Comparison of the clinical performance of the i-gelTM, LMA SupremeTM, and Ambu AuraGainTM in adult patients during general anesthesia: a prospective and randomized study.

BACKGROUND: Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared. METHODS: American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed. RESULTS: Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups. CONCLUSIONS: All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.

Effects of addition of ketamine, fentanyl and saline with Propofol induction on hemodynamics and laryngeal mask airway insertion conditions in oral clonidine premedicated children.

BACKGROUND: The aim of this double-blind, prospective, randomized, controlled study was to compare the effect of addition of ketamine; fentanyl and saline with propofol anesthesia on hemodynamic profile and laryngeal mask airway (LMA) insertion conditions in oral clonidine premedicated children. METHODS: 180 children (age 2 - 10 years) were at first given oral clonidine (4 µg/kg) 90 minutes before operation, and then were randomly allocated to receive either ketamine 0.5 mg/kg (n=60), fentanyl 1 µg/kg (n=60) or 0.9% normal saline (n=60) before induction with propofol 3.0 mg/kg. Insertion of LMA was performed within 1 minute of injection of propofol. Heart rate and mean blood pressure were noted 1 min before induction (baseline), immediately after induction, before and after insertion of LMA for up to 3 min. Following LMA insertion, 6 subjective end points were noted-mouth opening, coughing, swallowing, patient's movement, laryngospasm, and ease of an insertion. LMA insertion summed score was prepared depending upon these variables. RESULTS: LMA insertion summed score was nearly similar in ketamine and fentanyl group, which were significantly better than saline group (P<0.004). Mean blood pressure and heart rate were maintained in ketamine than with fentanyl or saline group. Incidence of prolonged apnea (>120 secs.) was higher in fentanyl group compared to ketamine and saline group. CONCLUSION: Even in oral clonidine premedicated children, addition of ketamine with propofol provides hemodynamic stability and comparable conditions for LMA insertion like fentanyl propofol with significantly less prolonged apnea.

Effect of midazolam premedication on the dose of propofol for laryngeal mask airway insertion in children.

BACKGROUND: The present study was conducted on 120 pediatric patients of ASA Grade I and II of either sex aged 3-12 years scheduled for pediatric surgeries under general anaesthesia. PATIENTS #ENTITYSTARTX00026; METHODS: All patients were randomly divided into Group A and Group B. Group A was further divided into 3 subgroups of unpremedicated patients who received 3, 4 and 5 mg kg (-1) propofol only designated as A1, A2 and A3 respectively. Group B was further divided into subgroups of premedicated patients with midazolam (0.05 mg kg (-1) ) intravenous and received 3, 4 and 5 mg kg (-1) propofol designated as B1, B2 and B3 respectively. RESULTS: Results showed that increasing dose of propofol decreases the adverse events like inadequate jaw relaxation, limb movements, coughing, gagging and laryngospasm. Midazolam when added to propofol further reduces the incidence of adverse events and provides more favorable environment for insertion of LMA. At higher doses of propofol (5 mg kg (-1) ), hypotension is a major problem due to its cardiovascular depressant action. Therefore, 4 mg kg (-1) propofol along with midazolam is the optimum dose because there is more hemodynamic stability and we get better conditions for LMA insertion. CONCLUSION: Midazolam is an effective premedication in children which is synergistic with propofol and reduces its effective dose, required for LMA insertion.

Abo blood groups and completed reproductive performance of rural Haryanavi couples: analysing measures of selection intensities.

The possible differential effects of ABO blood group materno-paternal (fetal) incompatibility on completed reproductive performance were investigated on a sample of 100 couples (100 fathers and 100 mothers) from three villages in the Jind district of Haryana state, India. The average number of live births per mating couple was slightly higher for the incompatible matings (5.32) than the compatible ones (5.05). This advantage was offset by higher postnatal mortality in the former. Consequently, the average number of living children in the compatible matings (4.64) was higher than in the incompatible ones (4.18). With reference to individual ABO matings, the index of relative fertility (Irf) was the highest in A x AB followed by B x A type of incompatible matings. No decrease in live births in O x A and O x B incompatible matings was observed compared with their reciprocal compatible ones, i.e. A x O and B x O matings, as has been hypothesized in previous studies. The total pregnancy wastage was substantially higher in ABO-incompatible matings (24.59%) than compatible matings (8.45%). About 71% of the postnatal deaths took place within one year of the birth in the case of incompatible matings compared with 50% in the case of compatible matings. The study supports the hypothesis that selection is operative at the ABO locus as revealed by the measures of selection intensity. The loss of fitness in the present sample was associated with differential mortality. There were no differences in the proportions of average number of male live births in the compatible (0.55) and incompatible matings (0.58). However, in the individual mating types, there was some evidence of higher or lower proportions of male live births.