The effects of labor on airway outcomes with Supreme™ laryngeal mask in women undergoing cesarean delivery under general anesthesia: a cohort study.

BACKGROUND: Pregnancy is associated with higher incidence of failed endotracheal intubation and is exacerbated by labor. However, the influence of labor on airway outcomes with laryngeal mask airway (LMA) for cesarean delivery is unknown. METHODS: This is a secondary analysis of a prospective cohort study on LMA use during cesarean delivery. Healthy parturients who fasted > 4 h undergoing Category 2 or 3 cesarean delivery with Supreme™ LMA (sLMA) under general anesthesia were included. We excluded parturients with BMI > 35 kg/m2, gastroesophageal reflux disease, or potentially difficult airway (Mallampati score of 4, upper respiratory tract or neck pathology). Anesthesia and airway management reflected clinical standard at the study center. After rapid sequence induction and cricoid pressure, sLMA was inserted as per manufacturer's recommendations. Our primary outcome was time to effective ventilation (time from when sLMA was picked up until appearance of end-tidal carbon dioxide capnography), and secondary outcomes include first-attempt insertion failure, oxygen saturation, ventilation parameters, mucosal trauma, pulmonary aspiration, and Apgar scores. Differences between labor status were tested using Student's t-test, Mann-Whitney U test, or Fisher's exact test, as appropriate. Quantitative associations between labor status and outcomes were determined using univariate logistic regression analysis. RESULTS: Data from 584 parturients were analyzed, with 37.8% in labor. Labor did not significantly affect time to effective ventilation (mean (SD) for labor: 16.0 (5.75) seconds; no labor: 15.3 (3.35); mean difference: -0.65 (95%CI: - 1.49 to 0.18); p = 0.1262). However, labor was associated with increased first-attempt insertion failure and blood on sLMA surface. No reduction in oxygen saturation or pulmonary aspiration was noted. CONCLUSIONS: Although no significant increase in time to effective ventilation was noted, labor may increase the number of insertion attempts and oropharyngeal trauma with sLMA use for cesarean delivery in parturients at low risk of difficult airway. Future studies should investigate the effects of labor on LMA use in high risk parturients. TRIAL REGISTRATION: The study was prospectively registered at clinicaltrials.gov ( NCT02026882 ) on 3 January 2014.

Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial.

BACKGROUND: Avoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited. OBJECTIVE: We tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol. DESIGN: A randomised, multicentre, partially double-blinded, three-arm, parallel-group study. SETTING: Two university and two regional German hospitals, from February to October 2015. PATIENTS: A total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible. INTERVENTION: The patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia. MAIN OUTCOME MEASURES: This study was powered for the primary outcome 'time to state date of birth' and the secondary outcome 'intra-operative cough'. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery. RESULTS: The primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ±â€Š3.6, 10.1 ±â€Š4.0 and 9.8 ±â€Š5.1 min, respectively (P < 0.01). There was no difference in upper airway complications (cough and laryngospasm) across the groups, but these complications were less frequent than in previous studies. CONCLUSION: When using a remifentanil infusion for intra-operative analgesia in association with a LMA, desflurane was associated with a significantly faster emergence and noninferiority in the incidence of intra-operative cough than either sevoflurane or Propofol. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02322502; EudraCT identifier: 2014-003810-96.

Dificultades de procedimiento durante la intubación exitosa en octogenarios: un estudio prospectivo observacional / Procedural difficulties during successful intubation in octogenarians: a prospective observational study

Objetivo. Los octogenarios tienen una degradación anatómica y fisiopatológica que deriva en dificultades en el manejo de la vía aérea, específicamente en la intubación y ventilación con la mascarilla facial, que originan desaturación y/o aspiración. El objetivo de nuestro estudio fue examinar el proceso de manejo de la vía aérea con respecto a los pasos involucrados en la intubación, y cualquier desviación o retraso en las tareas. Materiales y métodos. Se realizó un estudio observacional prospectivo de vía aérea difícil en adultos mayores. Los criterios de inclusión incluyeron características de la vía aérea indicativas de vía aérea difícil, historia de intubación fallida, uso planificado de dispositivos especializados en la vía aérea y/o complicaciones previstas de la vía aérea debidas a comorbilidades. Se analizó a los pacientes mayores de 80 años. Los datos demográficos recogidos fueron: edad, peso, IMC, sexo, clasificación ASA, índices de la vía aérea, diagnóstico y procedimientos. Se analizaron los problemas de intubación (INT) (≥3 intentos de intubación), ventilación asistida laboriosa (VEN) (2 personas y/o aplicación de CPAP>20cmH2O) y complicaciones de la oxigenación (OXY) (SpO2<95%). Resultados. De los 41 pacientes incluidos en el estudio, 3 (7,3%) reflejaron los 3 supuestos: problemas (INT), laboriosidad (VEN) y desaturación (OXY); 8 (19,5%) reflejaron problemas (INT), 20 (48,8%) fueron descritos como laboriosos (VEN) y 14 (34,1%) experimentaron complicaciones de oxigenación (OXY). Conclusión. En octogenarios, encontramos una baja incidencia de dificultad de tipo INT-VEN-OXY conjunta. Sin embargo, se encontró que la ventilación con la mascarilla facial era laboriosa, con una alta incidencia de desaturación. La tasa de éxito de INT como única medida puede no describir con precisión el proceso de intubación. Nuestras recomendaciones alternativas son la selección de los dispositivos y las técnicas de vía aérea, y la necesidad de desarrollar protocolos específicos para las personas mayores (AU)

Objective. Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks. Materials and methods. An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH2O), and complications with oxygenation (OXY) (SpO2<95%) were analyzed. Results. Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY). Conclusion. In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly (AU)

A Shared Opportunity for Improving Electronic Medical Record Data.

With the recent rapid adoption of electronic medical records (EMRs), studies reporting results based on EMR data have become increasingly common. While analyzing data extracted from our EMR for a retrospective study, we identified various types of erroneous data entries. This report investigates the root causes of the incompleteness, inconsistency, and inaccuracy of the medical records analyzed in our study. While experienced health information management professionals are well aware of the many shortcomings with EMR data, the aims of this case study are to highlight the significance of the negative impact of erroneous EMR data, to provide fundamental principles for managing EMRs, and to provide recommendations to help facilitate the successful use of electronic health data, whether to inform clinical decisions or for clinical research.

¿Debería desempeñar un papel la mascarilla laríngea en la terapia electroconvulsiva? / Should the laryngeal mask airway play a role in electroconvulsive therapy?

No disponible

Biting the inflation line: an unusual case of poor sealing with Ambu® AuraGain™ / Mordiendo la línea de inflado: un caso inusual de un sellado deficiente con Ambu® AuraGain™

No disponible

Sore throat following three adult supraglottic airway devices: A randomised controlled trial.

BACKGROUND: Sore throat is a common complaint after surgery. It affects patient satisfaction and can affect activity after discharge. The supraglottic airway device (SAD) offers an alternative to traditional tracheal intubation with potential benefit in preventing sore throat. OBJECTIVE: The aim of this study was to compare the incidence of sore throat following three different SADs, the laryngeal mask airway Unique (LMA-U) and the more recent LMA Supreme (LMA-S) and the I-gel. DESIGN: A randomised single-blind controlled three parallel-group trial. SETTING: University Hospital of Nîmes, Division of Anaesthesia Intensive Care Pain and Emergency, Nîmes, France, from April 2009 to September 2012. PATIENTS: A total of 546 patients scheduled to undergo elective surgery of less than 2 h under general anaesthesia were randomly allocated to receive the LMA-U, the LMA-S or the I-gel. INTERVENTIONS: Anaesthesia was induced with propofol and sufentanil and maintained with propofol or with sevoflurane in air-oxygen. After airway device insertion, intra-cuff pressure was adjusted to less than 60 mmHg (LMA-U, LMA-S) and pressure-controlled ventilation initiated. MAIN OUTCOMES: The primary study endpoint was to compare incidence of sore throat 24 h postoperatively (H+24) following placement of the LMA-U, LMA-S and the I-gel. Secondary endpoints were clinical performance (airway leak pressure, dynamic airway compliance, complications during maintenance), ease of use (device insertion time, success on first attempt, ease of insertion and removal) and other adverse events (neck or jaw pain, dysphonia, dysphagia, nausea and vomiting). RESULTS: The authors analysed 177, 174 and 173 patients who received LMA-U, the LMA-S and the I-gel, respectively. The primary endpoint was assessed in 436 patients. In total, 104 patients (23.9%) patients reported a H+24 sore throat, with no difference between groups (P = 0.34). H+24 dysphagia with liquids was higher (P = 0.0065) with the LMA-S (12.1%) compared with LMA-U (5.3%) and I-gel (2.9%). Airway leak pressure (cmH2O) was lower (P < 0.0001) with LMA-U [21 (18 to 27)] compared with I-gel [26 (20 to 30)] and LMA-S [25 (21 to 30)]. Device insertion time (sec) was shorter (P < 0.0167) with the I-gel [30 (20 to 40)] compared with the LMA-U [34 (23 to 48)] and LMA-S [32 (22 to 50)]. CONCLUSION: The incidence of postoperative sore throat was not significantly different between the three SADs studied.

Funduplicatura de Nissen Laparoscópica con mascarilla laríngea Baska Mask® / Laparoscopic Nissen fundoplication with Baska Mask® laryngeal mask

La intubación traqueal ha sido considerada históricamente la técnica ideal en el manejo de la vía aérea en procedimientos quirúrgicos laparoscópicos. La introducción de este tipo intervenciones en los circuitos de cirugía mayor ambulatoria exige el empleo de técnicas anestésicas que ofrezcan una recuperación postoperatoria óptima y un alta precoz bajo unas condiciones de seguridad estrictas. La mascarilla laríngea se plantea como opción adecuada a la intubación traqueal, incluso en pacientes de mayor riesgo gracias a los nuevos modelos con modificaciones orientadas a mejorar sus características, lo que las convierten en dispositivos de gran proyección dentro del manejo total de la vía aérea. Presentamos el primer caso de funduplicatura de Nissen laparoscópica realizado con mascarilla laríngea Baska Mask® en un paciente con riesgo alto de regurgitación por reflujo gastroesofágico (AU)

Tracheal intubation has historically been considered the ideal technique to handle the airway in laparoscopic surgical procedures. The introduction of such procedures in ambulatory surgery requires the use of anesthetic techniques that offer optimal and early postoperative recovery under strict security conditions. Laryngeal mask is proposed as a suitable alternative to tracheal intubation, even in high risk patients due to new devices which have been modified to improve their characteristics, becoming great alternatives in the overall management of the airway. We report the first case of laparoscopic Nissen fundoplication performed with a laryngeal Baska Mask in patient with high risk of regurgitation due to its gastroesophageal reflux (AU)

¿Puede tener un papel la mascarilla laríngea en la práctica de la terapia electroconvulsiva? Un estudio piloto / Can the laryngeal mask play a role in electroconvulsive treatment? A pilot study

Introducción. Optimizar el control de la ventilación en el proceso anestésico de la terapia electroconvulsiva (TEC) puede ser una forma de mejorar la efectividad y la seguridad del tratamiento. Existen varios métodos para inducir una convulsión terapéutica adecuada en pacientes con enfermedad médica comórbida o en aquellos con elevado umbral convulsivo, aunque todos presentan alguna limitación. Un nuevo abordaje es la hiperventilación con mascarilla laríngea, que produce una mayor oxigenación e hipocapnia, disminuyendo el umbral convulsivo. Este hecho puede, hipotéticamente, servir para disminuir la energía necesaria para obtener una convulsión terapéutica adecuada. Material y métodos. Se ha realizado un estudio piloto aleatorizado y cruzado con 14 pacientes en TEC de mantenimiento, utilizando mascarilla laríngea versus mascarilla facial. Las sesiones de TEC con mascarilla facial se realizaron con la energía estándar, mientras que en las sesiones de TEC con mascarilla laríngea se disminuyó la energía en un 45%. Resultados. A pesar de la reducción del 45% en la energía aplicada con el uso de mascarilla laríngea, no se han encontrado diferencias significativas en la duración de la convulsión en ambos grupos. Conclusiones. Con estos resultados se podría proponer la ventilación con mascarilla laríngea como una alternativa para disminuir la energía aplicada sin repercutir en la duración de la crisis. Este es un estudio preliminar con una muestra pequeña, aunque abre nuevas líneas de investigación. Sería necesario aumentar la muestra y valorar otras medidas de calidad de las convulsiones en futuros estudios con el fin de estudiar sus efectos no solo en la dosis de energía necesaria, sino también en una posible mejora de la ventilación y una posible minimización de los potenciales efectos secundarios de la TEC, algo que sería relevante sobre todo en pacientes con comorbilidad médica (AU)

Introduction. Optimising ventilation control in the anaesthetic process of electroconvulsive therapy (ECT) can be a method for improving the effectiveness and safety of some treatments. There are several approaches for inducing adequate therapeutic seizures in patients with medical co-morbidity or in those with high seizure thresholds, although all of them present limitations. A new approach is hyperventilation with laryngeal mask, a method that improves oxygenation, achieves hypocapnia, and lowers seizure threshold. Thus, hyperventilation with laryngeal mask could, hypothetically, be useful to decrease the energy needed to obtain adequate therapeutic seizures. Material and methods. A randomized crossover study was conducted on 14 patients on maintenance ECT, using a laryngeal mask versus a facemask. When laryngeal masks were applied, the energy was reduced by 45% compared with the energy required when ventilated with facemasks (performed with standard dose). Results. The results of the study revealed that, despite a 45% energy reduction with laryngeal mask, there were no significant differences in seizure length in either group. Conclusions. These results prompt us to propose ventilation with laryngeal mask as an alternative to decrease energy applied without lowering seizure times. This is a preliminary study with a small sample, which opens new lines of research. Larger samples and other measurements of seizure adequacy are needed in future studies, in order to study possible improvements in ventilation and minimising adverse effects of ECT, especially in patients with medical co-morbidities (AU)

[Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine: Laryngeal mask is state of the art]. / Interdisziplinär konsentierte Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin: Larynxmaske ist State-of-the-art.

BACKGROUND: Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine. MATERIAL AND METHODS: Literature search in the database PubMed and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine levels of evidence. RESULTS: The evidence for successful application of the various types of LM is significantly higher than for LT application. Reports of smaller series of successful applications of LT are currently limited to selected research groups and centers. Insufficient evidence currently exists for the successful application of the LT especially for children below 10 kg body weight and, therefore, its routine use cannot currently be recommended. SGAs used for emergencies should have a possibility for gastric drainage. DISCUSSION: Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.

i-gel: a new supraglottic device for effective resuscitation of a very low birthweight infant with Cornelia de Lange syndrome.

Laryngeal Mask Airway (LMA) has been indicated as an effective device for airway management when face-mask ventilation and intubation have both failed in infants weighing >2000 g or delivered ≥34 weeks of gestation. All previous studies used a classic LMA. The current report describes the first case of a very low birthweight infant (1470 g, <3rd centile; 36(+3)gestational weeks) with micrognathia and palate cleft with Cornelia De Lange syndrome, resuscitated at birth with a new supraglottic airway device, i-gel size-1, positioned by a trainee paediatrician at first attempt. The procedure allowed reaching prompt effective ventilation and oxygenation of the patient, who was stabilised and intubated through i-gel.

Intubación traqueal «a ciegas» con la mascarilla air-Q ® (ILA-Cookgas). Comparación con la mascarilla laríngea de intubación ILMA-Fastrach™ / Blind tracheal intubation with the air-Q ® (ILA-Cookgas) mask. A comparison with the ILMA-Fastrach™ laryngeal intubation mask

Introducción y objetivos. El uso de los dispositivos supraglóticos en pacientes con dificultades para la intubación y/o ventilación se ha incrementado de manera progresiva tanto en el ámbito de la anestesia como en la medicina de urgencias. Este estudio se diseñó para evaluar la tasa de éxito de intubación «a ciegas» en pacientes sin criterios de vía aérea difícil con la mascarilla air-Q®, comparándola con el dispositivo supraglótico patrón: la mascarilla laríngea de intubación ILMA-Fastrach™. Pacientes y métodos. Se incluyeron 80 pacientes (40 por grupo). La inserción de los dispositivos se realizó de acuerdo con las instrucciones de los fabricantes. Tras la colocación, se realizó un test de fugas (aplicando una presión inspiratoria de 20 cmH2O por el ventilador). Se comprobó posteriormente la visión glótica usando un fibrobroncoscopio pediátrico, y se realizó la inserción de un tubo endotraqueal a través del dispositivo. En aquellos casos en que el intento resultó fallido, se retiró el dispositivo y se repitió nuevamente la secuencia. Se evaluaron, como objetivo primario, el éxito en la intubación, y como objetivos secundarios, la ventilación adecuada, el grado de visión fibrobroncoscópica y las complicaciones observadas tras su uso. Resultados. La ventilación adecuada en el primer intento de colocación fue mayor con ILMA-Fastrach™ que con air-Q® (90 frente a 60%, p = 0,0019), y el éxito global en la ventilación (primer y segundo intentos incluidos) fue mejor con ILMA-Fastrach™ (95 frente a 80%, p = 0,04). El grado de visión glótica de acuerdo con la escala de Brimacombe fue mejor con air-Q® (84,62 frente a 37,50%, p = 0,0017) en el segundo intento, pero no en el primero. No hubo diferencias en el porcentaje de intubación con ambos dispositivos. La incidencia de dolor de garganta fue similar con los 2 dispositivos empleados. Dos pacientes en el grupo de air-Q® presentaron ronquera y desaturación arterial. Conclusiones. Ambos dispositivos fueron igualmente eficaces para conseguir una adecuada intubación «a ciegas», y la incidencia de efectos adversos fue similar también con los 2. La ILMA-Fastrach™ permitió ventilar de forma adecuada a un mayor número de pacientes, pero como no se emplearon en ningún caso maniobras adicionales de recolocación, habrá que confirmar necesariamente estos resultados con futuros estudios (AU)

Background and objectives. Supraglottic airway devices are increasingly used in anesthesia and emergency medicine as a rescue for intubation and ventilation. This study was designed to investigate the air-Q® supralaryngeal device and compare it with the ILMA-Fastrach™ for airway rescue and intubation. Patients and methods. The devices were inserted in 80 patients (40 patients in each group) according to manufacturer’ instructions. An inspiration pressure of 20 cmH2O was applied through a ventilator for checking air leaks. If no air leak was detected, the glottis status was checked using a pediatric fiberoptic bronchoscope, followed by introducing an endotracheal tube through the supraglottic device. If the first attempt was unsuccessful, the device was removed and a second attempt was made in the same way. The primary outcome was the overall success rate for intubation. Other measurements were: successful ventilation, fiberoptic glottis view and adverse events. Results. Successful first-attempt ventilation was better with the Fastrach™ than with the air-Q® (90 vs. 60%, P = .0019) and overall ventilation success (first plus second attempts) was also better with ILMA-Fastrach™ (95 vs. 80%, P = .04). View of the glottis,according to Brimacombe scale, was better with air-Q® (84.62 vs. 37.50%, P = .0017) at the second, but not at the first, attempt. There were no differences in the percentage of successful intubations between the 2 devices. The incidence of sore throat was similar with both devices. Two patients in the air-Q® group suffered hoarseness and arterial desaturation, but the difference was not statistically significant. Conclusions. Both the ILMA-Fastrach™ and the air-Q® provided a similar rate of successful intubation, but ILMA-Fastrach™ was better for ventilation. The rate of adverse events was similar with both devices. Because no additional maneuver was used to facilitated intubation, there needs to be further studies to confirm these findings (AU)

Changing patterns in endotracheal intubation for anaesthesia trainees: a retrospective analysis of 80,000 cases over 10 years.

Several overseas studies have suggested that opportunities for anaesthesia trainees to learn and practise endotracheal intubation have decreased over time. We analysed the operating theatre data collection system at a large Australian metropolitan teaching hospital from 1998 to 2008 to determine if numbers for trainees' caseloads in general, and endotracheal intubation in particular had changed. The total caseload per trainee of approximately 800 cases per year was stable throughout the study period. The number of gastrointestinal endoscopies per trainee increased significantly with a corresponding decrease in the number of other cases. The mean number of endotracheal intubations per trainee per year fell by 10% and of supraglottic devices by 16%, neither of which was statistically significant. Endotracheal intubation for caesarean sections did however fall significantly from an average of nine to an average of six cases per trainee per year. Our findings contrast with other reports of much larger decreases in the number of endotracheal intubations performed by trainees over the last decade, but suggest that our local practice is similar to the international experience of decreasing opportunities for endotracheal intubation in obstetric anaesthesia.

A critique of elective pediatric supraglottic airway devices.

In 1988, when the Laryngeal Mask Airway-Classic (Intavent Orthofix, Maidenhead, UK), was introduced there were only two choices of airway management: tracheal tube or facemask. The supraglottic airway, as we now understand the term, did not exist. Yet, 20 years later, we are faced with an ever increasing choice of supraglottic airway devices (SAD). For many SADs, with the exception of the LMA-Classic and LMA-Proseal (Intavent Orthofix, Maidenhead, UK), there is a lack of high quality data of efficacy. The best evidence requires a randomized controlled trial comparing a new device against an established alternative, properly powered to detect clinically relevant differences in clinically important outcomes. Such studies in children are very rare. Safety data is even harder to establish particularly for rare events such as aspiration. Therefore, most safety data comes from extended use rather than high quality evidence which inevitably biases against newer devices. For reason of these factors, claims of efficacy and particularly safety must be interpreted cautiously. This narrative review aims to present the evidence surrounding the use of currently available pediatric SADs in routine anesthetic practice.

The laryngeal mask airway: prehospital and emergency department use.

The LMA now has a well-established role in airway management. There are several different types of LMAs to accommodate many different patient needs. The LMA has become one of the most important and versatile tools in the management of patients with difficult airways.

Éxito de inserción y ventilación con tubo versus máscara laríngea por anestesiólogos inexpertos: ensayo clínico controlado / Success of insertion and ventilation with pipe versus laryngeal(guttural) mask for anestesiólogist inexpert: clinical controlled test survey

La Máscara laríngea (ML) y el tubo laríngeo (TL) son dos de las últimas innovaciones creadas con el fin de facilitar el abordaje y la ventilación de la vía aérea Estudios evidencian menor respuesta neuroendocrina, menor trauma de las cuerdas vocales y menos cambios en la función respiratoria. Este estudio, compara el éxito de inserción y ventilación, la respuesta hemodinámica y la morbilidad postinserción entre el TL y la ML por personal inexperto. Definiéndose Éxito de inserción según el número de intentos de colocación del dispositivo y Éxito de ventilación, como la capacidad de mantener normocapnia y presiones de vía aérea menores de 30 cms de H2O. Se aleatorizaron 176 pacientes, ASA I-II, en dos grupos, siguiendo un protocolo anestésico estándar, bajo ventilación controlada. El éxito global de inserción al primer intento fue de 78,82 por cien (IC95 73-85) al segundo de 95,29 por cien, (IC 95 por cien 92-98) y al tercero de 98,24 por cien (IC 95 por cien 96-100), con un 98,83 por cien (IC 95 por cien 97 -101) para el TL y 98,23 por cien (IC 95 94 -100) para la ML, sin diferencias significativas entre los dos grupos. (p=0.546). El éxito de ventilación no presentó diferencias significativas, un 98,82 por cien para el TL y de 96,34 por cien para la ML, p=0.3616. La respuesta hemodinámica fue similar en los dos grupos encontrándose disminuciones de presión arterial entre el 0 y 20 por cien, consideradas como normales. No hubo diferencias en las presiones de la vía aérea y en la capnografía. La morbilidad fue de 9,76 por cien para ML y de 9,42 por cien para TL, p=0.922, siendo el malestar postoperatorio, la más frecuente queja.