INTRODUCTION: Laryngeal mask airway-blockbuster (LMA-BT) is a relatively new supraglottic airway device (SGAD). In this study, we compared LMA-BT with I-Gel LMA for efficacy of blind tracheal intubation. MATERIAL AND METHODS: We conducted a single-blind prospective study after ethical approval. One hundred American Society of Anesthesiology (ASA) Grade I-III (age 18-60 years) patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were included and randomly divided into 2 groups. Blind tracheal intubation was performed through LMA-BT ( n = 50) and I-Gel ( n = 50) in groups 1 and 2, respectively. The primary aim was to evaluate the first pass success rate of blind tracheal intubation through the LMAs. The secondary objectives noted were attempts and ease of LMA insertion, total time taken for LMA insertion, airway seal pressure of LMA, ease of NGT insertion through LMA, fibre-optic grading of laryngeal view through LMA, overall success rate and time of intubation through LMA, time for LMA removal, and complications, if any. RESULTS: In the LMA-BT group, the first pass success rate ( P < 0.019) and the overall success rate of intubation ( P < 0.005) were significantly higher than in the I-Gel group. Using LMA-BT also resulted in statistically significant shorter intubation time ( P < 0.0001) with higher airway seal pressure as compared to I-Gel ( P < 0.001). The difference in the first attempt insertion, number of insertion attempts, ease and time of LMA insertion and removal after intubation, and postoperative complications were comparable among the groups. CONCLUSIONS: LMA-BT is a superior device as compared to I-Gel LMA as a conduit for blind tracheal intubation.
Anesthesia, General , Intubation, Intratracheal , Laryngeal Masks , Humans , Intubation, Intratracheal/methods , Intubation, Intratracheal/instrumentation , Single-Blind Method , Adult , Prospective Studies , Female , Male , Middle Aged , Anesthesia, General/methods , Young Adult , Adolescent
Anesthesia providers must be experts in advanced airway management techniques such as laryngeal mask airway and endotracheal tube insertion. However, practicing anesthesia providers may work in clinical settings where advanced airway management techniques are rarely required. Infrequent advanced airway skill performance in these clinical settings can lead to skill decay, which is the gradual loss of acquired skills through infrequent practice or extended periods of skill nonuse. This literature review synthesizes available evidence regarding advanced airway management skill decay. Themes emerging from the literature review include skill decay association with decreased endotracheal intubation success rates, a timeframe within which advanced airway management skill decay may begin to occur, and recommendations for preventing decay of advanced airway management skills. With infrequent use of advanced airway skills in clinical settings, routine practice is crucial for skill maintenance. Clinical simulation could play a role in mitigating skill decay among practicing anesthesia providers at risk for decay in advanced airway management skills resulting from skill nonpractice.
Airway Management , Clinical Competence , Nurse Anesthetists , Humans , Nurse Anesthetists/education , Intubation, Intratracheal , Laryngeal Masks
Supraglottic airway (SGA) is an alternative to endotracheal intubation, however endotracheal intubation is often essential. One method to convert from an SGA to an endotracheal tube (ETT) is utilizing the SGA as a conduit for fiberoptic-guided advancement of an Aintree catheter (airway exchange catheter), and exchange of the SGA for an ETT. In this prospective randomized study, we compared two SGA devices in facilitating this exchange. Subjects were randomized to receive either the i-gel® or LMA® Supreme™ SGA. The SGA was placed and an Aintree intubation catheter was inserted through the SGA over a fiberoptic bronchoscope. Next, the SGA was removed, leaving the Aintree within the trachea, and an ETT was placed over the Aintree catheter and advanced into the trachea. The i-gel group exhibited shorter time to successful intubation (median, 191 vs. 434 seconds; P = .002). The i-gel group also had fewer study subjects requiring more than one attempt for successful Aintree placement (33% vs. 75%, P = .02). The i-gel group showed superior laryngeal view score (LVS) (6 vs. 4; P = .003). The i-gel SGA achieved a faster time to successful intubation, higher rate of first attempt Aintree placement, and superior LVS.
Fiber Optic Technology , Intubation, Intratracheal , Laryngeal Masks , Humans , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Male , Prospective Studies , Female , Middle Aged , Adult , Nurse Anesthetists , Aged
Peak pressures ≥ 20 mbar are not a contraindication for laryngeal masks. The oropharyngeal leak pressure of a laryngeal mask does not correspond to the pressure at which oesophagogastric air leakage occurs. Setting a peak pressure limit of 20 cm H2O on the respirator can lead to critical situations because the tidal volume may then remain too low. A good alternative is to use a pressure alarm limit. The use of laryngeal masks does not preclude the use of PEEP and/or relaxation.
Laryngeal Masks , Humans , Positive-Pressure Respiration/instrumentation
BACKGROUND: Flexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. PATIENTS AND METHODS: We analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. RESULTS: Of the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9-150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. CONCLUSION: AFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.
Bronchoscopy , Foreign Bodies , Humans , Bronchoscopy/methods , Foreign Bodies/surgery , Foreign Bodies/diagnosis , Male , Child, Preschool , Female , Infant , Retrospective Studies , Child , Tunisia , Laryngeal Masks/adverse effects
BACKGROUND: Tracheal intubation is the gold standard for airway management in emergency medicine, but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA). OBJECTIVE: The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against unfixed ones. METHODS: In a body donor model, LMA application was evaluated between medical students without previous airway experience and anesthesiologists by comparing the sealing of the larynx using a water column applied to the esophagus. RESULTS: LMAs were successfully applied in 46 out of 55 (83.6%) attempts by medical students and in 30 out of 39 (76.9%) attempts by anesthesiologists. Among medical students, 14.1% of all LMA applications were primarily leaky, compared with 18.8% in anesthesiologists. Esophageal sealing was better in Thiel-fixed specimens (leakage 10.9%) compared with unfixed specimens (leakage 22.9%). Our data showed no significant difference between anesthesiologists and medical students in terms of sealing of LMA. Therefore, we conclude that medical students without previous airway experience can quickly learn to apply LMA sufficiently and thus, achieve aspiration protection similar to anesthesiologists. CONCLUSION: Medical students without previous airway experience can successfully insert LMAs after a short introduction. Thiel-fixed specimens are suitable for studies as well as for training in LMA application.
Laryngeal Masks , Humans , Anesthesiologists , Intubation, Intratracheal , Airway Management , Esophagus
INTRODUCTION: One-lung ventilation (OLV) is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. Double-lumen endotracheal tubes and one-lumen tracheal tube combined with bronchial blocker might lead to intubation-related laryngeal injury. PATIENT CONCERNS: In the perioperative period, how to avoid further damage to the vocal cord while achieving OLV during operation is challenging work. DIAGNOSIS: She was diagnosed with systemic lupus erythematosus, bilateral vocal cord paralysis, and lung tumor. INTERVENTIONS: We used a combination of a laryngeal mask airway with bronchial blocker to avoid further damage to the vocal cord when achieving OLV. OUTCOMES: At 1-month follow-up, she had fully recovered without obvious abnormalities. CONCLUSION: When OLV was required for patients with bilateral vocal cord paralysis, a combination of a laryngeal mask airway with bronchial blocker was considered a better choice.
Laryngeal Masks , One-Lung Ventilation , Vocal Cord Paralysis , Female , Humans , Vocal Cord Paralysis/complications , Vocal Cord Paralysis/surgery , Intubation, Intratracheal/methods , One-Lung Ventilation/methods , Bronchi
La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)
Humans , Male , Female , Airway Management/methods , Pain Management , Tracheostomy , Laryngeal Masks , Intubation, Intratracheal , Spain , Anesthesia, General , Conscious Sedation , Anesthesiology
La sección de Vía Aérea de la Sociedad Española De Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) y la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) presentan la Guía para el manejo integral de la vía aérea difícil en el paciente adulto. Sus principios están focalizados en el factor humano, los procesos cognitivos para la toma de decisiones en situaciones críticas y la optimización en la progresión de la aplicación de estrategias para preservar una adecuada oxigenación alveolar con el objeto de mejorar la seguridad y la calidad asistencial. El documento proporciona recomendaciones basadas en la evidencia científica actual, herramientas teórico/educativas y herramientas de implementación, fundamentalmente ayudas cognitivas, aplicables al tratamiento de la vía aérea en el campo de la anestesiología, cuidados críticos, urgencias y medicina prehospitalaria. Para ello se realizó una amplia búsqueda bibliográfica según las directrices PRISMA-R y se analizó utilizando la metodología GRADE. Las recomendaciones se formularon de acuerdo con esta metodología. Las recomendaciones de aquellas secciones con evidencia de baja calidad se basaron en la opinión de expertos mediante consenso alcanzado a través de un cuestionario Delphi.(AU)
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.(AU)
Humans , Male , Female , Airway Management/methods , Pain Management , Tracheostomy , Laryngeal Masks , Intubation, Intratracheal , Spain , Anesthesia, General , Conscious Sedation , Anesthesiology
BACKGROUND: Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative-hypnotic. The combination of remimazolam and sevoflurane does not increase respiratory sensitivity, produce bronchospasm, or cause other adverse conditions. We aimed to observe the effects of different remimazolam doses on the minimum alveolar concentration (MAC) of sevoflurane at end-expiration during laryngeal mask insertion and evaluate the effect of sex on the efficacy of the combination of remimazolam on the suppression of laryngeal mask insertion in adult patients. METHODS: We included 240 patients undergoing laparoscopic surgery under general anesthesia with elective placement of a laryngeal mask (120 males and 120 females). The patients were randomly divided into four groups according to sex: a control group (randomization for female patients, RF0; randomization for male patients, RM0) and three remimazolam groups (RF1, RM1 / RM2, RF2 / RM3, RF3), with 30 patients in each group. Induction was established by vital capacity rapid inhalation induction (VCRII), using 8% sevoflurane and 100% oxygen (6 L/min) in all patients. The (RF1, RM1), (RM2, RF2), and (RM3, RF3) groups were continuously injected with remimazolam at doses of 1, 1.5, and 2.0 mg/kg/h, respectively, while the (RM0, RF0) group was injected with an equal volume of normal saline. The end-expiratory concentration of sevoflurane was adjusted to a preset value after the patient's eyelash reflex disappeared. After the end-expiratory concentration of sevoflurane was kept stable for at least 15 min, the laryngeal mask was placed, and the patient's physical response to the mask placement was observed immediately and within 30 s of placement. The MAC of sevoflurane was measured using the up-and-down sequential method of Dixon. RESULTS: The calculated MAC of end-expiratory sevoflurane during laryngeal mask insertion in adult females was (2.94 ± 0.18)%, (2.69 ± 0.16)%, (2.32 ± 0.16)% and (1.83 ± 0.15)% in groups RF0, RF1, RF2 and RF3; (2.98 ± 0.18)%, (2.80 ± 0.19)%, (2.54 ± 0.15)% and (2.15 ± 0.15)% in male groups RM0, RM1, RM2 and RM3, respectively. The MAC values were significantly lower in the (RF1-RF3, RM1-RM3) group when compared to the (RF0, RM0) group. There was no significant difference between (RF0, RF1) and (RM0, RM1), but the MAC value of the RF2-RF3 group was significantly lower than that of the RM2-RM3 group. CONCLUSIONS: Remimazolam can effectively reduce end-expiratory sevoflurane MAC values during laryngeal mask placement in adults. When remimazolam was measured above 1.5 mg/kg/h, the effect of inhibiting laryngeal mask implantation in female patients was stronger than that in male patients. Remimazolam at a dose of 1-2 mg/kg/h combined with sevoflurane induction can be safely and effectively used in these patients.
Anesthetics, Inhalation , Laryngeal Masks , Methyl Ethers , Adult , Humans , Male , Female , Sevoflurane , Benzodiazepines
Background The I-LMA ventilates while providing a port for blind insertion of an endotracheal tube. The ILMA Fastrach is used especially for intubating in a difficult airway scenario. Its accompanying endotracheal tube is not economical nor readily available. In comparison, two alternative endotracheal tubes - polyvinyl chloride and wire-reinforced tubes were used for tracheal intubation through the ILMA. AIMS AND OBJECTIVES: The aim of our study was to compare the ease of intubation when using conventional PVC tubes versus the wire-reinforced flexometallic tubes with the ILMA-FastrachTM. The number of attempts, time taken and additional maneuvers were noted. Intra-operative hemodynamic changes, post-operative sore throat, bleeding and hoarseness of voice was recorded over a period of 24 hours. METHODOLOGY: After informed consent, 60 ASA I-II patients undergoing elective surgeries under general anesthesia were allocated to undergo blind intubation with the PVC tube or the wire-reinforced flexometallic tube. RESULTS: More attempts were required for successful intubation using the wire-reinforced tube than the PVC tube with 76.7% passing in the first attempt in the PVC, and 53.3% passing in the first attempt in the flexometallic group. (P = 0.4). Average time for intubation in the PVC group: 28.24 ± 7.22 seconds. Average time for intubation in the flexometallic tube: 45.8 ± 15.78 sec. Occurrence of post-operative sore throat was 13.3% in the PVC group and 26.6% in the flexometallic group, with minimal hoarseness of voice 3.3% in the PVC group and 10% in the flexometallic group. There was also a slightly higher hemodynamic response in those who were intubated with the flexometallic tube than a PVC tube. CONCLUSION: Intubating via the ILMA-Fastrach with the PVC tube offered better intubating conditions with regards to lesser time taken, lesser attempts, less manipulation, and less hemodynamic variations as compared to the patients who were intubated using the wire-reinforced tube.
Résumé Arrière-plan: L'I-LMA ventile tout en fournissant un port pour l'insertion aveugle d'une sonde endotrachéale. L'ILMA Fastrach est utilisé notamment pour l'intubation dans un scénario de voies respiratoires difficiles. La sonde endotrachéale qui l'accompagne n'est ni économique ni facilement disponible. En comparaison, deux tubes endotrachéaux alternatifs du chlorure de polyvinyle et des tubes renforcés de fil ont été utilisés pour l'intubation trachéale via l'ILMA. Buts et objectifs: Le but de notre étude était de comparer la facilité d'intubation lors de l'utilisation de tubes en PVC conventionnels par rapport aux tubes flexométalliques renforcés de fil avec l'ILMA-FastrachTM. Le nombre de tentatives, le temps nécessaire et les manÓuvres supplémentaires ont été notés. Les changements hémodynamiques peropératoires, les maux de gorge postopératoires, les saignements et l'enrouement de la voix ont été enregistrés sur une période de 24 heures. Méthodologie: Après consentement éclairé, 60 patients ASA I-II subissant des interventions chirurgicales électives sous anesthésie générale ont été affectés à une intubation aveugle avec le tube en PVC ou le tube flexométallique renforcé de fil. Résultats: Plus de tentatives ont été nécessaires pour réussir l'intubation à l'aide du tube renforcé par fil métallique qu'avec le tube PVC, avec 76,7 % de réussite lors de la première tentative dans le groupe PVC et 53,3 % de réussite lors de la première tentative dans le groupe flexométallique. (P = 0,4). Temps moyen d'intubation dans le groupe PVC : 28,24 ± 7,22 secondes. Temps moyen d'intubation dans le tube flexométallique : 45,8 ± 15,78 sec. La survenue de maux de gorge postopératoires était de 13,3 % dans le groupe PVC et de 26,6 % dans le groupe flexométallique, avec un enrouement minime de la voix de 3,3 % dans le groupe PVC et de 10 % dans le groupe flexométallique. Il y avait également une réponse hémodynamique légèrement plus élevée chez ceux qui étaient intubés avec le tube flexométallique qu'avec un tube en PVC. Conclusion: L'intubation via l'ILMA-Fastrach avec le tube en PVC offrait de meilleures conditions d'intubation en ce qui concerne moins de temps, moins de tentatives, moins de manipulations et moins de variations hémodynamiques par rapport aux patients intubés à l'aide du tube renforcé de fil Mots-clés: Facilité d'intubation, sonde endotrachéale flexométallique, masque laryngé d'intubation des voies respiratoires, sonde endotrachéale en polychlorure de vinyle.
Laryngeal Masks , Pharyngitis , Humans , Laryngeal Masks/adverse effects , Polyvinyl Chloride , Hoarseness/etiology , Intubation, Intratracheal/adverse effects , Pharyngitis/etiology
BACKGROUND: There is limited research on the combined use of propofol and esketamine for anesthesia induction during flexible laryngeal mask airway (FLMA) in pediatric patients, and the effective dosage of propofol for FLMA smooth insertion remains unclear. We explored the effective dose of propofol combined with intravenous esketamine for the smooth insertion of FLMA in two distinct age groups of preschool children. METHODS: This is a prospective, observer-blind, interventional clinical study. Based on age, preschool children scheduled for elective surgery were divided into group A (aged 1-3 years) and group B (aged 3-6 years). Anesthesia induction was started with intravenous administration of esketamine (1.0 mg.kg- 1) followed by propofol administration. The FLMA was inserted 2 min after propofol administration at the target dose. The initial dose of propofol in group A and group B was 3.0 mg.kg- 1 and 2.5 mg.kg- 1, respectively. The target dose of propofol was determined with Dixon's up-and-down method, and the dosing interval of propofol was 0.5 mg.kg- 1. If there was smooth insertion of FLMA in the previous patient, the target dose of propofol for the next patient was reduced by 0.5 mg.kg- 1; otherwise, it was increased by 0.5 mg.kg- 1. The median 50% effective dose (ED50) for propofol was estimated using Dixon's up-and-down method and Probit analysis, while the 95% effective dose (ED95) was estimated through Probit analysis. Vital signs and adverse events during induction were recorded. RESULTS: Each group included 24 pediatric patients. Using Dixon's up-and-down method, the ED50 of propofol combined with esketamine for smooth insertion of FLMA in group A was 2.67 mg.kg- 1 (95%CI: 1.63-3.72), which was higher than that in group B (2.10 mg. kg- 1, 95%CI: 1.36-2.84) (p = 0.04). Using Probit analysis, the ED50 of propofol was calculated as 2.44 (95% CI: 1.02-3.15) mg.kg- 1 in group A and 1.93 (95% CI: 1.39-2.32) mg.kg- 1 in group B. The ED95 of propofol was 3.72 (95%CI: 3.07-15.18) mg.kg- 1 in group A and 2.74 (95%CI: 2.34-5.54) mg.kg- 1 in group B. In Group B, one pediatric patient experienced laryngospasm. CONCLUSION: The effective dose of propofol when combined with intravenous esketamine for smooth insertion of FLMA in children aged 1-3 years is 2.67 mg.kg- 1, which is higher than that in children aged 3-6 years (2.10 mg. kg- 1). TRIAL REGISTRATION: Chinese Clinical Trial Registry Center (Registration Number: ChiCTR2100044317; Registration Date: 2021/03/16).
Ketamine , Laryngeal Masks , Propofol , Humans , Child, Preschool , Child , Infant , Prospective Studies , Infusions, Intravenous , Anesthetics, Intravenous
BACKGROUND: Pulmonary aspiration is a potentially lethal perioperative complication that can be precipitated by gastric insufflation. Face mask ventilation (FMV), a ubiquitous anesthetic procedure, can cause gastric insufflation. FMV with an inspiratory pressure of 15 cm H2O provides the best balance between adequate pulmonary ventilation and a low probability of gastric insufflation. There is no data about the effects of FMV > 120 seconds. OBJECTIVES: To investigate the effect of prolonged FMV on gastric insufflation. METHODS: We conducted a prospective observational study at a tertiary medical center with female patients who underwent oocyte retrieval surgery under general anesthesia FMV. Pre- and postoperative gastric ultrasound examinations measured the gastric antral cross-sectional area to detect gastric insufflation. Pressure-controlled FMV with an inspiratory pressure of 15 cm H2O was continued from the anesthesia induction until the end of the surgery. RESULTS: The study comprised 49 patients. Baseline preoperative gastric ultrasound demonstrated optimal and good image quality. All supine measurements were feasible. The median duration of FMV was 13 minutes (interquartile range 9-18). In the postoperative period, gastric insufflation was detected in only 2 of 49 patients (4.1%). There was no association between the duration of FMV and delta gastric antral cross-sectional area (ß -0.01; 95% confidence interval -0.04 to 0.01, P = 0.31). CONCLUSIONS: Pressure-controlled FMV with an inspiratory pressure of 15 cm H2O carries a low incidence of gastric insufflations, not only as a bridge to a definitive airway but as an alternative ventilation method for relatively short procedures in selective populations.
Insufflation , Laryngeal Masks , Female , Humans , Anesthesia, General/adverse effects , Anesthesia, General/methods , Insufflation/adverse effects , Laryngeal Masks/adverse effects , Respiration, Artificial/adverse effects , Respiration, Artificial/methods , Stomach/diagnostic imaging , Prospective Studies
OBJECTIVE: To elucidate the safety and effectiveness of laryngeal mask airway (LMA) use in pediatric patients undergoing laparoscopic inguinal hernia repair. METHODS: Studies were searched on the PubMed, EMBASE, and Cochrane Library databases. Only randomized controlled trials (RCTs) were included. Primary outcomes were major perioperative respiratory adverse events (PRAEs), namely laryngospasm, bronchospasm, desaturation, and aspiration. Secondary outcomes were minor PRAEs, anesthesia time, and recovery time. A meta-analysis was performed to calculate risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (CI) by using random effects models. RESULTS: In total, 5 RCTs comprising 402 patients were included. Regarding major PRAEs, laryngospasm (RR: 0.43, 95 % CI: 0.12 to 1.47; p = 0.18), bronchospasm, and aspiration all demonstrated no difference between the laryngeal and endotracheal groups. Desaturation exhibited a trend, but this trend was not sufficiently supported with statistical evidence (p = 0.09). For minor PRAEs, fewer patients experienced incidence of cough after laryngeal mask use (RR: 0.27, 95 % CI: 0.11 to 0.67; p = 0.005). Other PRAE, namely hoarseness (p = 0.06), sore throat (RR: 1.88, 95 % CI: 0.76 to 4.66; p = 0.18), and stridor, did not differ between the 2 groups. Additionally, both anesthesia time (WMD: -6.88 min, 95 % CI: -11.88 to -1.89; p < 0.00001) and recovery time (WMD: -4.85 min, 95 % CI: -6.51 to -3.19; p < 0.00001) were shortened in the LMA group. CONCLUSION: LMA used in pediatric laparoscopic inguinal hernia repair demonstrated no greater safety risks than endotracheal tube intubation did. Thus, anesthesiologists may shift from conventional endotracheal tube use to LMA use. Moreover, anesthesia and recovery times were shortened in the LMA group, which resulted in more efficient use of the operating room. Because of these benefits, LMA could be an appropriate option for pediatric patients undergoing laparoscopic inguinal hernia repair. LEVEL OF EVIDENCE: Treatment Study, LEVEL III.
Bronchial Spasm , Hernia, Inguinal , Laparoscopy , Laryngeal Masks , Laryngismus , Respiration Disorders , Child , Humans , Laryngeal Masks/adverse effects , Laryngismus/epidemiology , Laryngismus/etiology , Bronchial Spasm/complications , Hernia, Inguinal/complications , Intubation, Intratracheal/adverse effects , Respiration Disorders/etiology , Laparoscopy/adverse effects
BACKGROUND: Laryngeal mask airway surfactant administration (S-LMA) has the potential benefit of surfactant administration whilst avoiding endotracheal intubation and ventilation, ventilator-induced lung injury and bronchopulmonary dysplasia (BPD). OBJECTIVES: To evaluate the benefits and harms of S-LMA either as prophylaxis or treatment (rescue) compared to placebo, no treatment, or intratracheal surfactant administration via an endotracheal tube (ETT) with the intent to rapidly extubate (InSurE) or extubate at standard criteria (S-ETT) or via other less-invasive surfactant administration (LISA) methods on morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome (RDS). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and three trial registries in December 2022. SELECTION CRITERIA: Randomised controlled trials (RCTs), cluster- or quasi-RCTs of S-LMA compared to placebo, no treatment, or other routes of administration (nebulised, pharyngeal instillation of surfactant before the first breath, thin endotracheal catheter surfactant administration or intratracheal surfactant instillation) on morbidity and mortality in preterm infants at risk of RDS. We considered published, unpublished and ongoing trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and extracted data. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: We included eight trials (seven new to this update) recruiting 510 newborns. Five trials (333 infants) compared S-LMA with surfactant administration via ETT with InSurE. One trial (48 infants) compared S-LMA with surfactant administration via ETT with S-ETT, and two trials (129 infants) compared S-LMA with no surfactant administration. We found no studies comparing S-LMA with LISA techniques or prophylactic or early S-LMA. S-LMA versus surfactant administration via InSurE S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' postmenstrual age (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.27 to 8.34, I 2 = not applicable (NA) as 1 study had 0 events; risk difference (RD) 0.02, 95% CI -0.07 to 0.10; I 2 = 0%; 2 studies, 110 infants; low-certainty evidence). There may be a reduction in the need for mechanical ventilation at any time (RR 0.53, 95% CI 0.36 to 0.78; I 2 = 27%; RD -0.14, 95% CI -0.22 to -0.06, I 2 = 89%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 17; 5 studies, 333 infants; low-certainty evidence). However, this was limited to four studies (236 infants) using analgesia or sedation for the InSurE group. There was little or no difference for air leak during first hospitalisation (RR 1.39, 95% CI 0.65 to 2.98; I 2 = 0%; 5 studies, 333 infants (based on 3 studies as 2 studies had 0 events); low-certainty evidence); BPD among survivors to 36 weeks' PMA (RR 1.28, 95% CI 0.47 to 3.52; I 2 = 0%; 4 studies, 264 infants (based on 3 studies as 1 study had 0 events); low-certainty evidence); or death (all causes) during the first hospitalisation (RR 0.28, 95% CI 0.01 to 6.60; I 2 = NA as 2 studies had 0 events; 3 studies, 203 infants; low-certainty evidence). Neurosensory disability was not reported. Intraventricular haemorrhage ( IVH) grades III and IV were reported among the study groups (1 study, 50 infants). S-LMA versus surfactant administration via S-ETT No study reported death or BPD at 36 weeks' PMA. S-LMA may reduce the use of mechanical ventilation at any time compared with S-ETT (RR 0.47, 95% CI 0.31 to 0.71; RD -0.54, 95% CI -0.74 to -0.34; NNTB 2, 95% CI 2 to 3; 1 study, 48 infants; low-certainty evidence). We are very uncertain whether S-LMA compared with S-ETT reduces air leak during first hospitalisation (RR 2.56, 95% CI 0.11 to 59.75), IVH grade III or IV (RR 2.56, 95% CI 0.11 to 59.75) and death (all causes) during the first hospitalisation (RR 0.17, 95% CI 0.01 to 3.37) (1 study, 48 infants; very low-certainty evidence). No study reported BPD to 36 weeks' PMA or neurosensory disability. S-LMA versus no surfactant administration Rescue surfactant could be used in both groups. There may be little or no difference in death or BPD at 36 weeks (RR 1.65, 95% CI 0.85 to 3.22; I 2 = 58%; RD 0.08, 95% CI -0.03 to 0.19; I 2 = 0%; 2 studies, 129 infants; low-certainty evidence). There was probably a reduction in the need for mechanical ventilation at any time with S-LMA compared with nasal continuous positive airway pressure without surfactant (RR 0.57, 95% CI 0.38 to 0.85; I 2 = 0%; RD -0.24, 95% CI -0.40 to -0.08; I 2 = 0%; NNTB 4, 95% CI 3 to 13; 2 studies, 129 infants; moderate-certainty evidence). There was little or no difference in air leak during first hospitalisation (RR 0.65, 95% CI 0.23 to 1.88; I 2 = 0%; 2 studies, 129 infants; low-certainty evidence) or BPD to 36 weeks' PMA (RR 1.65, 95% CI 0.85 to 3.22; I 2 = 58%; 2 studies, 129 infants; low-certainty evidence). There were no events in either group for death during the first hospitalisation (1 study, 103 infants) or IVH grade III and IV (1 study, 103 infants). No study reported neurosensory disability. AUTHORS' CONCLUSIONS: In preterm infants less than 36 weeks' PMA, rescue S-LMA may have little or no effect on the composite outcome of death or BPD at 36 weeks' PMA. However, it may reduce the need for mechanical ventilation at any time. This benefit is limited to trials reporting the use of analgesia or sedation in the InSurE and S-ETT groups. There is low- to very-low certainty evidence for no or little difference in neonatal morbidities and mortality. Long-term outcomes are largely unreported. In preterm infants less than 32 weeks' PMA or less than 1500 g, there are insufficient data to support or refute the use of S-LMA in clinical practice. Adequately powered trials are required to determine the effect of S-LMA for prevention or early treatment of RDS in extremely preterm infants. S-LMA use should be limited to clinical trials in this group of infants.
Bronchopulmonary Dysplasia , Laryngeal Masks , Respiratory Distress Syndrome, Newborn , Respiratory Distress Syndrome , Infant, Newborn , Infant , Humans , Surface-Active Agents , Respiratory Distress Syndrome, Newborn/prevention & control , Morbidity , Infant, Extremely Premature , Bronchopulmonary Dysplasia/prevention & control , Cerebral Hemorrhage
BACKGROUND: Mask ventilation is a critical airway procedure made more difficult in the bearded patient. OBJECTIVE: We sought to objectively investigate whether application of transparent cling film (TegadermTM; 3M Healthcare, Maplewood, MN) over a beard in the operating room improves the quality of mask ventilation. METHODS: This was a randomized crossover trial of bearded adult patients undergoing surgery. Exclusions included emergency procedures, American Society of Anesthesiologists physical status classification > 3, a documented history of difficult mask ventilation, and body mass index (BMI) > 50. Transparent cling film was applied snuggly over the lower face with a 2- to 3-cm slit cut over the mouth after anesthesia induction. Mask ventilation performed by an anesthesiology resident, anesthesiology assistant, or anesthesiology assistant student and standardized to a thenar-eminence grip without use of airway adjuncts in a sniffing position. Standardized pressure-controlled ventilations were delivered via an anesthesia machine. A calibrated external pneumotachograph was used to measure delivered and returned tidal volumes from which raw and percent air leak were calculated. A clinically significant difference was determined a priori to be 15%, necessitating the enrollment of 25 patients. RESULTS: Of 25 subjects, 96% were men with a mean ± SD BMI of 29.3 ± 6. Seventeen (68%) had a full beard and 8 (32%) had a partial beard. The mean ± SD leakage was 48% ± 26% for transparent cling film vs. 46% ± 20% without its application, which was not significantly different (p = 0.67). CONCLUSIONS: The use of transparent cling film to cover the lower half of the bearded face did not have an impact on the ability or efficacy to perform mask ventilation in the operating room setting. CLINICALTRIALS: gov, Number NCT04274686.
Laryngeal Masks , Respiration, Artificial , Adult , Male , Humans , Female , Respiration, Artificial/methods , Tidal Volume , Bandages , Hand , Face
There are few pertinent studies about the application of laryngeal mask airways (LMAs) in lateral decubitus surgery. Therefore, the aim of our study was to evaluate the effects of lateral position and pneumoperitoneum on oropharyngeal leak pressure (OLP) and ventilation efficiency for the LMA SaCoVLM. Patients undergoing elective retroperitoneal laparoscopic urological surgery were randomized 1:1 to the Supreme group or SaCoVLM group. The primary outcome was the OLP with LMA insertion. The secondary outcomes were the first-attempt success rate, insertion time, adjustment times, gastric tube success rate, LMA alignment accuracy, LMA removal time, regurgitation or aspiration, LMA blood staining, and incidence of adverse events 24 h after surgery. We recruited 70 patients to complete the study. Regardless of lateral position and pneumoperitoneum, the OLP was greater in the SaCoVLM group (n = 35) than in the Supreme group (n = 35), with a median difference of 4-7 cmH2O. The first-attempt success rate of the SaCoVLM group was higher than that of the Supreme group (91.4% vs. 77.1%, risk ratio (RR): 1.19; 95% CI 0.96 to 1.46, P = 0.188). Thus, in the lateral position with pneumoperitoneum, although the new video LMA SaCoVLM has a higher OLP than the LMA Supreme, both devices provide sufficient ventilation efficiency.
Laparoscopy , Laryngeal Masks , Humans , Laryngeal Masks/adverse effects , Oropharynx , Pneumoperitoneum , Pressure
OBJECTIVES: To investigate the effects and safety of lidocaine viscous gargle on postoperative sore throat (POST) in patients receiving a laryngeal mask airway (LMA) in general anesthesia. METHODS: In this randomized controlled trial, 90 patients undergoing urological surgery were allocated into 2 treatment arms (n=45): lidocaine viscous gargle before LMA insertion (Group G) and topical application of lidocaine viscous on the LMA (Group T). Outcome data were collected before placement of LMA (T0), after insertion of LMA (T1), immediately (T2), one hour (T3), and 24 hours after removal of LMA (T4). We analyzed the incidence of POST, pharynx dryness, and adverse events. RESULTS: The incidence of POST was lower in Group G than Group T at T2 (11.1% vs. 28.9%; p=0.063), T3 (11.1% vs. 24.4%; p=0.167), and T4 (2.2% vs. 4.4%; p=0.566), but there was no significant difference between groups. No patient in either group experienced severe pain or treatment-related adverse events. There was a significantly lower incidence of pharynx dryness in Group G than Group T (p<0.05) at T2, T3, and T4. CONCLUSION: Lidocaine viscous gargle showed no statistically significant difference in incidence of POST and incidence of pharynx dryness compared with topical application of lidocaine on the LMA. Both approaches were safe for patients receiving LMA.Chinese Clinical Trial Register No.: ChiCTR2200059720.
Laryngeal Masks , Pharyngitis , Humans , Laryngeal Masks/adverse effects , Intubation, Intratracheal/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Pharyngitis/epidemiology , Pharyngitis/etiology , Anesthesia, General/adverse effects , Lidocaine
