Peri-operative brachial plexus injury following self-positioning for stereotactic radiofrequency ablation.

A 71-year-old woman with a known accessory cervical rib and distinct scoliosis was scheduled for elective, percutaneous stereotactic radiofrequency ablation of a non-resectable intrahepatic cholangiocellular carcinoma. Patient positioning and fixation using a Bluebag fixation system (Medical Intelligence, Schwabmünchen, Germany) and a dedicated adjustable armrest were customised in the patient while awake. In order to provide safe conditions for mask ventilation and tracheal intubation, the patient was returned to standard supine positioning without changing the position of the armrest. Following the induction of general anaesthesia, the patient's arm was returned to the previously defined position. Upon completion of the procedure and emergence from anaesthesia, the patient immediately reported symptoms of severe brachial plexus damage. Therefore, we suggest that awake positioning according to current recommendations does not completely preclude the possibility of neurologic injury.

Randomized crossover study assessing oropharyngeal leak pressure and fiber optic positioning : Laryngeal Mask Airway Supreme™ versus Laryngeal Tube LTS II™ size 2 in non-paralyzed anesthetized children.

BACKGROUND: As there are currently no data available comparing the practicability of the laryngeal mask airway (LMA) Supreme™ size 2 versus the laryngeal tube LTS II™ size 2 in children, this trial was conducted to quantify the differences between these two airway devices concerning leak pressure and fiber optic-controlled positioning in non-paralyzed, anesthetized pediatric patients. METHODS: A total of 56 children aged 1-6 years and weighing between 11 and 23 kg were enrolled in the study. Anesthesia was intravenously induced according to local standards using fentanyl and propofol. After induction of anesthesia both airway devices were inserted consecutively in accordance with the randomization protocol. RESULTS: The mean oropharyngeal leak pressure was significantly higher for the LTS II™ (33±8 cmH2O) than for the LMA Supreme™ (21±7 cmH2O, p < 0.0001). Fiber optic position monitoring was better when the LMA Supreme™ was used (p  < 0.001). The first attempt success rates for insertion (55Supreme LMA vs. 43LTSII, p < 0.001), the insertion time (25 s Supreme LMA vs. 34 s LTSII, p < 0.04) and the frequency of bloodstaining (0Supreme LMA vs 4LTSII, p < 0.04) for the initially used device were better for the LMA Supreme™ than the laryngeal tube LTS II™. CONCLUSION: We conclude that oropharyngeal leak pressure, fiber optic position, first attempt insertion success rate and bloodstaining differed between the LMA Supreme™ and the LTS II™ in children.

LMA ProSeal(TM) vs. i-Gel(TM) in ventilated children: a randomised, crossover study using the size 2 mask.

BACKGROUND: The Laryngeal Mask Airway (LMA) ProSeal(TM) and the i-Gel(TM) are two extraglottic devices with either an inflatable cuff or a non-inflatable cuff. AIM: We test the hypothesis that oropharyngeal leak pressure and fiberoptic position of the airway tube differ between the size 2 LMA ProSeal(TM) and the i-Gel(TM) in non-paralysed ventilated children. METHODS: Fifty-one children aged 1.5-6 years weighing 10-25 kg were studied using a crossover design. Anaesthesia was with remifentanil/propofol mixture. The LMA ProSeal(TM) and the i-Gel(TM) were inserted into each patient in random order. RESULTS: Oropharyngeal leak pressure for the LMA ProSeal(TM) and the i-Gel(TM) was similar at 22 (5) and 21 (5) cm H(2) O, respectively. Fiberoptic position of the airway tube for the LMA ProSeal(TM) and the i-Gel(TM) was similar, with the vocal cords visible from the distal airway tube in 94% and 96%, respectively. CONCLUSION: We conclude that oropharyngeal leak pressure and fiberoptic position of the airway tube are similar for the size 2 LMA ProSeal(TM) and i-Gel(TM) in non-paralysed ventilated children.

Comparison of guided insertion of the LMA ProSeal vs the i-gel.

In a randomised, non-crossover study, we tested the hypothesis that the ease of insertion using a duodenal tube guided insertion technique and the oropharyngeal leak pressure differ between the LMA ProSeal and the i-gel in non-paralysed, anesthetised female subjects. One hundred and fifty-two females aged 19-70 years were studied. Insertion success rate, insertion time and oropharyngeal leak pressure were measured. First attempt and overall insertion success were similar (LMA ProSeal, 75/76 (99%) and 76/76 (100%); i-gel 73/75 (97%) and 75 (100%), respectively). Mean (SD) insertion times were similar (LMA ProSeal, 40 (16) s; i-gel 43 (21) s). Mean oropharyngeal leak pressure was 7 cmH(2) O higher with the LMA ProSeal (p < 0.0001). Insertion of the LMA ProSeal and i-gel is similarly easy using a duodenal tube guided technique, but the LMA ProSeal forms a more effective seal for ventilation.