Laryngeal Mark Airway in Oral and Dental Surgeries- A Review

Oral and dental surgery requires a stable airway that is unobstructed, protects lung from aspiration, low interference with the surgical field and few complications. The laryngeal mask airway (LMA), is an alternative to nasal mask and endotracheal intubation, provides advantages of intubation while avoiding some of its complications. LMA is easy to insert and can be used for both spontaneous and controlled ventilations. Operation theater pollution is very less with scavenging of gases. Many other variants of LMA have been developed over the years on same principle, providing additional features and benefits. The LMA flexible, a wire reinforced LMA, is specifically designed for head and neck surgeries. In the intervening years, LMA has been extensively used in oral and dental surgeries despite some being skeptical about it. The purpose of this article is to review the laryngeal mask airway with especial emphasis on its use in oral and dental surgery

A comparison between propofol and sevoflurane for easy insertion of laryngeal mask airway among adults in minor elective surgeries: An observational study

Background: The laryngeal mask airway (LMA) has reached ample popularity for the management of airway during surgery. Propofol, used as induction agent, causes change in blood pressure and heart rate (HR) while insertion of LMA. Sevoflurane, whereas, has the potential to be a good induction agent as propofol. We have compared propofol and sevoflurane for easy insertion of LMA among adults in minor surgeries. Aim and Objectives: The primary objective of the study was to compare the ease of insertion of LMA and its characteristics related to insertion among adults in minor elective surgeries using intravenous propofol or inhalational sevoflurane. While time taken to set induction and actual event of LMA insertion along with number of attempts, jaw relaxation time, LMA insertion time, apnea time, monitoring hemodynamic changes, and occurrence of complications were taken as secondary objectives. Materials and Methods: It was a prospective and observational study done in Department of Anesthesiology and Operation Theaters of Fortis Hospital, Kolkata, after getting ethical approval. Total 100 patients were recruited by consecutive sampling and divided into two groups - P (propofol) and S (sevoflurane) group. Anesthesia induction time, jaw relaxation time, LMA insertion time, etc. were noted. LMA insertion conditions were assessed by a 3-point scale using six variables, total score was calculated for each group. Hemodynamic parameters and induction complications were also recorded. Results: There was no significant difference in demographic parameters, American Society of Anesthesiologists class, Modified Mallampati Grading, and LMA size, between the groups. LMA insertion time was comparable between the two groups. Regarding complications, there was no incidence of coughing while minor gagging (4%) and laryngospasm (6%) were noted only with sevoflurane. Final summation of scores showed excellent insertion characteristics with propofol (94%) and sevoflurane (84%), respectively, with no significant difference. Conclusion: Inhalational sevoflurane may be regarded as a viable alternative to inj. propofol for insertion of laryngeal mask among adults in minor elective surgeries.

Comparative study of ProSeal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia

Background: Supra glottic airway devices (SGAD) is integral to airway management during general anesthesia. PLMA, a second-generation SGAD with a gastric channel and an efficient seal, is an alternative for the COETT, which is the gold standard for securing the airway. SGAD has the advantage of lesser hemodynamic changes during insertion and removal. This study aimed to compare the hemodynamic and ventilatory changes between PLMA and the endotracheal tube (ETT). Methods: Prospective randomized study, conducted at Yenepoya medical college hospital on 90 patients undergoing elective laparoscopic surgeries under general Anaesthesia. The patients were divided into groups; group p=45 patients (PMLA) and E=45 patients (COETT). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) and end-tidal carbon dioxide (EtCO2) were documented at baseline, at 1, 3, 5 and 8 minutes after placement of airway device. Results: Differences in vital parameters at baseline were statistically insignificant. HR, SBP, DBP and MAP were significantly higher in group E compared to group P at 1st, 3rd, 5th and 8 min after the insertion of the airway device. There was no statistically significant difference in SpO2 and EtCO2. Post-extubation laryngopharyngeal morbidity was noted in 5 patients with ETT compared to 1 patient with PMLA. Conclusions: PLMA provides better hemodynamic stability at insertion when compared to ETT. Both PLMA and ETT provide good oxygenation and ventilation during elective laparoscopic surgeries. Insertion at first attempt was more successful with PLMA when compared to ETT.

Second-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges

INTRODUCTION@#Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery.@*METHODS@#Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO2), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO2), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared.@*RESULTS@#The values of ETCO2, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO2 at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar.@*CONCLUSION@#During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.

Unilateral lingual nerve and hypoglossal nerve injury caused by a novel laryngeal mask airway: a case report

Abstract Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.

A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotra Results: cheal intubation than PLMA insertion. The elevation in these hemodynamic parameters significantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic res Conclusion: ponse produced when PLMA was used for securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.

Comparison of I-gel and Laryngeal mask airway (LMA) Supreme during laparoscopic Gynecological procedure

Background: The I-gel is a latex-free SAD that has a non-inflatable cuff and medical-grade thermoplastic elastomer. The design allows for a more close interaction when engaging with supraglottic tissue. The goal of the present prospective study was to compare the performance of the I-gel with that of the LMA-Supreme. Methods: The present prospective study was conducted on 100 adult patients with age between 18 to 60 years with American Society of Anesthesiologists (ASA) physical status I or II who were scheduled to undergo elective laparoscopic Gynecological procedure under general anesthesia were included in the study. Patient having gastric reflux, Obesity (BMI >30kg/m2), cervical spine disease or difficult airway were excluded from the study. The study was conducted after obtaining approval from the Institutional Review Board. A written informed consent for participation in the study was obtained from each patient. Results: The mean time for insertion in the Group SLMA was 29 sec which was significantly more as compared to 21 sec in Group I-gel (p<0.0001). 84% cases from the Group I-gel had ease of insertion which was significantly more as compared to 82% among the Group SLMA. There was no significant difference in the incidence of postoperative complications between the groups (p>0.05). Conclusion: In conclusion, both devices were similarly successful ventilatory devices for gynaecological laparoscopic procedures in terms of ease of insertion, first-time success rates, time to insertion, and oropharyngeal leak pressure

COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSE WITH LARYNGOSCOPIC ENDOTRACHEAL INTUBATION AND LARYNGEAL MASKAIRWAY INSERTION IN ADULT HYPERTENSIVE PATIENTS

INTRODUCTION: Laryngoscopy and endotracheal intubation has been the mainstay in providing adequate airway management, delivering general anaesthesia but are associated with hypertension, tachycardia and arrhythmias. These haemodynamic responses may be more hazardous in hypertensive patients. OBJECTIVE: In this study, we aimed to compare the haemodynamic response elicited by laryngoscopic endotracheal intubation with laryngeal mask airway insertion, in ASA II of adult hypertensive patients. METHODS: The study conducted on 100 hypertensive patients of either sex aged between 20 and 60 years belonging to ASA II grade and scheduled for elective surgery. The patients were randomly divided into two groups of 50 patients each. In one group (Group I) laryngoscopic endotracheal intubation was done and in another group (Group II) laryngeal mask airway was inserted. Baseline vitals of the patients (SBP, DBP, MAP, HR, SpO2) were documented. Patients were given inj. Midazolam 2mg IM and Phenargan 25 mg IM as premedication before the elective surgery. General anaesthesia was administered. Haemodynamics including heart rate, blood pressure and SpO2 were recorded every minute till intubation or insertion and at 1,3,5 minutes after intubation or insertion and then every 5 minutes till 20 minutes. RESULTS: All the haemodynamic responses (SBP,DBP,MAP,HR) in Laryngoscopy + Endotracheal Intubation Group compared to the Laryngeal Mask Airway Insertion Group was statistically signi?cant as the p value is <0.05. CONCLUSION: The laryngeal mask airway may be used for airway management during anaesthesia in hypertensive patients on treatment in whom the pressor response would be deleterious.

Clinical evaluation of the use of laryngeal tube versus laryngeal mask airway for out-of-hospital cardiac arrest by paramedics in Singapore

INTRODUCTION@#It remains unclear which advanced airway device has better placement success and fewer adverse events in out-of-hospital cardiac arrests (OHCAs). This study aimed to evaluate the efficacy of the VBM laryngeal tube (LT) against the laryngeal mask airway (LMA) in OHCAs managed by emergency ambulances in Singapore.@*METHODS@#This was a real-world, prospective, cluster-randomised crossover study. All OHCA patients above 13 years of age who were suitable for resuscitation were randomised to receive either LT or LMA. The primary outcome was placement success. Per-protocol analysis was performed, and the association between outcomes and airway device group was compared using multivariate binomial logistic regression analysis.@*RESULTS@#Of 965 patients with OHCAs from March 2016 to January 2018, 905 met the inclusion criteria, of whom 502 (55.5%) were randomised to receive LT while 403 (44.5%) were randomised to receive LMA. Only 174 patients in the LT group actually received the device owing to noncompliance. Placement success rate for LT was lower than for LMA (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.90). Complications were more likely when using LT (OR 2.82,0 95% CI 1.64-4.86). Adjusted OR for prehospital return of spontaneous circulation (ROSC) was similar in both groups. A modified intention-to-treat analysis showed similar outcomes to the per-protocol analysis between the groups.@*CONCLUSION@#LT was associated with poorer placement success and higher complication rates than LMA. The likelihood of prehospital ROSC was similar between the two groups. Familiarity bias and a low compliance rate to LT were the main limitations of this study.

Optimizando el uso de tubo orotraqueal y máscara laríngea en paciente pediátrico / Orotracheal tube and Laryngeal mask airway in the pediatric patient optimizing it's use

Managing a pediatric patient is a challenge for the anesthesiologist. Optimizing the use of airway devices through solving common questions among general anesthesiologists turns out to be a way of improving and maximizing de safety we offer our patients, reducing de occurrence of the most common complications the pediatric patient has, which are respiratory complications.

El enfrentamiento del paciente pediátrico supone un desafío para el anestesiólogo. En este contexto el optimizar el uso de los dispositivos de vía aérea, resolviendo dudas muy frecuentes entre los anestesiólogos generales, supone una practica que aumenta la seguridad de nuestros pacientes, reduciendo las complicaciones mas frecuentes en ellos que son las complicaciones respiratorias.

Value of ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with laryngeal mask airway / 中华麻醉学杂志

Objective:To determine the value of ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with laryngeal mask airway (LMA).Methods:A total of 272 American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 25-78 yr, weighing 40-85 kg, with mechanical ventilation time 30-120 min, scheduled for elective lower limb vascular surgery or lithotripsy under general anesthesia with LMA, were selected.The parameters of submental soft tissue of tongue thickness (TT), distance from skin to the hyoid bone (DSHB), distance from skin to epiglottis midway (DSEM) and distance from skin to anterior commissure of the vocal cords (DSAC) were measured using ultrasonography before operation.The type of LMA was chosen according to the instruction book.The development of failure of LMA placement at the first attempt, air leakage around LMA cuff during mechanical ventilation, peak airway pressure >20 cmH 2O and gastric insufflation detected by ultrasonography were recorded.The development of one or more adverse events mentioned above was considered to be poor ventilation.The patients were divided into normal ventilation group (N group) and poor ventilation group (P group) according to whether poor ventilation occurred.The receiver operating characteristic curve for ultrasonographic measurement of submental soft tissue distance in predicting poor ventilation with LMA was drawn, and the area under the curve (AUC) and 95% confidence interval (CI), sensitivity and specificity and cut-off value were calculated.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for poor ventilation with LMA. Results:The AUC for TT, DSHB, DSEM and DSAC measured using ultrasonography in predicting poor ventilation with LMA (95%CI) was 0.866 (0.813-0.919), 0.755 (0.683-0.827), 0.835 (0.772-0.899) and 0.705 (0.628-0.782) ( P<0.05 or 0.01), respectively.The results of logistic regression analysis showed that TT≥6.140 cm, DSHB≥1.145 cm, DSEM≥2.175 cm and DSAC≥1.075 cm were risks factor for poor ventilation with LMA. Conclusion:Ultrasonographic measurement of TT, DSHB, DSEM and DSAC can predict the development of poor ventilation with LMA.

An Observational Study to Evaluate the Haemodynamic Changes between Endotracheal Intubation and Laryngeal Mask Airway Insertion

Introduction: Neuromuscular blockers like Rocuroniumbromide can impair respiratory functions during generalanaesthesia. Therefore aim of present study was to find outthe biochemical changes of Rocuronium bromide and othermuscle relaxant in cardiac surgery.Material and Methods: Present study was carried out onsixty (60) patients of different age groups from both sexesscheduled for various cardiac surgical procedures at L.P.S.Institute of Cardiology, GSVM medical college Kanpurduring the period of August 1998 to August 1999. Patientswere classified in 3 equal groups. Muscle relaxants were givenaccording to the group and biochemical parameters like PCo2,PO2, pH etc. were recorded carefully at the interval of two,five and ten minutes.Results: No statistically significant changes were observed inPCo2, pH, Na+, K+ at 2 minutes, 5 minutes and 10 minutes afterthe administration of all three drugs (P >0.05) compared withcontrol values. Statistically Significant changes in PO2 andO2 saturation was observed at 2 minutes, 5 minutes and 10minutes after the administration of Pancuronium (P <0.05).Conclusion: Rocuronium bromide is safer in cardiac surgeryas compared to other muscle relaxants.

A comparative study of supraglottic airway devices Baska mask and ProSeal-laryngeal mask airway in short gynaecological procedures

Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.

A comparative evaluation of I-gel and laryngeal mask airway supreme in laparoscopic surgeries: a randomized comparative study

Background: Supraglottic airway device results in less hemodynamic responses during laparoscopic surgery but supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation as laparoscopic surgery also leads to higher airway pressure. In this study the efficiency of the I-gel with SLMA is compared in patients undergoing laparoscopic cholecystectomy surgeries.Methods: Sixty patients were randomized in to two groups, group A where I-gel was considered for airway management and group B where LMA Supreme was the device chosen for airway management.Results: Oropharyngeal seal pressure was significantly lower in group A than group B, 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in group A than group B. Hemodynamics were comparable between the two groups. Time taken to insert the airway device and Ryle’s tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in group A than group B with no significant (p>0.05) association.Conclusions: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to I-gel group.

Comparative Evaluation of Effective Dose 50 (ED 50) of Propofol in Adult Patients with Saline-Propofol, Dexmedetomidine-Propofol and Fentanyl - Propofol for Laryngeal Mask Airway Insertion

Introduction: Propofol a short acting intravenous anaestheticis widely used with various adjuncts to facilitate improvedinsertion conditions of Proseal Laryneal Mask Airway(PLMA). We compared the median effective dose (ED 50)propofol requirement and insertion conditions of PLMA withsaline - propofol, dexmedetomidine - propofol and fentanyl -propofol.Material and Methods: This was a prospective randomizeddouble blind study conducted in 100 adult patients of AmericanSociety of Anaesthesiology (ASA) class I/II scheduled toundergo elective surgical procedures. They were randomlyallocated into four groups of 25 each - Group N normal saline,Group F1 fentanyl 1 mcg/kg, Group F2 fentanyl 2mcg/kg andGroup D dexmedetomidine 1mcg/kg. The study drug wasdiluted in 50ml saline and infused over 10 minutes followedby a predetermined dose of propofol as per Dixon’s up anddown method. The ease of PLMA insertion was assessed asper Muzi mouth opening score. Hemodynamic parameterswere observed starting from baseline (T0), at 10 min post testdrug infusion (T1), post propofol injection (T2), 1min postLMA insertion (T3) and till 3 minutes post LMA insertion(T4).Results: The ED50 of propofol for the insertion of PLMAwith normal saline, fentanyl (1mcg/kg), fentanyl (2 mcg/kg)and dexmedetomidine (1mcg/kg) as adjuncts were found outto be 3.25mg/kg, 2mg/kg, and 1.67mg/kg and 1.92mg/kgrespectively. PLMA insertion conditions and hemodynamicparameters were comparable between the four groups. Leastincidence of apnoea was noted in group D with only 8 patientsrequiring assisted ventilation.Conclusion: Dexmedetomidine significantly reduces therequirement of induction dose propofol for PLMA insertionwhile providing stable hemodynamic and excellent insertionconditions

A Comparative Study between Standard Weight‑Based Technique and Pinna Size-Based New Technique for Classic Laryngeal Mask Airway Size Selection in Pediatric Population

Introduction: The laryngeal mask airway (LMA) is a non-invasive supraglottic airway device designed to maintain the airway,which sits outside of and creates a seal around the larynx. In clinical practice, the most commonly used method for sizeestimation is the weight-based method. However, this may not be suitable due to lack of standardization in pediatric patients,emergencies, overweight, etc. Therefore, this study was undertaken to evaluate the efficacy of the new pinna size-basedmethod for the estimation of LMA size.Materials and Methods: A total of 100 pediatric patients, aged under 15 years, undergoing ambulatory surgeries, belonging toAmerican society of anesthesiologists (ASA) Grades I and II, were randomly divided into two groups: Weight-based and Pinnasize-based estimation. Parameters such as number of attempts and change of size required were monitored.Results: LMAs were inserted in both the groups in the first attempt. However, LMAs needed to be exchanged in 2% of casesin Group A and in 16% of cases in Group B.Conclusion: Pinna size-based estimation for the size of LMA is a convenient and feasible alternative to the traditional weightbased estimation.

Study to assess the effect of mini-dose Succinylcholine for ease of laryngeal mask airway insertion

Background: Propofol as sole induction agent is often insufficient for the laryngeal mask airway insertion and higher doses are at times required. The present study proposes to assess the effectiveness of 0.25mg/kg mini dose succinylcholine towards facilitation of laryngeal mask airway (LMA) insertion.Methods: In a single blinded randomized controlled trial, 68 patients posted for elective general and orthopaedic surgery were equally assigned to two groups during LMA insertion: Group S (Study group)- patients received a bolus of succinylcholine 0.25mg/kg diluted in 2 ml of 0.9% sodium chloride. Group C (Control group)-patients received a bolus dose of 2 ml of 0.9% sodium chloride. The number of attempts required and ease of LMA insertion, hemodynamic parameters and adverse responses were noted and compared between the groups.Results: The LMA was inserted in first attempt in 32 (94.11%) patients in group S and in 24 (70.58%) patients in group C. The control group had 67.62% grade 1, 32.38% grade 2 and 0% grade 3, while succinylcholine group had 73.53% grade 1, 26.47% grade 2 and 0% grade 3. Hemodynamic parameters didn’t differ significantly between the two groups at any point, but significant difference was observed between occurrence of fasciculation, head and limb movements, sore throat and coughing.Conclusions: Succinylcholine does seem to help in insertion of the laryngeal mask airway but the results could not gain the level of statistical significance, partly attributed to small sample size.

Intubating Laryngeal Mask Airway as an Independent Ventilatory and Intubating Device in Lateral Position: A Fibreoptic Study

Sudden airway loss during surgery in a laterally positionedpatient may have hazardous consequences. We studiedwhether the intubating laryngeal mask airway (ILMA) facilitatesfibreoptic guided tracheal intubation in patients positioned inthe lateral position. Anesthesia was induced with propofol,fentanyl, and rocuronium in 90 consenting patients of eithersex, weighing 50-70 Kg undergoing surgery. Patients wererandomized to three groups (n=30 each); Group 1 (Controlgroup) Supine position, or positioned on their right or left sides(Group 2 and Group 3 respectively) before induction of generalanesthesia. ILMA insertion and fibreoptic guided intubation wasperformed in that position. The grade of the glottic view, timerequired for intubation and number of adjusting maneuversused were recorded. Data were compared by ANOVA, multiple‘t’ test and chi(2) test. Demographic and airway measureswere similar in the three groups. The time required for ILMAinsertion (<30 secs) and success rate was similar in threegroups. The time to intubation was also similar ineach group (15.24±3.4719.68±17.29 secs, 19.35±11.83 secsin Groups 1, 2, 3 respectively; p = > 0.05), as was intubationsuccess (97.7%). Hence ILMA offers a frequent success rateand a clinically acceptable intubation time (<1 min) even in thelateral position.

Comparative evaluation of induction with propofol vs induction with sevoflurane for insertion of laryngeal mask airway in children

Background: There is increasing use of laryngeal mask airway in children because of ease of insertion and minimal disturbances in cardio respiratory system and lesser risk of airway injury during perioperative period as compared to endotracheal tube. It is also simple, well-tolerated, safe, reusable, cost effective method of airway management in paediatric patients. Intravenous propofol (1%) is a preferred induction agent for LMA insertion till date, while sevoflurane, a halogenated volatile inhalational, non-irritating anaesthetist agent with pleasant odour is also suitable for inhalational induction of children. This study was carried out to study and compare clinical efficacy of propofol and sevoflurane for laryngeal mask airway (LMA) insertion in children undergoing short surgical procedures.Methods: In this study, total 100 children of ASA grade I/II of either sex with age group 3-8 years, weighing between 10-20 kg were enrolled. They were induced with either sevoflurane (group S) or intravenous propofol (group P) 3 mg/kg. Then appropriate size LMA was inserted. Various parameters like jaw relaxation and ease of insertion attempts required hemodynamic changes were noted and compared in two groups.Results: In group P, 94% patients and groups S, 90% patients had full jaw relaxation. The LMA insertion was easy in 98% patients in groups P and 94% patients in groups S. In 98% patients of groups P and 96% patients in groups S, LMA was inserted successfully in first attempt. The mean time required for LMA insertion was 19.16±5.29 seconds in groups P and 20.8±6.39 seconds in groups S. Both the groups were comparable with respect to haemodynamic changes observed which were transient and clinically not significant though statically significant.Conclusions: Both the groups showed comparable and satisfactory LMA insertion conditions, hence both can be routinely used for induction of anaesthesia in children.

A Comparative Study of Ease of Insertion of Laryngeal Mask Airway with Propofol and Thiopentone with Lignocaine Spray

Introduction: Study was conducted to determine the conditionsfor insertion of LMA following induction of anaesthesia with(Propofol, 2 mg/kg) and (Thiopentone, 5 mg/kg, preceded by10%Lignocaine spray to the posterior oropharyngeal wall) byobserving six different parameters (gagging, laryngospasm,body movements, coughing, ease of insertion, jaw relaxation)and assessing all six parameters together with Lund andStovner gradingsystem. The hemodynamic parameters wererecorded during induction of anaesthesia and following LMAinsertion.Material and Methods: Patients were allocated randomlyinto two groups, (40 patients per group), Group A- Propofoland Group B- Thiopentone, preceded with 10%Lignocainespray.Results: In Group A significant decrease in HR (p<0.05),systolic BP (p<0.01), diastolic BP (p<0.01) and mean BP(p<0.01) was observed as compared to Group B. The overallassessment for the ease of insertion of LMA was 100%inGroup A and 97.5%in Group B which was statistically notsignificant (p=0.314). No significant difference was observedin gagging (p=0.152), laryngospasm (p=0.314), bodymovements (p=0.221), coughing (p=0.221), jaw relaxation(p=0.314) and the ease of insertion (p=0.314).Discussion: 10% Lignocaine spray suppresses upper airwayreflexes in Thiopentone group and facilitates LMA insertionwithout any adverse response.Conclusion: Thiopentone preceded with 10%Lignocainespray to the posterior oropharynx (Group B) provides almostequal conditions for LMA insertion as compared to Propofol(Group A) with better hemodynamic stability