Effect of 5% EMLA Cream on Postoperative Sore Throat in Adults Following General Endotracheal Anesthesia: A Randomized Placebo-Controlled Study.

BACKGROUND: Postoperative sore throat (POST) is a distressing complaint in adults after endotracheal intubation. This study aimed to evaluate the effect of topical application of a eutectic mixture of local anesthetics (EMLA) cream over the endotracheal tube (ETT) cuff on the incidence and severity of POST, cough, and hoarseness of voice in adults after surgery. METHODS: In this randomized, placebo-controlled study, adult patients 18 to 65 years old, in American Society of Anesthesiologists (ASA) physical status I and II, and of either sex were scheduled to receive 5% EMLA cream (intervention arm) or lubricant gel (placebo-controlled arm) applied over the ETT cuff. POST was graded as none (0), mild (1), moderate (2), or severe (3). A score of ≥2 was considered as significant POST. The incidence of POST at the sixth postoperative hour was the primary outcome. Secondary outcomes included the incidence of POST at 0, second, and 24 hours, and the incidence of significant POST (score ≥2). The incidence and severity of postoperative cough and hoarseness of voice were recorded simultaneously. RESULTS: Two hundred and four patients completed the study. The incidence of POST was significantly lower in the EMLA group versus placebo at the sixth postoperative hour (4.9% vs 40.1%; relative risk [RR], 0.12; 95% confidence interval [CI], 0.05-0.29; P < .001); and at 0 hour (74.5% vs 93.1%; RR, 0.8; 95% CI, 0.7-0.9; P < .001) and second hour (51.9% vs 84.3%; RR, 0.61; 95% CI, 0.5-0.75; P < .001) but comparable at 24 hours (1.9% vs 3.9%; RR, 0.5; 95% CI, 0.09-2.67; P = .4). The number needed to treat to prevent POST with EMLA cream application was 5 at 0 hour and 3 at the second and sixth hour. The proportion of patients with significant POST over 24 hours were less in the EMLA group (9.8% vs 43.1%; P < .001). The incidence of postoperative cough and hoarseness of voice was significantly less at the 0, second, and sixth hours in the EMLA group, but comparable at 24 hours. The incidence of severe cough (8.8% vs 31.4%; P < .001) and hoarseness of voice (2% vs 7.4%; P < .001) over 24 hours was less in the EMLA group. CONCLUSIONS: The application of EMLA cream over ETT cuff reduces the incidence and severity of POST, cough, and hoarseness of voice in adults after general anesthesia in the early postoperative period compared to lubricant gel.

Duration of Exposure to General Endotracheal Anesthesia during Cesarean Deliveries at Term and Perinatal Complications.

OBJECTIVE: To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes. STUDY DESIGN: This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes. RESULTS: Two hundred eighteen maternal-perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ. CONCLUSION: When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications. KEY POINTS: · Cesarean delivery under general anesthesia is associated with increased perinatal complications.. · Perinatal complications are increased with increasing duration of exposure to general anesthetics.. · Maternal complications were not increased with shorter duration of exposure to general anesthesia..

Aerosol Generation During Laryngology Procedures in the Operating Room.

OBJECTIVE: Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases. STUDY DESIGN: Prospective quantification of aerosol generation. METHODS: Airborne particles (0.3-25 µm in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO2 ) laser use with or without jet ventilation, all utilizing intermittent suction. RESULTS: Greater than 99% of measured particles were 0.3 to 1.0 µm in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 µm particles (P < .0001). 1.0 to 25 µm particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 µm particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO2 laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 µm particles. Overall, there was no difference when comparing CO2 laser use during jet ventilation versus GETA. CONCLUSIONS: CO2 laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2759-2765, 2021.

Periprocedural pulmonary aspiration: An analysis of medical malpractice cases and alleged causative factors.

RATIONALE AIMS AND OBJECTIVES: Pulmonary aspiration is a feared complication of anaesthesia that is associated with significant morbidity and mortality. Within the small existing body of literature on medical malpractice claims related to periprocedural aspiration, very little information is available regarding the case-specific factors that were alleged to contribute to each aspiration event. METHODS: This study searched an extensive nationwide database of medical malpractice claims and identified 43 relating to periprocedural pulmonary aspiration. RESULTS: The most common mechanism of causation cited in these claims (37%) was the failure to secure the airway with an endotracheal tube (ETT) when an elevated aspiration risk existed, most commonly because endotracheal intubation was not originally selected as part of the anaesthetic plan. The second most common alleged category of causation (33%) was the failure to perform a proper rapid-sequence induction and/or place a nasogastric tube (NGT) for decompression prior to induction. An equal amount of cases resulted in defendant versus plaintiff verdicts (44.2% each), while a settlement was reached in the remaining 11.6% of cases. CONCLUSION: These findings are generalizable to clinical practice improvement on a broader scale. They demonstrate the need to develop reliable, high-sensitivity tests for detecting elevated risk before clinicians can be expected to take special steps to protect susceptible patients, and they also show that medical malpractice can be alleged because of failure to uphold currently accepted standards of care even when the published evidence for those standards is weak. This study demonstrates that careful review of medical malpractice litigation can elucidate common contributory factors and facilitate improvements in clinical practice and decision-making.

Sudden Increase in EtCO2 During Upper Endoscopy Under General Endotracheal Anesthesia Suggests the Presence of Tracheoesophageal Fistula: A Case Report.

Acquired tracheoesophageal fistula is a rare and devastating complication of lung cancer. The diagnosis is typically confirmed on barium esophagram. We report a case of a patient with lung cancer status after palliative chemoradiotherapy and esophageal stenting for malignant stenosis who presented with signs and symptoms suggestive of tracheoesophageal fistula; however, no evidence of fistula was found on barium esophagram. During subsequent esophagogastroduodenoscopy, the presence of a fistula was verified by capnography, given extreme elevations in end-tidal CO2 concentrations during endoscopic CO2 insufflation.

Practical considerations in the management of sedation for colonoscopy.

PURPOSE OF REVIEW: The purpose of this review is to discuss the unique elements of providing anesthesia services for colonoscopy including the practical issues within an endoscopy suite, nothing by mouth status for colonoscopy, chronic medication instructions, appropriate anesthesia equipment, informed consent, pharmacology of agents for sedation, anesthetic techniques, and issues related to postprocedural care. RECENT FINDINGS: The national trend is toward increasing number and complexity of colonoscopy procedures using anesthesia services. Providing anesthesia services in a dedicated endoscopy suite has unique elements related to open scheduling and the rapid turnover environment. Agents for sedation and general anesthesia for colonoscopy are chosen for rapid onset, amnestic properties, and raid emergence/recovery. SUMMARY: Sedation for colonoscopy is a rapidly expanding subspecialty with special needs created by the increasing medical complexity of the patients, the demands of the endoscopy procedures, the challenges of the endoscopy suite, and the rapid turnover of the outpatient environment.

[Cardiac arrest after induction of anesthesia in neurosurgical patients].

The paper reports two clinical cases observed with a time lag of four years. In both cases, there were severe clinical symptoms of intracranial hypertension before the surgery. Prompt full-scale resuscitation was required in both cases due to asystole that developed immediately after induction of anesthesia and tracheal intubation. In one case, cardiac activity was successfully recovered by complex resuscitation with the emergency drainage of the cerebral ventricles. The possible causes of complications and preventive measures were discussed.

Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study.

Peroral endoscopic myotomy (POEM) has been developed as a minimally invasive endoscopic treatment for achalasia for years. However, the optimal length of submucosal tunnel and myotomy of muscle bundles during procedure of POEM has not yet been determined, so we aim to assess safety and efficacy of modified POEM with shorter myotomy of muscle bundles in achalasia patients. Consecutive achalasia patients had been performed modified POEM with shorter myotomy, and assessed by symptoms, high-resolution manometry, and barium swallow examinations before and 3 months after POEM for safety and efficacy evaluation. Modified POEM with shorter submucosal tunnel (mean length 6.8 cm) and endoscopic myotomy of muscle bundles (total mean length 5.4 cm) were completed in 46 consecutive achalasia patients. During the 3-month follow up in all cases, significant improvement of symptoms (a significant drop in the Eckardt score 8.4 ± 3.2 vs. 2.7 ± 1.9; P < 0.001), decreased lower esophageal sphincter pressure (39.4 ± 10.1 vs. 24.4 ± 9.1 mmHg; P < 0.001) and integrated relaxation pressure (38.6 ± 10.4 vs. 25.7 ± 9.6 mmHg; P < 0.01), and a drop in height of esophagus barium-contrast column (5.4 ± 3.1 vs. 2.6 ± 1.8 cm; P < 0.001) were observed. The frequencies of adverse events were lower in those under endotracheal anesthesia and CO2 insufflations compared with intravenous anesthesia and air insufflations. Only three patients were found to have gastroesophageal reflux disease on follow up. Modified POEM with shorter myotomy under endotracheal anesthesia and CO2 insufflations shows its good safety and excellent short-term efficacy in the treatment of achalasia. But further studies are warranted to assess the long-term efficacy.

Office airway surgery.

The emergence and refinement of flexible endoscopes during the second half of the twentieth century has facilitated flexible bronchoscopy's rise as the standard for evaluation of and often intervention in the tracheobronchial tree. Many of these procedures require only topical anesthesia and may be conducted in office settings without sedation. The relocation of procedures previously reserved for the operating room or endoscopy suite confers cost savings, improves provider flexibility, and maintains patient safety while increasing satisfaction and limiting convalescence.

The differential impact of two anesthetic techniques on cortisol levels in Nigerian surgical patients.

BACKGROUND: Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immunologic, and metabolic alterations. AIM: The aim was to compare the effects on the stress response by isoflurane-based intratracheal general anesthesia (ITGA) and bupivacaine-based epidural anesthesia (EA), using cortisol as a biochemical marker. MATERIALS AND METHODS: Following the approval of the Hospital Ethical Board, informed written consent from patients recruited into this study was obtained. One group received general anesthesia with relaxant technique (group A) while the other group had bupicaine epidural anesthesia with catheter placement for top-ups (group B) for their surgeries. Both groups were assessed for plasma cortisol levels - baseline, 30 minutes after skin the start of surgery and at skin closure. RESULTS: There was no statistically significant difference in the baseline mean heart rate, mean arterial pressure (mean MAP) and the mean duration of surgery between the two groups; the baseline mean plasma cortisol level was 88.70 ± 3.85 ng/ml for group A and 85.55 ± 2.29 ng/ml for group B, P=0.148. At 30 minutes after the start of surgery the plasma cortisol level in the GA group was 361.60 ± 31.27 ng/ml while it was 147.45 ± 22.36 ng/ml in the EA group, showing a significant difference, P=0.001. At skin closure the mean plasma cortisol value of 384.65 ± 48.04 ng/ml recorded in the GA group was found to be significantly higher than the value of 140.20 ± 10.74 ng/ml in the GA group, P<0.002. CONCLUSION: Using plasma cortisol as a measure, bupivacaine-based epidural anesthesia significantly reduces the stress response to surgical stimuli when compared with isoflurane-based tracheal general anesthesia.

Impact of anesthetic methods on neonatal outcome in women receiving temporary balloon occlusion of the common iliac artery during cesarean section for placenta accreta.

OBJECTIVE: Placenta accreta is associated with significant maternal morbidity and is the leading indication for peripartum hysterectomy. In our institution, occlusion balloon catheters are commonly placed in bilateral common iliac arteries in order to reduce blood loss and facilitate surgery in patients with this obstetric complication. Few studies, however, have evaluated the effect of different anesthetic methods for cesarean hysterectomy on neonatal outcome. In this study, we compared Apgar scores among neonates born to mothers under general anesthesia with those who received regional anesthesia. CASE REPORTS: A retrospective analysis of 19 women with placenta accreta/percreta who underwent cesarean hysterectomy in our hospital, revealed that the 1-minute Apgar score was <7 in 4/12 neonates born to women who underwent general anesthesia and in 1/7 neonates born to mothers who received regional anesthesia. The 5-minute Apgar score was >7 after immediate resuscitation in all neonates. There were no significant differences in demographic data, induction-to-delivery period, or Apgar scores between the general and the regional anesthesia groups. CONCLUSION: We acknowledge that the retrospective nature of this study makes it difficult to conclude whether the different anesthesia management strategies had an impact on Apgar score; however, according to our clinical observation, regional anesthesia may be a better alternative in the induction-to-delivery period, especially for women with accreta/percreta and in situations in which poor neonatal outcome is expected.

Rotura de tráquea / Tracheal fracture

En este trabajo se presenta un caso de rotura traqueal posextubación orotraqueal ocurrido durante una cirugía laparoscópica habitual. La rotura o laceración traqueal se produce por un aumento de la presión en la vía aérea, el uso de mandriles, la exposición a gases anestésicos o sobreinsuflación en el manguito del tubo endotraqueal, o por praxis no anestésicas (cirugía de esófago, broncoscopías, etc.) Es detectada en el posoperatorio inmediato (quirófano, sala de recuperación posanestésica o primeras horas en sala), y aunque es una patología de muy baja incidencia, el anestesiólogo debe estar involucrado activamente en su diagnóstico porque las posibilidades de morbimortalidad son elevadas. El objetivo de esta presentación es señalar las causas del evento para tratar de evitar su ocurrencia, describir los primeros signos y síntomas para ayudar a su diagnóstico precoz y realizar una recopilación de los tratamientos reconocidos. Recordemos que por su baja incidencia no se conocen trabajos randomizados sobre la adopción a tiempo de medidas clínicas y quirúrgicas, incluidas la del tratamiento expectante, que es la conducta más aceptada, rápida y con menores o ninguna secuela para resolver la rotura traqueal posextubación.

This paper presents a case of tracheal fracture after endotracheal extubation following a routine laparoscopic surgery. Tracheal fracture or laceration may be caused by an increase of pressure in the airway, the use of mandrels, exposure to anesthetic gases or excessive insufflation in the cuff of the endotracheal tube, or due to non-anesthetic practices (esophageal surgery, bronchoscopy, etc.) It was detected in the immediate postoperative period (operating theater, post-anesthesia recovery room or first hours in the ward), and although it is a rare occurrence, the anesthesiologist must be actively involved in its diagnosis because of the high possibilities of morbi-mortality. The purpose of this presentation is to point out the causes of this occurrence so as to attempt to avoid it, to describe the first signs and symptoms for early diagnosis and to compile renowned treatment. Bear in mind that due to its low incidence there are no known randomized papers on timely adoption of clinical and surgical measures, including the expectant treatment, which is the most accepted and fastest one, with the least or no consequences to solve the post-extubation tracheal fracture.

Neste trabalho é apresentado um caso de ruptura traqueal pós-extubação orotraqueal durante uma cirurgia laparoscópica habitual. A ruptura ou laceração traqueal ocorre por aumento da pressão na via aérea, uso de mandris, exposição a gases anestésicos, superinsuflação no manguito do tubo endotraqueal, ou por práticas não anestésicas (cirurgia de esôfago, broncoscopias, etc.). É detectada no pós-operatório imediato - na sala de operações, na sala de recuperação pós-anestésica ou nas primeiras horas na sala- e apesar de ser uma patologia de incidência muito baixa, é necessário que o anestesiologista se envolva ativamente em seu diagnóstico, já que as possibilidades de morbimortalidade são elevadas. O objetivo desta apresentação é apontar as causas do evento a fim de evitar sua ocorrência, descrever os primeiros sinais e sintomas que facilitem o diagnóstico precoce e realizar uma recopilação dos tratamentos reconhecidos. É importante lembrar que por sua reduzida incidência não se conhecem trabalhos randomizados sobre adoção de medidas clínicas e cirúrgicas em tempo adequado, entre as quais se inclui o tratamento expectante, a conduta mais aceita, rápida e com menores ou nenhuma sequela para resolver a ruptura traqueal pós-extubação.

Does short-term endotracheal intubation affects the acoustic characteristics?

INTRODUCTION: Endotracheal intubation can produce various degrees of temporary and sometimes permanent damage to the laryngotracheal mechanism. Recent development of computer based voice analysis technology can now detect a minute changes in acoustic waveforms which a normal human ear cannot. In the study we compared and analyzed the acoustic waveforms of 35 patients undergoing surgery under intubation anaesthesia. OBJECTIVE: The aim of the present series is to analyze the effects of short term intubation with computerized voice laboratory. MATERIALS AND METHODS: Values of acoustic waveforms obtained from 35 patients were compared 48 hours after the short term endotracheal intubation anaesthesia. The comparisons were made in terms of perturbation (jitter and shimmer), harmonic- to noise ratio (HNR) and fundamental frequency (F0). RESULTS: The pre-intubated voice characteristics when compared with the post-intubation group did not reveal any statistical difference (P>0.05). However, there was only a minimal decrease in F0. CONCLUSION: The study revealed that, short term intubation anaesthesia does not alter the acoustic characteristics. The analysis of acoustic waveforms is a non invasive technique that helps to evaluate the effects of tracheal intubation on laryngeal function, a technique that warrants further evaluation.

New onset lumbar radicular pain after implantation of an intrathecal drug delivery system: imaging catheter migration.

BACKGROUND AND OBJECTIVES: Implanted delivery systems for intrathecal drug administration have become more commonplace in the management of refractory cancer and nonmalignant pain. Complications may be related to drug side effects or to technical problems possibly involving the pump and/or catheter. The occurrence of postimplantation, new onset, lumbar radicular pain warrants careful clinical and radiographic examination. We suggest a paradigm for imaging of potential intervertebral foraminal catheter migration. CASE REPORT: New onset, intractable, lumbar radicular pain occurred 3 months after implantation of a one-piece catheter into the lumbar cistern. Magnetic resonance imaging of the lumbar spine showed no granuloma but rather a contrast-enhancing lesion at the right L4-L5 intervertebral foramen. Subsequent computed tomography revealed migration of the catheter into the intervertebral foramen. Surgical repositioning of the catheter resulted in resolution of the symptoms. CONCLUSION: Patients with implanted drug delivery systems with positioning of the catheter tip into the lumbar cistern may develop new onset lumbar radicular pain as a result of catheter migration into an intervertebral foramen. Magnetic resonance imaging (MRI) is suggested as the initial imaging study to survey the spine and to evaluate for granuloma formation. Reimaging with computed tomography is essential to follow the course of the catheter and to delineate distal catheter tip location. It is suggested that positioning of the distal catheter tip at a location midway between the superior and inferior articular surfaces of the facet joint may minimize this complication.

Intrathecal and epidural anesthesia and analgesia for cardiac surgery.

Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.

Prediction of difficult laryngoscopy in a population of Nigerian obstetric patients.

Difficulty in the maintenance of the airway during obstetric anaesthesia is a major contributory factor in anaesthetic related morbidity and mortality. There is an eightfold increase in the incidence of failed intubation in obstetrics. This is attributable to the physiological changes in pregnancy. Eighty consecutive obstetric patients, over a one year period who required general anaesthesia for caesarian section were evaluated using five bedside tests viz: Mallampati test, Thyrometal distance, Sterno-mental distance, Horizontal length of the Mandible and Inter-incisor gap. Eight patients had difficult laryngoscopy (10%). Mallampati test had a sensitivity, specificity and positive predictive value of 87.1%, 99.6% and 70% respectively. The values obtained for the Thyro-mental distance were 62.5%, 93.1% and 50% respectively. The other tests were not able to predict intubation difficulty significantly. When all tests were combined, sensitivity, specificity and positive predictive were values 100%, 36.1% and 14.8%. The combination of Mallampati and Thyro-mental distance had values of 100%, 93.1% and 61.5%--sensitivity, specificity and positive predictive value. Mallampati can be used as the sole predictor of difficult intubation in Nigerian obstetric patients.

[Heart rhythm variability as a criterion for selecting anesthesia for maxillofacial surgical procedures in children]. / Variabel'nost' serdechnogo ritma kak kriterii vybora anestezii pri cheliustno-litsevykh operatsiiakh u detei.

The aim of this study was to improve the quality of anesthesia for maxillofacial operations in children. The authors suggest the criteria of its adequacy, based on analysis of heart rhythm variability. The most informative characteristics of heart rhythm structure were detected on the basis of the results of examinations of 100 children aged 5 months to 16 years. The data indicate that in children subjected to maxillofacial surgery the most hazardous (as regards the risk of arrhythmia) anesthesia is mask narcosis with fluothane; the optimal narcosis is endotracheal and intravenous.

A prospective randomized trial comparing the cuffed oropharyngeal airway (COPA) with the laryngeal mask for elective minor surgery in female patients.

OBJECTIVE: The cuffed oropharyngeal airway (COPA), a modified Guedel-type airway with a cuff at the distal end, has recently been introduced into anesthetic practice. The aim of this study was to compare the COPA with the well established laryngeal mask airway (LMA). Special consideration was granted to the difficult airway. PATIENTS AND METHODS: Two hundred and fifty-two women of ASA class I or II undergoing elective gynecological or breast surgery under general anesthesia were randomly assigned to either cuffed oropharyngeal or laryngeal mask airway management. Insertion and removal of the device, airway maintenance throughout the procedure, and postoperative course and complications were assessed. RESULTS: A patent airway was obtained with either device in all patients. Global first-time success rates for insertion were similar in the two study groups. Initial failure of correct placement occurred more frequently in the COPA as compared to the LMA group if the interincisor gap was < 5 cm and mandibular protrusion impossible (p < 0.01). Neither thyromental distance nor Mallampati scores nor body mass index (BMI) were of relevance for insertion success. The incidence of postoperative complaints and of mucosal injuries was significantly higher with the LMA. CONCLUSION: On the whole, high overall success and low complication rates render COPA and LMA equally suitable for routine anesthetic airway management.