strength and the force required to pull apart the expansion lines in the experimental groups were lower than those in the control groups for ETTs (3.32 ± 0.37 N vs. 35.03 ± 4.47 N, 95% CI = − 34.69 to − 28.72 N, P < 0.0001) and LMAs (36.55 ± 2.20 N vs. 26.18 ± 1.67 N, 95% CI = − 12.21 to − 8.53 N, P < 0.0001). Conclusion An intravenous catheter can be directly inserted into the damaged ETT or LMA expansion lines; it is a simple, rapid, and effective repair method. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01776-5.
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Affiliation(s)
- Tingting Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
| | - Jiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.,Ambulatory Surgery Center, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Xuesheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China
| | - Shangui Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, China.
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Koo CH, Oh AY, Jeon YT, Hwang JW, Ryu JH. Standard digit-based versus 90° rotation technique for supraglottic airway device insertion: a meta-analysis of randomized controlled trials. Korean J Anesthesiol 2022; 75:266-275. [PMID: 34883010 PMCID: PMC9171549 DOI: 10.4097/kja.21441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt insertion and placement of supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of insertion success rate, insertion time, and postoperative complications. METHODS A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included. RESULTS The first-attempt (risk ratio [RR]: 1.16, 95% CI [1.09, 1.25], P < 0.001) and overall success rates (RR: 1.06, 95% CI [1.03, 1.09], P < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference: -4.42 s, 95% CI [-6.70, -2.15 s], P < 0.001). The incidences of postoperative sore throat (RR: 0.63, 95% CI [0.49, 0.83], P < 0.001) and blood staining (RR: 0.28, 95% CI [0.20, 0.39], P < 0.001) were lower in the 90° rotation group. CONCLUSIONS The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases postoperative complications as compared with that of the standard digit-based technique in anesthetized patients.
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Affiliation(s)
- Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Rustagi K, Garg R, Bharti SJ, Kumar V, Gupta N, Mishra S, Bhatnagar S. To compare clinical versus ultrasound assessment of correct placement of ProSeal Laryngeal mask airway (PLMA): a prospective randomized study. J Clin Monit Comput 2022; 36:529-535. [PMID: 33725219 DOI: 10.1007/s10877-021-00684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Extraglottic airway devices (EAD) have revolutionized the perioperative airway management. The accuracy of clinical tests to identify malposition has been questioned by recent studies where fibreoptic evaluation identified various malpositions that were undiagnosed by a clinical test. Ultrasound (USG) has evolved to guide various airway interventions. However, USG is under-evaluated in the assessment of the EADs position. Our study aimed to compare clinical versus USG assessment of optimal placement of ProSeal laryngeal mask airway (PLMA). This randomized control trial was done in 212 consenting patients undergoing onco-surgery with PLMA as an airway device. Patients were randomized in Group CL (n-107) and US (n-105). Following primary assessment-using clinical tests and USG evaluation using a scoring system, fibreoptic evaluation of the placement of PLMA was done and then assessed for optimal position. The accuracy of each technique for optimal placement was compared statistically. We found that the sensitivity and specificity of the clinical evaluation were 98.77% and 34.62% with a diagnostic accuracy of 83.18% when compared with fibreoptic evaluation. While USG evaluation using the scoring system has sensitivity and specificity of 95.45% and 29.41% with a diagnostic accuracy of 84.76%. It was noted that USG assessment has a higher positive predictive value (87.5%) as compared to clinical assessment (82.47%). The incidence of rotation was higher in the clinical group. There was no difference in airway related morbidity. USG is comparable to clinical tests for evaluation of the optimal placement of PLMA. However, USG has various advantages over clinical assessment as it is quick and identifies the unacceptable placement of PLMA where the tip of PLMA may not lie over the tip of the esophagus, thereby, avoiding unnecessary mucosal injury during forceful or repeated attempts for gastric drainage tube insertion.Trial registration: Clinical Trials Registry (CTRI/2017/11/010359) dated 3rd November 2017.
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Affiliation(s)
- Kanika Rustagi
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India.
| | - Sachidanand Jee Bharti
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, Room No 139, First Floor, Ansari Nagar, New Delhi, 110029, India
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Süzer MA, Özhan MÖ, Çaparlar CÖ, Eşkin MB, Atik B. Airway management in general anesthesia for endovascular treatment of cerebral arteriovenous malformation: a retrospective observational study. Braz J Anesthesiol 2021:S0104-0014(21)00424-3. [PMID: 34963618 DOI: 10.1016/j.bjane.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/04/2021] [Accepted: 12/11/2021] [Indexed: 12/05/2022] Open
Abstract
Background and objective This retrospective and observational study aimed to retrospectively evaluate the use of the endotracheal tube (ETT) and the Laryngeal Mask Airway (LMA) for the airway management with respect to airway safety, hemodynamic stability, adverse respiratory events, and recovery characteristics in patients who underwent endovascular treatment (EVT) for cerebrovascular arteriovenous malformation under general anesthesia between 2011 and 2018. Methods The study included data from the patient's electronic medical records and anesthesia files. The primary outcome measure was the incidence of hemodynamic disturbances and respiratory adverse events during airway management. The secondary outcome measure was the comparison of recovery characteristics. Results The airway was secured using ETT in 41 patients and LMA in 39 patients. Airway safety was established in all patients without a complication throughout the procedure. Mean arterial blood pressure and heart rate were increased to > 20% of baseline levels at intubation and extubation periods in more patients in the ETT group than the LMA group (27 vs. 3; p = 0.07, and 11 vs. 2; p = 0.021). Respiratory adverse events including straining and coughing were observed in ten patients in the ETT group but only in one patient in the LMA group (p = 0.013). Time to extubation, to neurological assessment, and to discharge from the angiography unit were similar (p > 0.05). Conclusion It was concluded that LMA provided sufficient airway safety as with ETT and may be used as an alternative to ETT for EVTs under general anesthesia.
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Liu Y, Song Y, Wang M, Yang M, Shen H, Wang Z, Chen L, Yang J, Gong S, Yu Y, Shi Z, Zhang W, Zou X, Sun X, Wang Y, Fu Q, Cao J, Mi W. LMA® protector™ in patients undergoing laparoscopic surgeries: a multicenter prospective observational study. BMC Anesthesiol 2021; 21:318. [PMID: 34930137 PMCID: PMC8686540 DOI: 10.1186/s12871-021-01535-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery. METHODS Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™. RESULTS Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients. CONCLUSIONS The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry ( ChiCTR1800018300 , date of registration: September 2018).
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Affiliation(s)
- Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuxiang Song
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical school of Chinese PLA, Beijing, China
| | - Miaomiao Wang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Meihua Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hao Shen
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Wang
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Liyong Chen
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianjun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shengkai Gong
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Zhao Shi
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Research Institute of Anesthesiology, Tianjin, China
| | - Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xuli Zou
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xude Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yuan Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Qiang Fu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Cereceda-Sánchez FJ, Clar-Terradas J, Moros-Albert R, Mascaró-Galmés A, Navarro-Miró M, Molina-Mula J. [I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial]. Aten Primaria 2021; 53:102062. [PMID: 34044355 PMCID: PMC8167161 DOI: 10.1016/j.aprim.2021.102062] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. DESIGN Randomized experimental pilot study by groups. SETTING Out-hospital care basic life support units on the Island of Mallorca. PARTICIPANTS Adults attended after cardiorespiratory arrest of non-traumatic origin. INTERVENTIONS Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. MAIN MEASUREMENTS Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. RESULTS Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). CONCLUSIONS The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.
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Affiliation(s)
| | | | - Rut Moros-Albert
- Gerencia SAMU 061 Baleares, Palma de Mallorca, Islas Baleares, España
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14
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Park KN, Jeong HJ. Transient unilateral lingual nerve injury following the use of laryngeal mask airway Supreme: a case report. Braz J Anesthesiol 2021:S0104-0014(21)00367-5. [PMID: 34627831 DOI: 10.1016/j.bjane.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/08/2021] [Accepted: 08/08/2021] [Indexed: 11/22/2022] Open
Abstract
Lingual nerve injury rarely occurs after using the laryngeal mask airway (LMA). A 40-year-old woman with no comorbidities visited the hospital for left breast-conserving surgery. Anesthesia was performed using LMA Supreme™. She complained of decreased sensation in the right front part of the tongue postoperatively. She received prednisolone and tongue sensation returned on postoperative day 28. The lingual nerve could be damaged by the LMA, particularly the lateral edge of the tongue base and inner part of the mandible around the third molar. When using the LMA, it is necessary to check the cuff pressure to prevent lingual nerve damage.
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Nakanishi T, Sakamoto S, Yoshimura M, Toriumi T. AutoFlow® versus volume-controlled ventilation for laparoscopic gynecological surgery using LMA® ProSeal™: a randomized controlled trial. BMC Anesthesiol 2021; 21:181. [PMID: 34182933 PMCID: PMC8237450 DOI: 10.1186/s12871-021-01406-6] [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] [Received: 02/23/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background During laparoscopic gynecological surgery, increased peak airway pressure (PAWP) can cause airway leak upon ventilation with the LMA® ProSeal™. We hypothesized that compared with the use of volume-controlled ventilation (VCV), the use of the AutoFlow® mode would decrease PAWP and airway leak during laparoscopic gynecological surgery with LMA ProSeal. Methods This single-center, randomized, controlled trial allocated 80 adult women undergoing elective laparoscopic gynecological surgery to one of two groups, namely, the AutoFlow group or the VCV group. Ventilation settings for both groups were 8 ml/kg of tidal volume and 5 cmH2O of positive end-expiratory pressure, and respiratory rate was adjusted to maintain end-tidal carbon dioxide at 35–40 mmHg. Airway leak, PAWP, and other ventilatory parameters and vital signs were recorded at four timepoints (1, 1 min after insertion of the gastric tube; 2, 2 min after intravenous administration of rocuronium 0.6–0.8 mg/kg; 3, 1 min after initiation of pneumoperitoneum; and 4, 1 min after changing to the Trendelenburg position). The primary outcome was PAWP during pneumoperitoneum and in the Trendelenburg position, whereas the secondary outcomes included PAWP at other timepoints and airway leak development. We used the Mann–Whitney U test for PAWP and Fisher’s exact test for comparing airway leak among the groups. Results Data from 40 patients in the AutoFlow group and 39 in the VCV group were used for analysis. PAWP at pneumoperitoneum pressure and in the Trendelenburg position was significantly lower in the AutoFlow group than in the VCV group [median (interquartile range), 16 (15–18) cmH2O vs. 18 (17–19) cmH2O; P < 0.001]. Similarly, patients in the AutoFlow group showed lower PAWP at the other three timepoints measured. Airway leak occurred in four patients in the AutoFlow group and in two patients in the VCV group; however, this incidence was not significantly different (P = 0.68). Conclusions Even though AutoFlow ventilation decreased PAWP, it did not reduce the incidence of airway leak compared with VCV during laparoscopic gynecological surgery with the LMA ProSeal. Trial registration UMIN Clinical Trials Registry, identifier UMIN000023173. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01406-6.
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Affiliation(s)
- Toshiyuki Nakanishi
- Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Shunan, Japan. .,Present address: Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
| | - Seishi Sakamoto
- Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Shunan, Japan
| | - Manabu Yoshimura
- Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Shunan, Japan
| | - Takashi Toriumi
- Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Shunan, Japan
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16
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Deepak GP, Kumar R, Agarwal M, Bharadwaj M, Kumar NG, Sarma R. Comparison of Ambu AuraGain at low cuff pressure, Ambu AuraGain at high cuff pressure and i-gel in relation to incidence of postoperative upper airway complications. Indian J Anaesth 2021; 65:439-444. [PMID: 34248186 PMCID: PMC8252994 DOI: 10.4103/ija.ija_189_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background and Aims: Postoperative upper airway complications are frequently encountered with the use of supraglottic airway devices (SADs). Cuff pressure is one of the risk factors for upper airway complications with SADs. Among SADs, i-gel has shown lesser incidence. The effect of different cuff pressures on the incidence of postoperative upper airway complications is not known with Ambu AuraGain and nor has Ambu AuraGain been compared with i-gel in this regard. So, we undertook this study. Methods: A total of 200 patients undergoing elective laparoscopic surgery were randomised into 3 groups based on the SAD used and intra-cuff pressure: i-gel (IG) (n = 66); Ambu AuraGain at 25 cmH2O cuff pressure (AL) (n = 67); and Ambu AuraGain at 60 cmH2O cuff pressure (AH) (n = 67). The oropharyngeal leak pressures (OLPs) were measured after insertion and generation of carboperitoneum. An observer who was blind to the intraoperative details assessed the patients for two postoperative days for sore throat, dysphagia, dysphonia, or any other upper airway complications. Results: The OLPs before and after carboperitoneum in the 3 groups were (IG-24.22 ± 7.87 and 28.31 ± 8.52, AL-24.40 ± 5.84 and 26.94 ± 5.93, AH-25.02 ± 5.02 and 28.91 ± 5.6) cmH2O (P = 0.747 and P = 0.231). The overall incidence of postoperative sore throat among the 3 groups was: IG-5.7%, AL-14.9%, and AH-17.9%; P = 0.135. Dysphagia was seen only with Ambu AuraGain at high pressure in 4 patients (5.97%) (P = 0.017). Conclusion: Limiting cuff pressure in Ambu AuraGain to 25, as against 60 cmH2O, does not affect the OLP but has the potential of reducing the incidence of dysphagia.
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Affiliation(s)
- G P Deepak
- Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
| | - Rakesh Kumar
- Department of Anaesthesiology, Dr. Baba Saheb Ambedkar Medical College, Rohini, New Delhi, India
| | - Munisha Agarwal
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Manoj Bharadwaj
- Department of Anaesthesiology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Neera G Kumar
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Riniki Sarma
- Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India
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17
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Jänig C, Balogh O, Krappitz S, Willms A, Schmidbauer W, Piepho T. [Manikin-based comparison of the use of different supraglottic airways by laypersons]. Med Klin Intensivmed Notfmed 2021. [PMID: 34125259 DOI: 10.1007/s00063-021-00834-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/01/2021] [Accepted: 04/23/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Supraglottic airways (SGA) are an established method of airway management both in prehospital medicine and clinical settings. Endotracheal intubation is the gold standard, but SGA offer advantages in terms of faster application learnability. OBJECTIVES In the present study it was investigated whether the time until the first sufficient ventilation in the three examined SGAs applied by bystander differed significantly. MATERIALS AND METHODS A total of 160 visitors to a shopping mall were assigned to one of the three SGA after permutative block randomization. The primary endpoint of the present study was the required placement time until the first sufficient ventilation. RESULTS Participants managed to place the i‑gel laryngeal mask airway (i-gel, Intersurgical Beatmungsprodukte GmbH, Sankt Augustin, Germany) after a median time of 11 s, whereas the median time until the first sufficient ventilation using a classic laryngeal mask airway (LMA; 26 s) or a laryngeal tube (LT; 28 s) was significantly longer. Thus, the time savings when using the i‑gel compared to the LT and LMA were each significant (p < 0.001), whereas the times between LT and LMA did not differ significantly (p 0.65). CONCLUSION The results show that laypersons are able to successfully apply various supraglottic airways to the phantom after a short learning period. The i‑gel laryngeal mask could be placed with the highest success rate and speed.
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18
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Cereceda-Sánchez FJ, Molina-Mula J. Use of supraglottic airway devices under capnography monitoring during cardiopulmonary resuscitation: A systematic review. Aust Crit Care 2021; 34:287-295. [PMID: 33069590 DOI: 10.1016/j.aucc.2020.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/04/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bag-valve-mask ventilation is the most commonly applied method during cardiopulmonary resuscitation. Globally, advanced airway management with blind insertion devices such as supraglottic airway devices has been implemented for years by different emergency services. The efficiency of ventilation via such devices could be measured by capnography. OBJECTIVE The objective of this study was to determine whether capnography is useful in patients undergoing cardiopulmonary resuscitation and to assess the effectiveness of ventilation via supraglottic airway devices. REVIEW METHODS USED This is a systematic review written following the steps of Preferred Reporting Items for Systematic Review and Meta-analyses protocols. DATA SOURCES A bibliographic search was carried out from the following databases: EBSCOhost, Scopus, EMBASE, Virtual Health Library, PubMed, Cochrane Library, Spanish Medical Index, Spanish Bibliographic Index in Health Sciences, and Latin American and Caribbean Health Sciences Literature, from inception until September 2019. REVIEW METHODS Studies describing the use of capnography with supraglottic airway devices during cardiopulmonary resuscitation manoeuvres were selected and evaluated using the Critical Appraisal Skills Programme. RESULTS Twenty-four articles were identified by title and abstract: six were randomised clinical trials, 11 were nonrandomised clinical trials, six were descriptive prospective studies, and one was a descriptive retrospective study. Nine primary research articles were selected for synthesis. Only one provided objective values of capnography obtained with ventilation with these devices, correlating them with the results of resuscitation. CONCLUSIONS The evidence published so far is scarce, mostly from observational studies with high risk of bias in general. Although a degree of recommendation cannot be established, some results indicate that capnography has the potential to facilitate advanced clinical practice of ventilation with supraglottic airway devices during cardiopulmonary resuscitation.
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Affiliation(s)
| | - Jesús Molina-Mula
- University of Balearic Islands, Ctra. de Valldemossa, km 7.5, Palma (Islas Baleares), Spain
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19
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Shiveshi P, Anandaswamy TC. Comparison of Proseal LMA with i-Gel in children under controlled ventilation: a prospective randomised clinical study. Braz J Anesthesiol 2021:S0104-0014(21)00118-4. [PMID: 33823205 DOI: 10.1016/j.bjane.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/31/2020] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Supraglottic airway device is presently the most common modality of airway management in children for short surgical procedures. The i-gel is one such novel supraglottic airway device with a non-inflatable cuff. The objective of the present study was to evaluate the efficiency of i-gel compared to LMA Proseal regarding oropharyngeal leak pressure, insertion time, ease of insertion, and fibreoptic view of larynx. Methods After obtaining ethical clearance and parental consent, 70 children aged 2–10 years, weighing 10–30 kg were randomised to receive LMA Proseal or i-gel for airway management. Data with respect to oropharyngeal leak pressure, insertion time, ease of insertion, number of attempts, and fibreoptic score were collected. The primary outcome was the oropharyngeal leak pressure with the two supraglottic airway devices measured by manometric stability. Results Demographic data were comparable between the two groups. The oropharyngeal leak pressure (LMA Proseal vs. i-gel, 20.51 ± 4.71 cmH2O vs. 19.57 ± 5.71 cmH2O), ease of insertion, number of attempts, and fibreoptic view score was similar between the two groups. The insertion time was faster with i-gel (22.63 ± 5.79 s) compared to LMA Proseal (43.26 ± 7.85 s). Conclusion I-gel was similar to LMA Proseal with respect to oropharyngeal leak pressure in children under controlled ventilation.
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Sun R, Bao X, Gao X, Li T, Wang Q, Li Y. The impact of topical lidocaine and timing of LMA removal on the incidence of airway events during the recovery period in children: a randomized controlled trial. BMC Anesthesiol 2021; 21:10. [PMID: 33419400 PMCID: PMC7791716 DOI: 10.1186/s12871-021-01235-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background The timing of laryngeal mask airway (LMA) removal remains undefined. This study aimed to assess the optimal timing for LMA removal and whether topical anesthesia with lidocaine could reduce airway adverse events. Methods This randomized controlled trial assessed one-to-six-year-old children with ASA I-II scheduled for squint correction surgery under general anesthesia. The children were randomized into the LA (lidocaine cream smeared to the cuff of the LMA before insertion, with mask removal in the awake state), LD (lidocaine application and LMA removal under deep anesthesia), NLA (hydrosoluble lubricant application and LMA removal in the awake state) and NLD (hydrosoluble lubricant application and LMA removal in deep anesthesia) groups. The primary endpoint was a composite of irritating cough, laryngeal spasm, SpO2 < 96%, and glossocoma in the recovery period in the PACU. The secondary endpoints included the incidence of pharyngalgia and hoarseness within 24 h after the operation, duration of PACU stay, and incidence of agitation in the recovery period. The assessor was unblinded. Results Each group included 98 children. The overall incidence of adverse airway events was significantly lower in the LA group (9.4%) compared with the LD (23.7%), NLA (32.6%), and NLD (28.7%) groups (P=0.001). Cough and laryngeal spasm rates were significantly higher in the NLA group (20.0 and 9.5%, respectively) than the LA (5.2 and 0%, respectively), LD (4.1 and 1.0%, respectively), and NLD (9.6 and 2.1%, respectively) groups (P=0.001). Glossocoma incidence was significantly lower in the LA and NLA groups (0%) than in the LD (19.6%) and NLD (20.2%) groups (P< 0.001). At 24 h post-operation, pharyngalgia incidence was significantly higher in the NLA group (15.8%) than the LA (3.1%), LD (1.0%), and NLD (3.2%) groups (P< 0.001). Conclusions LMA removal in the awake state after topical lidocaine anesthesia reduces the incidence of postoperative airway events. Trial registration ChiCTR, ChiCTR-IPR-17012347. Registered August 12, 2017.
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Affiliation(s)
- Ruiqiang Sun
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China.
| | - Xiaoyun Bao
- Tianjin Huaming Community Healthcare Service Center, Tianjin, China
| | - Xuesong Gao
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Tong Li
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Quan Wang
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Yueping Li
- Department of Anesthesiology, Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
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21
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Hameed M, Samad K, Ullah H. [Comparison of two supraglottic airway devices on postoperative sore throat in children: a prospective randomized controlled trial]. Rev Bras Anestesiol 2020; 70:240-247. [PMID: 32507285 DOI: 10.1016/j.bjan.2020.03.006] [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: 09/22/2019] [Revised: 02/16/2020] [Accepted: 03/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sore throat is well recognized complaint after receiving general anesthesia. This study is conducted to compare the severity and frequency of postoperative sore throat in children undergoing elective surgery - following the use of Ambu laryngeal mask airway) or I-gel® - who are able to self-report postoperative sore throat. METHOD Seventy children, 6 to 16 years-old, undergoing elective surgery randomly allocated to either Ambu laryngeal mask (Ambu Group) or I-gel® (I-gel Group). After the procedure, patients were interviewed in the recovery room immediately, after one hour, 6 and 24 hours postoperatively by an independent observer blinded to the device used intra-operatively. RESULTS On arrival in the recovery room 17.1% (n=6) of children of the Ambu Group complained of postoperative sore throat, against 5.7% in I-gel Group (n=2). After one hour, the results were similar. After 6 hours, postoperative sore throat was found in 8.6% (n=3) of the children in Ambu group vs. 2.9% (n=1) in I-gel Group. After 24hours, 2.9% (n=1) of the kids in Ambu Group compared to none in I-gel Group. There was no significant difference found in the incidence of postoperative sore throat in both devices on arrival (p=0.28); after 1 hour (p=0.28); after 6 hours (p=0.30); and after 24 hours (p=0.31). The duration of the insertion was shorter in Ambu Group and it was easier to insert the I-gel® (p=0.029). Oropharyngeal seal pressure of I-gel® was higher than that of Ambu laryngeal mask (p=0.001). CONCLUSION The severity and frequency of postoperative sore throat in children is not statistically significant in the I-gel Group compared to Ambu Group.
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Affiliation(s)
- Malika Hameed
- Aga Khan University Hospital, Department of Anesthesiology, Karachi, Pakistan.
| | - Khalid Samad
- Aga Khan University Hospital, Department of Anesthesiology, Karachi, Pakistan
| | - Hameed Ullah
- Aga Khan University Hospital, Department of Anesthesiology, Karachi, Pakistan
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Turna CK, Arslan ZI, Alparslan V, Okyay K, Solak M. [Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial]. Rev Bras Anestesiol 2020; 70:118-124. [PMID: 32482361 DOI: 10.1016/j.bjan.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. METHODS Eighty patients with ASA physical status I-III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. RESULTS There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9±22.1s vs. 50.7±21.2s; p<0.001). A significant difference was found when the times of total intubation were compared (29.9±22.1s vs. 97.4±42.7s; p<0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p<0.05). CONCLUSIONS Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.
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Affiliation(s)
- Canan Kamile Turna
- Kocaeli University Medical Faculty, Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Zehra Ipek Arslan
- Kocaeli University Medical Faculty, Anesthesiology and Reanimation, Kocaeli, Turkey.
| | - Volkan Alparslan
- Kocaeli University Medical Faculty, Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Kamil Okyay
- Kocaeli University Medical Faculty, Anesthesiology and Reanimation, Kocaeli, Turkey
| | - Mine Solak
- Kocaeli University Medical Faculty, Anesthesiology and Reanimation, Kocaeli, Turkey
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Lee JH, Nam S, Jang YE, Kim EH, Kim HS, Kim JT. Clinical performance of Ambu AuraGain TM versus i-gel TM in anesthetized children: a prospective, randomized controlled trial. Anesth Pain Med (Seoul) 2020; 15:173-180. [PMID: 33329810 PMCID: PMC7713828 DOI: 10.17085/apm.2020.15.2.173] [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: 09/05/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022] Open
Abstract
Background Ambu AuraGain and i-gel have different characteristics in design each other. However, few reports evaluate which device has more benefits for ventilation in children undergoing paralyzed general anesthesia. This prospective, randomized controlled trial compared the clinical performance AuraGain and i-gel in anesthetized children. Methods Children aged between 1 month and 7 years undergoing elective surgery were randomly assigned to the AuraGain and i-gel groups. The primary outcome was initial oropharyngeal leak pressure (OLP). Secondary outcomes were OLP at 10 min post-insertion, first-attempt and total insertion success rates, number of attempts and ease of gastric suction catheter placement, peak inspiratory pressure, fiberoptic bronchoscopic view score, ventilation quality, requirement of additional manipulation post-insertion, and complications. Results Data of 93 patients were analyzed. The initial OLPs of the AuraGain and i-gel were 27.5 ± 7.7 and 25.0 ± 8.0 cmH2O, respectively (P = 0.130). The OLP was significantly increased 10 min post-insertion in both groups. The initial success rates of the AuraGain and i-gel insertion were comparable. Suction catheter placement via the gastric port was easier (P = 0.018) and fiberoptic bronchoscopic view was better with the AuraGain (P < 0.001). The i-gel required additional manipulations post-insertion (P = 0.038). The incidence of complications during the emergence period was 10.8% for the i-gelTM and 2.2% for the AuraGain (P = 0.1) Conclusions OLP is comparable between AuraGain and i-gel. The AuraGain would be more favorable than the i-gelTM for use in pediatric patients under general anesthesia considering other outcomes.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seungpyo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Marinho S, Frias P, Oliveira I, Silva R, Rodrigues F, Paiva A. Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:212-214. [PMID: 32178913 DOI: 10.1016/j.redar.2020.01.003] [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] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.
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Affiliation(s)
- S Marinho
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | - P Frias
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Oliveira
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - R Silva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - F Rodrigues
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Paiva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
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Choi SR, Lee TY, Kim SW, Park SY, Chung CJ, Kim JH. Comparison of clinical performance of i-gelⓇ and Baska MaskⓇ during laparoscopic cholecystectomy. Korean J Anesthesiol 2019; 72:576-582. [PMID: 31426623 PMCID: PMC6900424 DOI: 10.4097/kja.19195] [Citation(s) in RCA: 8] [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: 05/07/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The supraglottic airway device is an appropriate alternative to tracheal intubation in laparoscopic surgery. We compared the Baska MaskⓇ with i-gelⓇ by measuring the oropharyngeal leak pressure (OLP) and hemodynamic and respiratory parameters during laparoscopic cholecystectomy. METHODS A total of 97 patients were randomly allocated to either i-gel group (n = 49) or Baska Mask group (n = 48). Insertion time, number of insertion attempts, fiber-optic view of the glottis, and OLP were recorded. Heart rate, mean arterial pressure, peak airway pressure (PAP), lung compliance, and perioperative complications were assessed before, during, and after pneumoperitoneum. RESULTS There were no significant differences between the two groups regarding demographic data, insertion time, fiber-optic view of the glottis, and the use of airway manipulation. The OLP was higher in the Baska Mask group than in the i-gel group (29.6 ± 6.8 cmH2O and 26.7 ± 4.5 cmH2O, respectively; P = 0.014). Heart rate, mean arterial pressure, PAP, and lung compliance were not significantly different between the groups. The incidence of perioperative complications was small and not statistically significant. CONCLUSIONS Both the i-gel and Baska Mask provided a satisfactory airway during laparoscopic cholecystectomy. Compared with the i-gel, the Baska Mask demonstrated a higher OLP.
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Affiliation(s)
- So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Tae Young Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sung Wan Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong Ho Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine, Busan, Korea
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26
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Kim GW, Kim JY, Kim SJ, Moon YR, Park EJ, Park SY. Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion. BMC Anesthesiol 2019; 19:4. [PMID: 30611202 PMCID: PMC6320569 DOI: 10.1186/s12871-018-0674-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/19/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background Insertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator. Methods After approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded. Results Data were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001). Conclusion Laryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion. Trial registration cris.nih.go.kr, identifier: KCT0001945 (2016-06-17).
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Affiliation(s)
- Go Wun Kim
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jong Yeop Kim
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Soo Jin Kim
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeo Rae Moon
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Jeong Park
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sung Yong Park
- Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Gálvez JA, Jalali A, Ahumada L, Simpao AF, Rehman MA. Neural Network Classifier for Automatic Detection of Invasive Versus Noninvasive Airway Management Technique Based on Respiratory Monitoring Parameters in a Pediatric Anesthesia. J Med Syst 2017; 41:153. [PMID: 28836107 DOI: 10.1007/s10916-017-0787-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/20/2017] [Indexed: 01/09/2023]
Abstract
Children undergoing general anesthesia require airway monitoring by an anesthesia provider. The airway may be supported with noninvasive devices such as face mask or invasive devices such as a laryngeal mask airway or an endotracheal tube. The physiologic data stored provides an opportunity to apply machine learning algorithms distinguish between these modes based on pattern recognition. We retrieved three data sets from patients receiving general anesthesia in 2015 with either mask, laryngeal mask airway or endotracheal tube. Patients underwent myringotomy, tonsillectomy, adenoidectomy or inguinal hernia repair procedures. We retrieved measurements for end-tidal carbon dioxide, tidal volume, and peak inspiratory pressure and calculated statistical features for each data element per patient. We applied machine learning algorithms (decision tree, support vector machine, and neural network) to classify patients into noninvasive or invasive airway device support. We identified 300 patients per group (mask, laryngeal mask airway, and endotracheal tube) for a total of 900 patients. The neural network classifier performed better than the boosted trees and support vector machine classifiers based on the test data sets. The sensitivity, specificity, and accuracy for neural network classification are 97.5%, 96.3%, and 95.8%. In contrast, the sensitivity, specificity, and accuracy of support vector machine are 89.1%, 92.3%, and 88.3% and with the boosted tree classifier they are 93.8%, 92.1%, and 91.4%. We describe a method to automatically distinguish between noninvasive and invasive airway device support in a pediatric surgical setting based on respiratory monitoring parameters. The results show that the neural network classifier algorithm can accurately classify noninvasive and invasive airway device support.
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Affiliation(s)
- Jorge A Gálvez
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| | - Ali Jalali
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Luis Ahumada
- Enterprise Analytics and Reporting, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Allan F Simpao
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Mohamed A Rehman
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Lee YC, Yoon KS, Park SY, Choi SR, Chung CJ. A comparison of i-gel™ and Laryngeal Mask Airway Supreme™ during general anesthesia in infants. Korean J Anesthesiol 2017; 71:37-42. [PMID: 29441173 PMCID: PMC5809706 DOI: 10.4097/kjae.2018.71.1.37] [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: 02/14/2017] [Revised: 06/05/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. Methods Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. Results Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. Conclusions This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.
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Affiliation(s)
- Yoon Chan Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Kyoung Seop Yoon
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - So Ron Choi
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
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Marques-Pires R, Trindade H. The airway approach to a neonate with Treacher Collins syndrome - Case report. Rev Esp Anestesiol Reanim 2017; 64:233-236. [PMID: 28094032 DOI: 10.1016/j.redar.2016.10.003] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022]
Abstract
Neonates and small infants with syndromes characterized by the presence of craniofacial abnormalities may represent great challenges regarding the management of the airway. We describe the case of a 9-day-old neonate with Treacher Collins syndrome, in which a laryngeal mask was essential to improve the airway obstruction, ventilate the patient and serve as an airway conduit for a fiberoptic intubation. By presenting this case, we intend to show that in neonates with Treacher Collins syndrome, in whom difficulties ventilation and intubation are expected, a thoughtful airway management planning is mandatory.
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Affiliation(s)
- R Marques-Pires
- Anesthesiology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal.
| | - H Trindade
- Anesthesiology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
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Kim YY, Kang GH, Kim WH, Choi HY, Jang YS, Lee YJ, Kim JG, Kim H, Kim GY. Comparison of blind intubation through supraglottic devices and direct laryngoscopy by novices: a simulation manikin study. Clin Exp Emerg Med 2016; 3:75-80. [PMID: 27752621 PMCID: PMC5051610 DOI: 10.15441/ceem.15.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/17/2016] [Revised: 03/27/2016] [Accepted: 03/31/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to compare intubation performance between blind intubation through supraglottic airway devices and direct laryngoscopy by novices under manikin simulation. We hypothesized that the intubation time by novices using supraglottic airway devices was superior to that with the Macintosh laryngoscope (MCL). METHODS A prospective, randomized crossover study was conducted with 95 participants, to evaluate i-gel, air-Q, LMA Fastrach, and MCL devices. Primary outcomes were the intubation time and the success rate for intubation. RESULTS The i-gel showed the shortest insertion and tube passing time among the four devices; the i-gel and air-Q also showed the shortest total intubation time (all P<0.0083; i-gel vs. air-Q, P=0.03). The i-gel and MCL showed the highest cumulative success rate (all P<0.0083; i-gel vs. MCL, P=0.12). CONCLUSION Blind intubation through the i-gel showed almost equal intubation performance compared to direct laryngoscopy.
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Affiliation(s)
- Young Yong Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Won Hee Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Young Choi
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Jae Lee
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyeongtae Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Arévalo-Ludeña J, Arcas-Bellas JJ, Alvarez-Rementería R, Alameda LEM. Fiberoptic-guided intubation after insertion of the i-gel airway device in spontaneously breathing patients with difficult airway predicted: a prospective observational study. J Clin Anesth 2016; 35:287-292. [PMID: 27871545 DOI: 10.1016/j.jclinane.2016.08.015] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/22/2015] [Accepted: 08/09/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway. DESIGN Prospective observational study. SETTING Operating room in a tertiary care hospital. PATIENTS Eighty-five adult patients with at least 3 difficult airway predictors or difficult airway management history were included. INTERVENTIONS The i-gel device was inserted in spontaneous ventilation under oropharyngeal local anesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anesthesia was induced to introduce the endotracheal tube guided by fiberoptic bronchoscope. MEASUREMENTS We recorded the i-gel insertion time (tgel), intubation time (tint), and O2 saturation in pulse oximetry in different moments: basal (t0), after 3 minutes of preoxygenation with a face mask at 100% fraction of inspired O2 (t1), after i-gel mask insertion (t2), and after intubation (t3). Adverse events during the procedure were also recorded, and patient discomfort was questioned. MAIN RESULTS All patients were successfully intubated. O2 saturation in pulse oximetry values were (mean±SD): 96.9±1.22 (t0), 99.0±0.85 (t1), 96.2±2.37 (t2), and 96.0±2.54 (t3). tgel and tint were 38.0±7.76 seconds and 36.5±5.55 seconds (mean±SD), respectively. No serious adverse events were recorded, and no patient suffered airway damage. Visual analogue scale for patient discomfort was 2 (interquartile range, 1-3). CONCLUSIONS i-gel insertion in spontaneously breathing patients avoids the "cannot ventilate" scenario. The subsequent fiberoptic-guided intubation through the i-gel is a safe and effective technique. More studies might be necessary to confirm the results presented, but we consider that the technique described is an adequate alternative to classic orotracheal intubation with fiberoptic bronchoscope in spontaneous ventilation for certain patients with predicted difficult airway.
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Affiliation(s)
- Julian Arévalo-Ludeña
- Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Jose Juan Arcas-Bellas
- Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Rafael Alvarez-Rementería
- Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Luis Enrique Muñoz Alameda
- Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain.
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López Correa T, Sastre JA, Garzón JC. [Blind tracheal intubation through 2 supraglottic devices: the Ambu AuraGain vs the LMA Fastrach]. Emergencias 2016; 28:83-88. [PMID: 29105428] [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] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Supraglottic devices are now considered first-line tools for managing the difficult airway. Our main aim was to compare the percentage of successful blind intubations achieved with the Ambu AuraGain and LMA Fastrach devices. MATERIAL AND METHODS Randomized, single-blind, parallel group trial. The following variables were analyzed: adequate ventilation, visualization of the glottis on the Brimacombe scale, success of blind intubation, and adverse events. RESULTS The devices were inserted in 80 patients (40 per group). Adequate ventilation was achieved with both devices, in 92.5% in the AuraGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P<.001). The rate of intubation success was higher with the LMA (70%) than with the AuraGain (17.5%) (P<.001). Hoarseness and signs of bleeding were observed more often with the AuraGain device than with the LMA: hoarseness, 12.5% vs 0%, respectively, P.027; blood, 17.5% vs 0%, P=.006 CONCLUSION Even though the 2 devices are similarly effective, blind intubation was superior with the LMA Fastrach mask
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Affiliation(s)
- Teresa López Correa
- Servicio de Anestesiología y Reanimación, Hospital Nuestra Señora de Sonsoles, Ávila, España
| | - José A Sastre
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Salamanca, España
| | - José C Garzón
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Salamanca, España
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Kömür E, Bakan N, Tomruk ŞG, Karaören G, Doğan ZT. Comparison of the Supraglottic Airway Devices Classic, Fastrach and Supreme Laryngeal Mask Airway: A Prospective Randomised Clinical Trial of Efficacy, Safety and Complications. Turk J Anaesthesiol Reanim 2015; 43:406-11. [PMID: 27366537 DOI: 10.5152/tjar.2015.97830] [Citation(s) in RCA: 4] [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: 11/10/2014] [Accepted: 06/04/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This prospective randomised study was designed to compare the Laryngeal Mask Airway (LMA) Classic, LMA Fastrach and LMA Supreme regarding ease of insertion and insertion time as primary outcomes and reposition, success rate of trials, effects on haemodynamic parameters, provision of an adequate and safe airway, amount of leakage and oropharyngeal and systemic complications as secondary outcomes. METHODS In this clinical trial, 90 patients aged 18-70 years of American Society of Anesthesiologists (ASA) group I-II were randomised into three groups as providing airway via LMA Classic, LMA Fastrach or LMA Supreme instead of tracheal intubation. No muscle relaxant was used. The allocated LMA was inserted by the same anaesthetist; bispectral index (BIS) was between 40% and 60%. RESULTS There was no statistical difference among the groups regarding the ease of insertion and insertion time as primary outcomes; the incidence of repositioning during placement was significantly higher in the LMA Classic group than that in other groups (p<0.05) and the rates of bloodstain on the device as well as oropharyngeal mucosal oedema were higher in the LMA Fastrach group than those in other groups (p<0.05) as secondary outcomes. CONCLUSION We suggest that LMA Classic, LMA Supreme and LMA Fastrach had similar effectiveness regarding efficiency and airway safety. However, LMA Supreme seems to be more advantageous as it is more appropriate for fewer oropharyngeal complications and there was no repositioning.
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Affiliation(s)
- Erdal Kömür
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Nurten Bakan
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Şenay Göksu Tomruk
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Gülşah Karaören
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Zelin Topaç Doğan
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Kim EM, Kim MS, Koo BN, Lee JR, Lee YS, Lee JH. Clinical efficacy of the classic laryngeal mask airway in elderly patients: a comparison with young adult patients. Korean J Anesthesiol 2015; 68:568-74. [PMID: 26634080 PMCID: PMC4667142 DOI: 10.4097/kjae.2015.68.6.568] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. Methods Fifty patients aged 65-85 years (elderly group) and 50 patients aged 20-40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. Results In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 ± 19.6 vs. 22.2 ± 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). Conclusions The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.
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Affiliation(s)
- Eun Mi Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sub Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Vaidya S, Kundra P, Gopalakrishnan S, Parida P, Yuvaraj K, Mohan P M. Supraglottic Airway Devices and Effect on Voice-Comparison of LMA Proseal and i-gel: Double-Blind Randomized Clinical Trial. J Voice 2015; 30:631-7. [PMID: 26471807 DOI: 10.1016/j.jvoice.2015.06.006] [Citation(s) in RCA: 3] [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: 04/18/2015] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Laryngeal mask airway (LMA) is an important alternative to endotracheal intubation for all professional voice users undergoing surgery. However, dysphonia is a known complication of LMA Proseal (PLMA) use. The i-gel airway (IGA) provides adequate airway seal without the need for an inflatable cuff. Hence, it helps to minimize the risk of tissue compression. This study compares effect of PLMA and IGA on voice at 24th hour after anesthesia. DESIGN This is a double-blind randomized clinical trial. METHODS Ninety anesthesiologists class 1 adults scheduled for surgeries lasting up to 60-120 minutes were included in the study. Participants were randomly allocated to group PLMA (n = 43) and group IGA (n = 43). Cuff pressure was monitored and maintained at just seal pressure in group PLMA. Voice was evaluated using perceptive and acoustic analysis (jitter, shimmer, and harmonics-to-noise ratio [HNR]) preoperatively and at 24th hour after anesthesia. Voice of patients with pharyngolaryngeal complaints was categorized into rough, breathy, asthenic, strain, or normal pattern. RESULTS Acoustic parameters jitter, shimmer, and HNR deteriorated significantly in both group PLMA and IGA albeit the change being comparable. Incidence of pharyngolaryngeal complaints was similar in both the groups. A total of 10% patients in group PLMA and 12.5% in group IGA developed breathy voice significant deterioration in all acoustic variables at 24th postoperative hour, but differences were not significant between group PLMA and group IGA. CONCLUSIONS PLMA and IGA both produce comparable and significant deterioration in acoustic variables at 24th hour after short duration general anesthesia.
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Affiliation(s)
- Shriram Vaidya
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Pankaj Kundra
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Surianarayanan Gopalakrishnan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Pradiptakumar Parida
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Kotteeswaran Yuvaraj
- Department of Anaesthesiology & Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Manju Mohan P
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
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Choi CG, Yang KH, Jung JK, Han JU, Lee CS, Cha YD, Song JH. Endotracheal intubation using i-gel® and lightwand in a patient with difficult airway: a case report. Korean J Anesthesiol 2015; 68:501-4. [PMID: 26495062 PMCID: PMC4610931 DOI: 10.4097/kjae.2015.68.5.501] [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: 06/30/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022] Open
Abstract
This case report involves tracheal intubation using i-gel® in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel® was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel® and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel® and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.
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Affiliation(s)
- Chun Gil Choi
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Ki-Hwan Yang
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jong-Kwon Jung
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jeong Uk Han
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Choon Soo Lee
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young-Deog Cha
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jang-Ho Song
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
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Kim H, Lee JY, Lee SY, Park SY, Lee SC, Chung CJ. A comparison of i-gel™ and LMA Supreme™ in anesthetized and paralyzed children. Korean J Anesthesiol 2014; 67:317-22. [PMID: 25473460 PMCID: PMC4252343 DOI: 10.4097/kjae.2014.67.5.317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/26/2014] [Accepted: 07/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background Both the i-gel™ (i-gel) and LMA Supreme™ (Supreme) are new single-use second generation supraglottic airway devices available in pediatric sizes. This study was designed to investigate the i-gel in comparison with the Supreme in children undergoing general anesthesia. Methods One hundred children with American Society of Anesthesiologists physical status I or II undergoing general anesthesia were randomly assigned to either the i-gel or the Supreme group (50 children in each group). The device size was chosen according to weight of the children. We assessed the insertion success rate, insertion time, oropharyngeal leak pressure, grade of the fiberoptic glottic view, number of airway manipulations required, and postoperative complications. Results There were no differences in the demographic data between the two groups. The success rate of insertion was same in both groups. The insertion time of the i-gel was longer than that of Supreme (P = 0.004). The oropharyngeal leak pressure in the i-gel group was higher than that in the Supreme group (P = 0.013). On fiberoptic examination, the vocal cords were visible in 90% of the children in the i-gel group and in 96% of the children in the Supreme group. The number of airway manipulations required was higher in the i-gel group (14 cases) than in the Supreme group (1 case) (P < 0.001). There were no differences in complications including blood staining of the device and sore throat between both groups. Conclusions Both the i-gel and Supreme provided a satisfactory airway during general anesthesia in children. Compared to the Supreme, the i-gel demonstrated a higher oropharyngeal leak pressure, longer time for insertion, and a greater number of airway manipulations during anesthesia.
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Affiliation(s)
- Hyuk Kim
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Ji Yeon Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Seung Yoon Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Sang Yoong Park
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Seung Cheol Lee
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
| | - Chan Jong Chung
- Department of Anesthesiology and Pain Medicine, Dong-A University Hospital, Busan, Korea
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Sung JK, Kim HG, Kim JE, Jang MS, Kang JM. Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report. Korean J Anesthesiol 2014; 66:237-9. [PMID: 24729847 PMCID: PMC3983421 DOI: 10.4097/kjae.2014.66.3.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 12/25/2022] Open
Abstract
A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations.
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Affiliation(s)
- Joon Kyung Sung
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee Medical University, Seoul, Korea
| | - Hyung Gon Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Graduate School, Kyung Hee Medical University, Seoul, Korea
| | - Myung-Soo Jang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jong-Man Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Garzón Sánchez JC, López Correa T, Sastre Rincón JA. [Blind tracheal intubation with the air-Q(®) (ILA-Cookgas) mask. A comparison with the ILMA-Fastrach™ laryngeal intubation mask]. ACTA ACUST UNITED AC 2014; 61:190-5. [PMID: 24556513 DOI: 10.1016/j.redar.2013.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/30/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Supraglottic airway devices are increasingly used in anesthesia and emergency medicine as a rescue for intubation and ventilation. This study was designed to investigate the air-Q(®) supralaryngeal device and compare it with the ILMA-Fastrach™ for airway rescue and intubation. PATIENTS AND METHODS The devices were inserted in 80 patients (40 patients in each group) according to manufacturer' instructions. An inspiration pressure of 20cmH2O was applied through a ventilator for checking air leaks. If no air leak was detected, the glottis status was checked using a pediatric fiberoptic bronchoscope, followed by introducing an endotracheal tube through the supraglottic device. If the first attempt was unsuccessful, the device was removed and a second attempt was made in the same way. The primary outcome was the overall success rate for intubation. Other measurements were: successful ventilation, fiberoptic glottis view and adverse events. RESULTS Successful first-attempt ventilation was better with the Fastrach™ than with the air-Q(®) (90 vs. 60%, P=.0019) and overall ventilation success (first plus second attempts) was also better with ILMA-Fastrach™ (95 vs. 80%, P=.04). View of the glottis,according to Brimacombe scale, was better with air-Q(®) (84.62 vs. 37.50%, P=.0017) at the second, but not at the first, attempt. There were no differences in the percentage of successful intubations between the 2 devices. The incidence of sore throat was similar with both devices. Two patients in the air-Q(®) group suffered hoarseness and arterial desaturation, but the difference was not statistically significant. CONCLUSIONS Both the ILMA-Fastrach™ and the air-Q(®) provided a similar rate of successful intubation, but ILMA-Fastrach™ was better for ventilation. The rate of adverse events was similar with both devices. Because no additional maneuver was used to facilitated intubation, there needs to be further studies to confirm these findings.
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Affiliation(s)
- J C Garzón Sánchez
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | - T López Correa
- Servicio de Anestesiología y Reanimación, Complejo Asistencial de Ávila, Ávila, España
| | - J A Sastre Rincón
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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[Rare problem with the insertion of a Supreme™ laryngeal mask airway device. Case of the trimester]. ACTA ACUST UNITED AC 2013; 61:e20-2. [PMID: 24156888 DOI: 10.1016/j.redar.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
A breast tumor was resected under general anesthesia. After induction, the airway was managed with a Supreme™ laryngeal mask airway device. The insertion of the laryngeal mask airway device, the insertion of the orogastric tube through the drain tube, as well as the mechanical ventilation, were very difficult from the beginning. On removing the laryngeal mask airway device to solve the problem, it was observed that the drain tube was broken, and the orogastric tube had passed into the anterior, laryngeal part of the device through the split. It was later found out that the laryngeal mask airway device, as well as the whole manufacturing batch, had suffered a design modification: the cuff was constructed with a softer material without reinforcement in the tip, and the drain tube had a heat-sealing defect that facilitated the break. The incident was reported to the local supplier and the manufacturer, and the defective batch of laryngeal mask airway devices was recalled. The incident was also reported to other hospitals via SENSAR, to warn other users of the potential dangers of the design modification in the Supreme™ laryngeal mask airway.
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Jeon IS, Kim SB, Lee DG, Park JG, Bae SC. Bilateral symmetric lacerations of the soft palate after general anesthesia using the laryngeal mask airway ProSeal(TM): A case report. Korean J Anesthesiol 2009; 56:438-442. [PMID: 30625767 DOI: 10.4097/kjae.2009.56.4.438] [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: 11/10/2022] Open
Abstract
ProSeal(TM) laryngeal mask airway (PLMA) was developed to be more effective especially with glottic airway sealing and is suppose to be an improved device over the classic laryngeal mask airway (cLMA). The PLMA's cuff is bulkier, softer, and more pliable than the cLMA. We reviewed a case were a patient had hand surgery under general anesthesia using the PLMA. After having the hand surgery, the patient suffered from dyspnea and had difficulty with their respirations at a supine position. The problems with dyspnea and respiration after surgery resulted because of difficulties from inserting PLMA No.5 into the patient. We suspect from this case that the problems in dyspnea and respiration were due to the folded cuff and incomplete placement of the PLMA, which resulted in lacerations of the mucosa in the soft palate of the patient. In this paper, we considered the probable causes for lacerations of the mucosa in the soft palate and reviewed all of the relevant literature, especially about the proper placement of the PLMA.
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Affiliation(s)
- In Suk Jeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea.
| | - Sang Baek Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea.
| | - Dong Gi Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea.
| | - Jin Gue Park
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea.
| | - Sang Cheul Bae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Gumi, Korea.
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