Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review.

PURPOSE: The purpose of the present study was to determine whether, in patients undergoing general anesthesia, those provided with a laryngeal mask airway (LMA) have a lower risk of airway-related complications than those undergoing endotracheal intubation. MATERIALS AND METHODS: A systematic review of randomized prospective controlled trials was done to compare the risk of airway complications with an LMA versus an endotracheal tube (ETT) in patients receiving general anesthesia. Two independent reviewers identified 29 randomized prospective controlled trials that met the predetermined inclusion and exclusion criteria. The data for each individual outcome measure were combined to analyze the relative risk ratios (RRs). The Cochrane RevMan software was used for statistical analysis. RESULTS: When an ETT was used to protect the airway, a statistically significant greater incidence of hoarse voice (RR 2.59, 95% confidence interval [CI] 1.55 to 4.34), a greater incidence of laryngospasm during emergence (RR 3.16, 95% CI 1.38 to 7.21), a greater incidence of coughing (RR 7.12, 95% CI 4.28 to 11.84), and a greater incidence of sore throat (RR 1.67, 95% CI 1.33 to 2.11) was found compared with when an LMA was used to protect the airway. The differences in the risk of regurgitation (RR 0.84, 95% CI 0.27 to 2.59), vomiting (RR 1.56, 95% CI 0.74 to 3.26), nausea (RR 1.59, 95% CI 0.91 to 2.78), and the success of insertion on the first attempt (RR 1.08, 95% CI 0.99 to 1.18) were not statistically significant between the 2 groups. CONCLUSIONS: For the patients receiving general anesthesia, the use of the LMA resulted in a statistically and clinically significant lower incidence of laryngospasm during emergence, postoperative hoarse voice, and coughing than when using an ETT. The risk of aspiration could not be determined because only 1 study reported a single case of aspiration, which was in the group using the ETT.

Role of food and clay particles in toxicity of copper and diazinon using Daphnia magna.

Toxicity changes in copper and diazinon were investigated in the presence of food, clay, and their mixture by using Daphnia magna. In sorption equilibrium experiments, copper was significantly attracted (>34% sorbed) to food, clay, and food-clay mixture due to their negative zeta potential, while diazinon was less sorbed (<11%). In the exposure test with food and clay particles, it was revealed that copper was remarkably reduced in the presence of clay particles indicating the change in bioavailability of copper by sorption to clay. This was considered as the primary mechanism for toxicity reduction whereas diazinon toxicity was food dependent in the analysis of toxicity using toxicity change index (TCI). It was also shown that certain foods could not only act as a sorbent to copper and diazinon, but also as a material of energy source to alleviate the toxic damage. Meanwhile, clay can be considered as a prominent sorbent to copper but not to diazinon and can inhibit the sorption interaction between foodstuffs and toxicants through the aggregation and sedimentation processes. Furthermore, clay particles, as shown in TCI analysis, may be a potentially risky material as a physiological stressor or a toxicant carrier in contaminated environments.