The neuromuscular effects of rocuronium under sevoflurane-remifentanil or propofol-remifentanil anesthesia: a randomized clinical comparative study in an Asian population.

BACKGROUND: We conducted a prospective, randomized, multicenter study to evaluate the differences in the blocking effect of different doses of rocuronium between sevoflurane- or propofol-remifentanil anesthesia in an Asian population. METHODS: A total of 368 ASA I-II patients was enrolled. Anesthesia was induced with 2.0 mg/kg propofol and 0.1 µg/kg/min remifentanil (TIVA) or 5.0 vol.% sevoflurane with 0.1 µg/kg/min remifentanil (SEVO). Tracheal intubation was facilitated at 180 s after the administration of rocuronium at 0.3, 0.6, or 0.9 mg/kg and then intubation condition was evaluated. The time to maximum block and recovery profile were monitored by TOF stimulation of the ulnar nerve and by recording the adductor pollicis response using acceleromyography. RESULTS: The numbers of patients with clinically acceptable intubation conditions were 41, 82, and 97 % (TIVA) and 34, 85, and 90 % (SEVO) at each dose of rocuronium, respectively. There were no significant differences in the time to maximum block between groups at each rocuronium dose. There were significant differences in the recovery to a train-of-four ratio of 90 % between the groups: 42.7 (19.5), 74.8 (29.9), and 118.4 (35.1) min (TIVA) and 66.5 (39.3), 110.2 (43.5), and 144.4 (57.5) min (SEVO) at 0.3, 0.6, and 0.9 mg/kg, respectively (P < 0.001). CONCLUSIONS: There are no significant differences in intubation conditions between propofol-remifentanil and sevoflurane-remifentanil anesthesia at the same dose of rocuronium. The type of anesthetic does not significantly influence the time to maximum block by rocuronium. Rocuronium at a dose of 0.9 mg/kg should be used for better intubation conditions with both anesthesia regimens in an Asian population. TRIAL REGISTRATION: UMIN-CTR Clinical Trial ( http://www.umin.ac.jp/ctr/index.htm ; UMIN#000007289 ; date of registration 14(th) February 2012).

[A Case of Suspected Delayed Postoperative Malignant Hyperthermia].

Malignant hyperthermia occurred 10 hours after surgery in a 72-year-old man who had received emergency laparoscopic cholecystectomy for severe acute cholecystitis with cholelethiasis. He had a high fever (39.4 degrees C) with liver damage before surgery. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and epidural block using ropivacaine. Rocuronium was used as a muscle relaxant During surgery, body temperature decreased by cooling the body surface, but tachycardia continued. Ten hours after surgery, body temperature increased to the maximum of 40.6 degrees C and he went into shock. Then another 10 hours later, he developed cardiac arrest He recovered, but 22 hours later, second cardiac arrest occurred. After his second recovery, dantrolene was administered and body temperature decreased. He had hypoxic brain damage, but was dischanged from the hospital after tracheostomy on the 150th hospital day. From his clinical course, especially decrease in body temperature by dantrolene, he was suspected to have developed malignant hyperthermia. We should consider malignant hyperthermia when patient had a severe high fever postoperatively.

A copper(I) thiocyanate-based photoresponsive semiconducting 2D coordination polymer.

A coordination polymer, [Cu(SCN)(iqi)]n (iqi = isoquinoline), containing copper(I) thiocyanate and a nitrogen-containing π-conjugated ligand, iqi, has been synthesized and its physical properties were evaluated. This coordination polymer has a two-dimensional (2D) sheet structure consisting of copper(I) thiocyanate and shows photoluminescence derived from 3MLCT and photoconductive properties.

Composite-, plain-auditory evoked potentials index and bispectral index to measure the effects of sevoflurane.

The composite auditory evoked potentials index (cAAI) uses both cortical electroencephalogram (EEG) and response to auditory stimuli, while the bispectral index (BIS) uses only the cortical EEG and auditory evoked potentials index (AAI) uses only response to auditory stimuli. We expected that the cAAI was more useful to monitor anesthetic effect of sevoflurane than the BIS and AAI. The present study compared the changes of cAAI, AAI, and BIS in different sevoflurane concentration. Forty-five adult patients were anesthetized with sevoflurane in 50 % nitrous oxide. AAI (AEP version 1.4), cAAI (AEP version 1.6), and BIS (A-2000) were compared (each 15 patients in AAI, cAAI, and BIS groups) before induction, just before and after intubation, at 10 min since sevoflurane was set to 1.0, 1.5 and 2.0 %, and after extubation. All three indices decreased significantly before intubation. The cAAI was significantly higher than the AAI at sevoflurane 1.0 and 1.5 %. The AAI and BIS were significantly lower at sevoflurane 2.0 % than those at sevoflurane 1.0 %, but the cAAI did not. The cAAI had the largest and AAI had the smallest inter-individual variation. In sevoflurane-nitrous oxide anesthesia, cAAI was inferior to AAI and BIS to discriminate different anesthetic effect. The cAAI had larger inter-individual variation than the AAI and BIS.

[Anesthesia for open reduction of ankle fracture in a patient with giant pituitary adenoma].

A few cases of the pituitary apoplexy have been reported after spinal anesthesia in patients with pituitary tumor. A patient with giant pituitary adenoma underwent open reduction of the ankle fracture. This 69-year-old man had no symptoms related to pituitary adenoma. Femoral and sciatic nerve blocks were chosen to avoid pituitary apoplexy, cerebral herniation and other complications related to spinal anesthesia. The surgery was successfully done without any complications and the patient was discharged uneventfully 25 days after surgery. When patient has a giant pituitary tumor, peripheral nerve block might be a good choice for anesthesia.

[A case of prolonged hypercapnea after interscalene brachial plexus block].

An 83-year-old woman was scheduled for surgery of the left upper and lower extremity fracture. She had past history of lung partial resection for lung cancer and rheumatoid arthritis, and recent history of pneumonia. She also had fluid retention in the thoracic cavity. Open resection of the femoral neck fracture was first performed uneventfully under spinal anesthesia with bupivacaine 0.5% 2 ml. Then, interscalene blaxioplexus block was performed with 0.75% ropivacaine 15 ml and 1% lidocaine 10 ml for tension band wiring of the fractured olecranon. Midazolam 1 mg and propofol 1.5 mg x kg(-1) x hr(-1) were administered for sedation. Thirty minutes after the block, oxgen saturation decreased to 92% under O2 3 l x min(-1) by a mask. She was intubated and arterial carbon dioxide tension was above 150 mmHg. A few hours later, she became conscious and mask CPAP was used after extubation for one day. Pa(CO2) was 90-100 mmHg for 3 days and decreased to 56.9 mmHg on the 6th day, but her consciousness had been clear. Phrenic nerve palsy and sedation in the patient with decreased lung function might have induced prolonged hypercapnea.

[A case report of ultrasound guided peripheral nerve block for lower extremity amputation of a patient with anti-phospholipid syndrome].

A 60-year-old female with anti-phospholipid syndrome underwent amputation of her left lower limb. She had had a history of cerebral infarction, cerebral hemorrhage, coagulation abnormalities, thrombocytopenia, and pneumothorax, and just recovered from disseminated intravascular coagulation. After intravenous fentanyl 25 microg, ultrasound-guided sciatic, femoral and lateral femoral cutaneous nerve blocks were performed. We used 0.75% ropivacaine 15 ml and 1% lidocaine 15 ml for sciatic nerve block, 0.75% ropivacaine 5 ml and 1% lidocaine 5 ml for femoral nerve block and 0.75% ropivacaine 5 ml for femoral cutaneous nerve block. For femoral nerve block, a catheter was inserted and ropivacaine was infused at 4 ml x hr(-1) after surgery. Amputation at the left thigh was successfully performed and postoperative course was uneventful. The sciatic, femoral and lateral femoral cutaneous nerve blocks were useful for amputation of a patient with severe coagulopathy by anti-phospholipid syndrome.

Propofol results in higher incidence of bronchoconstriction in allergic patients.

INTRODUCTION: Some reports showed allergic reaction to propofol. However, propofol has bronchodilating effect. The purpose of this study was to elucidate whether propofol is safely used for patients with allergy or bronchial asthma. METHODS: Seventy females with bronchial asthma or allergic diseases and 70 females without any allergic diseases for mastectomy were randomly allocated to propofol group (Propofol-allergy group and Propofol-non-allergy group) or sevoflurane group (Sevoflurane-allergy group and Sevoflurane-non-allergy group). In the propofol group, anesthesia was induced with propofol and fentanyl, and maintained with propofol, fentanyl and 50% nitrous oxide in oxygen. In the sevoflurane group, anesthesia was induced with sevoflurane, 50% nitrous oxide in oxygen and fentanyl, and maintained with sevoflurane and 50% nitrous oxide in oxygen. Laryngeal mask airway was inserted. Wheezing detected by auscultation, increase of inspiratory pressure and change of the waveform of end-tidal carbon dioxide, and allergic reaction detected by skin rash during anesthesia were compared among the groups. RESULTS: The number of patients who had wheezing was significantly larger in Propofol-allergy group than in other groups. CONCLUSIONS: Propofol might induce bronchoconstriction with a higher incidence in allergic patients than in non-allergic patients, and than sevoflurane.

Effects of repeat exposure to inhalation anesthetics on liver and renal function.

BACKGROUND: Cross hypersensitivity to inhalation anesthetics has not been studied. The aim of this study was to investigate it by comparing liver and renal function after repeated anesthesia with sevoflurane and isoflurane retrospectively. MATERIALS AND METHODS: The adult patients who received general anesthesia twice within the interval of 14 days to 1 year were retrospectively analyzed. Those who received sevoflurane anesthesia twice (SS group, 53 cases), isoflurane anesthesia twice (II group, 31 cases), sevoflurane followed by isoflurane anesthesia (SI group, 29 cases), isoflurane followed by sevoflurane anesthesia (IS group, 35 cases), and propofol-fentanyl anesthesia twice (PP group, 58 cases) were enrolled. Serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (Bil), gamma-glutamyl transpeptidase (γ-GTP), blood urea nitrogen (BUN), and creatinine (Cr) measured 1-3, 5-8, and 12-16 days after surgery were investigated. RESULTS: In the IS group, the number of the patients with abnormal values of ALT and γ-GTP 5-8 days after surgery were significantly smaller at second anesthesia compared to the first anesthesia. The number of the patients with abnormal values of AST, ALT, and γ-GTP were significantly larger in the II group than the SS and PP groups. The number of patients who had higher values in each parameter at second anesthesia compared to the first anesthesia was not different among the groups. CONCLUSIONS: Sevoflurane and isoflurane might have no cross hypersensitivity. Both anesthetics might not have any additional risks to increase liver and renal damage by second anesthesia.

Composite auditory evoked potentials index is not a good indicator of depth of anesthesia in propofol-fentanyl anesthesia: Randomized comparative study.

BACKGROUND: The composite auditory evoked potentials index (cAAI) was considered a measure of overall balance between noxious stimulation, analgesia, and hypnosis; while bispectral index (BIS) shows only hypnosis, and auditory evoked potentials index (AAI) shows response to stimuli. The present study compared the performance of cAAI, BIS, and AAI in propofol-fentanyl anesthesia. MATERIALS AND METHODS: Forty-five patients for abdominal surgery aged 30-65 years with ASA physical status I or II were randomly divided into three groups by an envelope method. Anesthesia was induced with midazolam, propofol, and fentanyl alongwith an epidural block. When hemodynamics were stable during surgery, propofol infusion rate was fixed at 4 mg/kg/h for 10 min, then increased to 6 mg/kg/h and kept it for 10 min. AAI (AEP version 1.4), cAAI (AEP version 1.6), or BIS (A-2000) was monitored in each 15 patients, and the performance of three indices was compared. RESULTS: All three indices decreased significantly before intubation. Only the AAI increased significantly by intubation. During anesthesia except for at propofol 6 mg/kg/h, the cAAI was significantly higher than the AAI. Only the AAI was significantly lower at propofol 6 mg/kg/h than at 4 mg/kg/h. The cAAI had the largest and AAI had the smallest inter-individual variations. The cAAI was higher than the manufacturer's recommended range of general anesthesia. CONCLUSION: In propofol-fentanyl anesthesia, AAI might be better to discriminate anesthetic depth than cAAI and BIS.

Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.

INTRODUCTION: Fever is frequently observed in critically ill patients. An independent association of fever with increased mortality has been observed in non-neurological critically ill patients with mixed febrile etiology. The association of fever and antipyretics with mortality, however, may be different between infective and non-infective illness. METHODS: We designed a prospective observational study to investigate the independent association of fever and the use of antipyretic treatments with mortality in critically ill patients with and without sepsis. We included 1,425 consecutive adult critically ill patients (without neurological injury) requiring >48 hours intensive care admitted in 25 ICUs. We recorded four-hourly body temperature and all antipyretic treatments until ICU discharge or 28 days after ICU admission, whichever occurred first. For septic and non-septic patients, we separately assessed the association of maximum body temperature during ICU stay (MAXICU) and the use of antipyretic treatments with 28-day mortality. RESULTS: We recorded body temperature 63,441 times. Antipyretic treatment was given 4,863 times to 737 patients (51.7%). We found that treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen independently increased 28-day mortality for septic patients (adjusted odds ratio: NSAIDs: 2.61, P=0.028, acetaminophen: 2.05, P=0.01), but not for non-septic patients (adjusted odds ratio: NSAIDs: 0.22, P=0.15, acetaminophen: 0.58, P=0.63). Application of physical cooling did not associate with mortality in either group. Relative to the reference range (MAXICU ≥ 39.5°C increased risk of 28-day mortality in non-septic patients (adjusted odds ratio 8.14, P=0.01), but not in septic patients (adjusted odds ratio 0.47, P=0.11) [corrected]. CONCLUSIONS: In non-septic patients, high fever (≥39.5°C) independently associated with mortality, without association of administration of NSAIDs or acetaminophen with mortality. In contrast, in septic patients, administration of NSAIDs or acetaminophen independently associated with 28-day mortality, without association of fever with mortality. These findings suggest that fever and antipyretics may have different biological or clinical or both implications for patients with and without sepsis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00940654.

Effects of antithrombin and gabexate mesilate on disseminated intravascular coagulation: a preliminary study.

PURPOSE: We hypothesized that antithrombin is more effective for disseminated intravascular coagulation (DIC) than is gabexate mesilate, which is a protease inhibitor, suggested from the previous studies. Initially, we compared the effects of antithrombin and gabexate mesilate for treating infection-related DIC. METHODS: Sixteen adult patients with a diagnosis of DIC with infection who were assessed with an acute DIC score 4 or higher at the admission to the intensive care unit were divided into antithrombin-treated and gabexate mesilate-treated groups. White blood cell counts, C-reactive protein, platelet counts, antithrombin, fibrin and fibrinogen degradation product, D-dimer, fibrinogen, thrombin antithrombin complex, plasmin plasminogen complex, prothrombin time, and activated partial thrombin time were measured on the day of admission and on days 1, 3, 5, and 7 thereafter. Mortality over 28 days was also compared. RESULTS: Platelet counts and antithrombin were significantly higher in the antithrombin group on day 7 and on days 5 and 7, respectively. Antithrombin increased to the normal level on day 1 in the antithrombin group but on day 7 in the gabexate mesilate group. C-reactive protein, fibrinogen degradation product, D-dimer, thrombin antithrombin complex, plasmin plasminogen complex, and prothrombin time were lower in the antithrombin group; but the differences were not significant. The 28-day mortality was 2 of 8 in the antithrombin group and 3 of 8 in the gabexate mesilate group, but they were not significantly different. CONCLUSIONS: Antithrombin may be a more effective treatment for coagulation and fibrinolysis disorders than gabexate mesilate in infection-related DIC, but there was no difference in 28-day mortality.

The effects of prewarming the I-gel on fitting to laryngeal structure.

PURPOSE: The supraglottic airway, I-gel (Intersurgical, Wokingham, United Kingdom), has a noninflatable cuff, which softens at body temperature to fit to laryngeal structure. The present study was performed to investigate the hypothesis that the cuff of I-gel can fit to laryngeal structure faster when prewarmed to body temperature than kept at room temperature. METHODS: A total of 180 adult patients were assigned to the warm group (90 patients) or the control group (90 patients). Anesthesia was induced with propofol, remifentanil, or fentanyl. Vecuronium or rocuronium was administered as a muscle relaxant. The I-gel was warmed to 37 °C before insertion in the warm group and it was in the room temperature (approximately 20 °C) in the control group. Insertion time, number of attempt for successful insertion, inspiratory pressure, leak pressure, and leak volume were compared between the 2 groups. RESULTS: Insertion time was 12.9 ± 9.3 seconds in the warm group and 14.5 ± 12.3 seconds in the control group. Number of attempt for insertion was 1 in 77 cases, 2 in 4 cases, and 3 in 1 case in the warm group and 1 in 79 cases and 2 in 7 cases in the control group. Inspiratory pressure, leak pressure, and leak volume were not significantly different between the 2 groups, whereas leak volume had a tendency to be smaller in the warm group. CONCLUSION: Prewarming the I-gel to body temperature did not have any significant benefits in comparison with the I-gel kept at room temperature.

[Is nitrous oxide useful for laryngeal mask airway insertion under 8% sevoflurane?].

BACKGROUND: The usefulness of nitrous oxide for laryngeal mask airway insertion under 8% sevoflurane anesthesia was investigated. METHODS: One hundred and fifty patients aged 40 to 60 years for general anesthesia were divided into GOS (nitrous oxide, oxygen, sevoflurane) and OS (oxygen, sevoflurane) groups. Anesthesia was induced with 8% sevoflurane and nitrous oxide 3 l x min(-1) and oxygen 3 l x min(-1) in the GOS group, or oxygen 6 l x min(-1) in the OS group. When verbal response disappeared, sevoflurane concentration was reduced to 3%. Five min after the start of induction, laryngeal mask airway was inserted. RESULTS: The changes in blood pressure and heart rate were significantly smaller and times to disappearance of eyelash response and verbal response were significantly shorter in the GOS group than those in the OS group. The frequencies of postoperative nausea, vomiting, and headache were not different between the groups. CONCLUSIONS: Nitrous oxide shortened induction time, decreased hemodynamic changes, but did not increase postoperative nausea, vomiting and headache when used for anesthesia induction with 8% sevoflurane to insert laryngeal mask airway.

[Repeated anesthesia for a patient with Tako-Tsubo cardiomyopathy].

An 85-year-old woman recieved emergency repair of left obturator hernia under general anesthesia. The surgery was completed uneventfully. Shortly after the admission to the recovery unit, blood pressure dropped to 80mmHg and ECG showed negative T wave. Hypotension was successfully treated with colloid infusion and dopamine administration, but negative T wave was unchanged by nitrate infusion. The serum CK-MB examination indicated no cardiomyogenic problems. On postoperative day 13, she received emergency colostomy under general anesthesia. Large negative T wave still persisted. Immediately after induction of anesthesia, she showed hypotension, which recovered by fluid infusion and intravenous ephedrine. The UCG after surgery showed hypokinesis of the apex of left ventricle. She was diagnosed as Tako-tsubo myocardiopathy. One month after the second surgery, she received closure of colostomy under general anesthesia combined with continuous epidural anesthesia, when negative T wave was seen on the ECG. Negative T wave returned to normal 10 weeks after the first surgery. When unknown tachycardia and negative T waves are seen, Tako-tsubo cardiomyopathy should be considered.

Comparison of the motor and sensory block by ropivacaine and bupivacaine in combination with lidocaine in interscalene block.

INTRODUCTION: The effects of ropivacaine and bupivacaine in interscalene block have been studied, but we usually combine lidocaine with ropivacaine or bupivacaine to fasten the onset. However, the effects of these combinations are not studied. PURPOSE: To compare the effects of two different concentrations of the combination of ropivacaine or bupivacaine with lidocaine. MATERIALS AND METHODS: One hundred adult patients scheduled for repair of fracture of the upper extremity under interscalene block were randomly allocated into one of the groups receiving the combination of 15 mL of ropivacaine 0.375% (Ropivacaine 0.375 group), ropivacaine 0.75% (Ropivacaine 0.75 group), bupivacaine 0.25% (Bupivacaine 0.25 group), or bupivacaine 0.5% (Bupivacaine 0.5 group) with lidocaine 1.0% 15 mL. The onset and duration of motor and sensory blocks were compared among the 4 groups by Kruskal Wallis test followed by Mann-Whitney U test. RESULTS: Three patients in the Ropivacaine 0.375 group did not show any motor blocks. Ropivacaine groups had significantly slower onset of motor block and longer duration of motor and sensory blocks than Bupivacaine groups. Bupivacaine 0.5 group had significantly longer duration of both blocks than Bupivacaine 0.25 group, while Ropivacaine 0.375 and 0.75 groups had the similar duration of both blocks. CONCLUSIONS: In interscalene block combined with lidocaine, ropivacaine had slower onset of motor block and longer duration of both blocks than bupivacaine. Only bupivacaine showed the different duration of the blocks between two concentrations.

Comparison of ear and chest probes in transcutaneous carbon dioxide pressure measurements during general anesthesia in adults.

OBJECTIVE: For transcutaneous carbon dioxide pressure (tcPCO(2)) measurement, the probe on the trunk or extremities has been used for many years. Our previous study showed that chest was better than arm for tcPCO(2) monitoring. Recently, the ear probe has been developed. The accuracy of tcPCO(2) as a surrogate measurement of arterial carbon dioxide pressure (PaCO(2)) has not been compared between the measurement with probe on the chest and measurement with probe on the earlobe. This study compared the accuracy of tcPCO(2) measured on the chest and tcPCO(2) measured on earlobe during general anesthesia in adults using linear regression analysis and Bland-Altman plot. METHODS: Ten patients aged 30-70 years scheduled for abdominal surgery under general anesthesia were enrolled. TcPCO(2) by TCM4™ (Radiometer, Copenhagen, Denmark, TtcPCO(2)) with its probe on the chest, tcPCO(2) by Sentec™ (Sentec AG, Therwil, Switzerland, StcPCO(2)) with ear probe, end-tidal carbon dioxide pressure (EtCO(2)), and PaCO(2) were simultaneously measured at four different sets of EtCO(2) levels in each patient. In total, 40 measurements were performed. The Scatter plot and Bland-Altman plot were obtained. Correlation coefficient (R(2)) ≥0.70 and limits of agreement ≤4 mmHg were judged as significant. RESULTS: TtcPCO(2) showed significant positive correlation with PaCO(2) (R(2) = 0.80) but StcPCO(2) did not (R(2) = 0.55). TtcPCO(2) and PaCO(2), and StcPCO(2) and PaCO(2) had large limits of agreement (-6.56 mmHg, 4.21 mmHg and -11.05 mmHg, 7.64 mmHg, respectively). TtcPCO(2) and StcPCO(2) had no significant correlation (R(2) = 0.63) and large limits of agreement (-8.98 mmHg to 7.91 mmHg). CONCLUSION: During general anesthesia in adults, both TtcPCO(2) and StcPCO(2) were not interchangeable with PaCO(2), but only TtcPCO(2) had good positive correlation with PaCO(2).

Anesthesia for a 228-kg patient (body mass index, 90.6) undergoing laparoscopic sleeve gastrectomy.

We undertook anesthesia of a 40-year-old woman with body weight of 228 kg and body mass index (BMI) of 90.6 kg/m(2) who was undergoing laparoscopic sleeve gastrectomy. This case may be the largest known patient undergoing general anesthesia in our country. Anesthesia was induced in a 30° head-up position with midazolam, fentanyl, droperidol, and inhalation of sevoflurane and nitrous oxide without muscle relaxants, and maintained with propofol, remifentanil, and pancuronium under pressure-controlled ventilation. The Airway Scope could not be inserted into her mouth, but her trachea was successfully intubated with a Macintosh laryngoscope. Dosages of anesthetics and fluid infusion rate were calculated first per ideal body weight. Then, infusion of propofol and remifentanil and administration of muscle relaxant were controlled by bispectral index, hemodynamics, and train-of-four response, respectively. Postoperative 12-h pressure-controlled ventilation and pain management by subcutaneous infusion of fentanyl and droperidol were successful. Subcutaneous heparin 5,000 units twice per day postoperatively did not induce thromboembolism.

Comparison of the Airtraq, Airway Scope, and disposable Macintosh laryngoscope blade.

BACKGROUND: The present study was performed to 1. compare usefulness of the Airtraq (ATQ) and the Airway Scope (AWS) with the Macintosh laryngoscope (MAC), 2. compare usefulness of the ATQ with the AWS, 3. compare usefulness of the AWS with the tip of the blade under the epiglottis as recommended by the manufacturer (AWS-Miller) and the AWS with the tip of the blade in the vallecula as the MAC (AWS-MAC), in tracheal intubation by expert anesthesiologists. METHODS: One hundred and twenty patients were divided into the ATQ, AWS-Miller, AWS-MAC, and the MAC groups of 30 patients each. Intubation was performed by expert anesthesiologists. How many attempts were necessary (number of the attempts), and the time required for successful tracheal intubation (intubation time) were compared among the four groups. RESULTS: In patients with Cormack and Lehane classification 1 and 2, the number of attempts was significantly larger in the AWS-Miller group than MAC and ATQ groups, and intubation time in the AWS-Miller group was significantly longer than those in the ATQ and MAC groups. In patients with Cormack and Lehane classification 3, intubation time was significantly shorter in the ATQ group than that in the MAC group. CONCLUSIONS: The MAC and ATQ were better than the AWS-Miller for patients with easy intubation, while the ATQ was better than the MAC for difficult intubation when the expert anesthesiologists did the intubation.

The supraglottic airway I-gel in comparison with ProSeal laryngeal mask airway and classic laryngeal mask airway in anaesthetized patients.

BACKGROUND AND OBJECTIVE: The I-gel is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to investigate the usefulness of the I-gel compared with the classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (pLMA) in anaesthetized, paralysed patients. METHODS: The American Society of Anesthesiologists physical status I-II patients (n = 167) scheduled for orthopaedic surgery were included in this prospective study. General anaesthesia was achieved with intravenous infusion of propofol, remifentanil and rocuronium. The patients were randomly assigned to I-gel, pLMA and cLMA groups (64, 53 and 50 patients, respectively). Properly sized I-gel (No. 3-4) or LMA (No. 4-5) was inserted. We assessed haemodynamic data, airway leak pressure, leak volume, success rates and postoperative complications. RESULTS: There were no differences in the demographic data and haemodynamic data immediately after insertion of devices among the three groups. The airway leak pressures of the I-gel group (27.1 +/- 6.4 cmH2O) and pLMA group (29.8 +/- 5.7 cmH2O) were significantly higher than that of the cLMA group (24.7 +/- 6.2 cmH2O). The success rates for first attempt of insertion were similar among the three groups (P = 0.670). There were no differences in the incidence of adverse events except for the larger incidence of sore throat in the cLMA group. CONCLUSION: I-gel may have a similar airway sealing to that of pLMA, higher than that of cLMA, and is not associated with adverse events. The I-gel might be an effective alternative as a supraglottic airway device.