Airway Insertion Research Articles

Comparison of the ease of insertion and complications of the classical method of laryngeal mask airway insertion with an alternative method.

Laryngeal mask airway (LMA), a supraglottic device for airway management and ventilation, is used both in emergencies, out of the operating room, and in the operating room during general anesthesia. This study aims to compare the success rate and complications of the classic insertion method (with a semi-inflated cuff) and another technique using the index and middle fingers of the second hand to prevent retroversion of the mask tip (alternative method). In total, 288 patients scheduled for short-time ophthalmologic elective surgeries under general anesthesia were randomly allocated to two groups for LMA placement; group C, classical method (with semi-inflated cuff), and group A, alternative method. Difficulty in placement, insertion duration, and the number of attempts were studied. Assessment of pharyngolaryngeal complications (blinded assessor) was made at the time of LMA removal. The success rate of LMA insertion in the classic group with first, second, and third attempts were 86.3%, 93.5%, and 94.2%, respectively, whereas in the alternative group these values in the first and second attempts were 98.6% and 100%, respectively, and there was no need for the third attempt. Insertion time was not significantly different. There was no meaningful difference between the rate of the bloody streak on the mask (P = 0.37) and the incidence of sore throat (P = 0.048) in the two groups of the study. This newly introduced technique can be considered as an alternative method when a difficult insertion situation is suspected or the classic technique of insertion has failed.

Comparison of Ambu AuraGain and BlockBuster laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anesthesia: A prospective randomized controlled study.

Ambu AuraGain has proven to be better compared with other supraglottic airway devices in terms of higher first-attempt insertion success rate, time and ease of insertion, high oropharyngeal leak pressure, and fewer complications in children. The performance of the BlockBuster laryngeal mask has not been evaluated in children. The primary objective of this study was to compare the oropharyngeal leak pressure of the BlockBuster laryngeal mask with those of the Ambu AuraGain during controlled ventilation in children. Fifty children aged 6 months to 12 years with normal airways were randomized into group A (Ambu AuraGain) and group B (BlockBuster laryngeal mask). After administration of general anesthesia, an appropriate size supraglottic airway (size 1.5/2.0/2.5) was inserted according to the groups. Oropharyngeal leak pressure, success and ease of supraglottic airway insertion, gastric tube insertion, and ventilatory parameters were noted. The glottic view was graded by fiberoptic bronchoscopy. Demographic parameters were comparable. The mean oropharyngeal leak pressure in the BlockBuster group (24.72 ± 6.81 cm H2 O) was significantly higher than Ambu AuraGain group (17.20 ± 4.28 cm H2 O) by 7.52 cm H2 O (95% CI 4.27 to 10.76; p=0.001). The mean time for supraglottic airway insertion in the BlockBuster and Ambu AuraGain group was 12.04 ± 2.55 s and 13.64 ± 2.76 s, respectively (mean difference- 1.6s, 95% CI 0.09-3.12; p=0.04). Ventilatory parameters, first-attempt supraglottic airway insertion success rate, and ease of gastric tube insertion were comparable between the groups. The BlockBuster group showed easy supraglottic airway insertion compared with the Ambu AuraGain group. The BlockBuster group had better glottic views with only the larynx seen in 23 out of 25 children compared to the Ambu AuraGain with only the larynx seen in 19 out of 25 children. No complication was noted in either group. We found that the BlockBuster laryngeal mask has higher oropharyngeal leak pressure compared with Ambu AuraGain in a pediatric population.

Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia.

The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented. Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment. Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute. This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.

Comparison of Efficacy of Sevoflurane and Propofol for Insertion of Proseal Laryngeal Mask Airway in Adults

Comparison of Efficacy of Sevoflurane and Propofol for Insertion of Proseal Laryngeal Mask Airway in Adults

Usefulness of bougie-preloaded proseal laryngeal mask airway versus digital insertion technique in correct placement of the device.

Digital technique of proseal laryngeal mask airway (PLMA) insertion carries high chance of failed first attempt successful placement. We aimed to compare the number of attempts taken for correct placement of bougie-preloaded PLMA versus traditional digital insertion technique. Ease of insertion, time taken, hemodynamic responses during insertion, and evidence of trauma were also assessed. This prospective, randomized, open-label study was performed in 60 patients. All patients were administered general anesthesia according to a standardized protocol.After induction of general anesthesia in group P, proseal insertion was performed following the traditional digital technique. In group B, bougie-preloaded PLMA was used. A soft gum elastic bougie was passed through the gastric channel of PLMA, with 15cm protruding distally through the gastric port. Attempts at successful insertion and ease of insertion were noted. Time taken for successful insertion was significantly shorter in group B compared to group P (15.3 ± 4.5 vs. 57 ± 12.02 s, respectively). The first attempt success in group B was 90% versus 60% in group P. The number of moderate to hard insertion was significantly lesser in group B (10 vs. 40, respectively). Blood stain on device was seen in 3.3% in group B compared to 30% in group P. MAP at insertion and at 1, 3, and 5 min was significantly higher in group P. Heart rates were comparable. Bougie-preloaded proseal insertion has significantly higher first attempt insertion success rates and is significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

No: 8411 Comparison of the effects of adding dexmedetomidine to anesthesia induction with propofol or thiopental on classic laryngeal mask airway insertion success

No: 8411 Comparison of the effects of adding dexmedetomidine to anesthesia induction with propofol or thiopental on classic laryngeal mask airway insertion success

A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation

Introduction While various supraglottic airway devices are available for use during out-of-hospital cardiac arrest (OHCA) resuscitation, comparisons of patient outcomes by device are limited. In this study, we aimed to compare outcomes of OHCA patients who had airway management by emergency medical services (EMS) with the iGel or King-LT. Methods We used the 2018-2021 ESO Data Collaborative public use research datasets for this retrospective study. All patients with non-traumatic OHCA who had iGels or King-LTs inserted by EMS were included. Our primary outcome was survival to discharge to home, and secondary outcomes included first-pass success, return of spontaneous circulation (ROSC), and prehospital rearrest. We examined the association between airway device and each outcome using two-level mixed effects logistic regression with EMS agency as the random effect, adjusted for standard Utstein variables and failed intubation prior to supraglottic airway insertion. Average treatment effects were calculated through propensity score matching. Results A total of 286,192 OHCA patients were screened, resulting in 93,866 patients eligible for inclusion in this analysis. A total of 9,456 transported patients (59.8% iGel) had associated hospital disposition data. Use of the iGel was associated with greater survival to discharge to home (aOR:1.36 [1.06, 1.76]; ATE: 2.2%[+0.5, +3.8]; n = 7,576), first pass airway success (aOR:1.94 [1.79, 2.09]; n = 73,658), and ROSC (aOR:1.19 [1.13, 1.26]; n = 73,207) in comparison to airway management with the King-LT. iGel use was associated with lower odds of experiencing a rearrest (aOR:0.73 [0.67, 0.79]; n = 20,776). Among patients who received a supraglottic device as a primary airway, use of the iGel was not associated with significantly greater survival to discharge to home (aOR:1.26 [0.95, 1.68]). Among patients who received a supraglottic device as a rescue airway following failed intubation, use of the iGel was associated with greater odds of survival to discharge to home (aOR:2.16 [1.15, 4.04]). Conclusion In this dataset, use of the iGel during adult OHCA resuscitation was associated overall with better outcomes compared to use of the King-LT. Subgroup analyses suggested that use of the iGel was associated with greater odds of achieving the primary outcome than the King-LT when used as a rescue device but not when used as the primary airway management device.

LMA Protector ve Baska Maskın Retrograd Üreteroskopik Cerrahide Karşılaştırılması: Prospektif Randomize Klinik Çalışma

Objective: The Baska and the Protector Laryngeal masks are single-use second-generation supraglottic airway devices with a dual gastric channel. Material and Methods: 64 American Society of Anesthesiologists physical status 1-2 patients between the ages of 18-70 undergoing retrograde ureteroscopic surgery enrolled in this prospective randomized study. Results: Demographic airway variables and airway characteristics were similar between the groups. Insertion time was shorter in the Baska mask group [14 (11-20) versus 20 (13-27) seconds, p=0.035]. The need for optimization maneuvers during insertion was higher for the Baska mask group (p=0.009). The laryngeal mask airway (LMA) insertion was easier in the LMA Protector group (p=0.023). The first insertion success rate was 75% for the LMA Protector and 84% in the Baska mask. The total success rate of both devices was 91%. Nasogastric tube insertion was faster in the Baska mask group [14 (12-15) versus 17 (13-25) seconds; p=0.003]. Fiberoptic views were similar between the groups. Minute volume after insertion of the device was higher in the LMA Protector group [8 (6.5-10) L/min versus 6 (5-7) L/min; p<0.001]. Expiratory tidal volume was higher in the LMA Protector group after insertion of the device, 15 minutes, 30 minutes, and 45 minutes after insertion (p<0.001, p=0.032, p=0.001, p=0.027 respectively). The end-tidal sevoflurane concentration (ETsevo) 30 minutes after device insertion was higher in the Baska mask group (1.49±0.38 vs 1.75±0.36; p=0.014). Conclusion: The LMA Protector is superior to the Baska mask in providing higher tidal volumes and decreased need for optimization maneuvers in retrograde ureteroscopic surgery.

Comparison of high-flow nasal cannula and conventional nasal cannula during sedation for endoscopic submucosal dissection: a retrospective study.

The high-flow nasal cannula (HFNC) is a relatively recent method that provides high-flow, heated, humidified gas delivery. We compared HFNC (group HF) and conventional nasal cannula (NC) (group CO) during deep sedation with propofol and remifentanil for endoscopic submucosal dissection (ESD). Single-center, retrospective observational cohort study. In this study, a total of 159 cases were analyzed (group CO, 71 and group HF, 88). We collected the data from electronic medical records from September 2020 to June 2021. The lowest oxygen saturation (SpO2), incidence of hypoxia (SpO2 < 90%), rescue interventions, and adverse events between the two groups were investigated. There were significant differences between the two groups in lowest SpO2 and incidence of hypoxia [group CO versus group HF; 90.3 ± 9.7% versus 95.7 ± 9.0%, 25 (35.2%) versus 10 (11.4%); p < 0.001, p < 0.001; respectively]. Among the rescue interventions, the number of jaw thrust, patient stimulation, O2 flow increase, and nasal airway insertion were significantly higher in the CO group than in the HF group. However, postprocedural chest X-ray showed higher rates of abnormal findings (atelectasis, aspiration, and pneumoperitoneum) in group HF than in group CO [group CO: 8 (11.3%) versus group HF: 26 (29.5%), p = 0.005]. In multivariable analysis, besides group CO, difficult type of lesion was the risk factor for hypoxia. Compared to the conventional NC, HFNC provided adequate oxygenation and a stable procedure without significant adverse events during sedation for ESD. However, caution is needed to avoid complications associated with deep sedation and difficult type of lesions.

Comparison of two techniques of laryngeal mask airway insertion – is reverse technique better than standard?

Background: Standard technique of Laryngeal Mask Airway (LMA) insertion has been routinely and successfully employed in adults. This technique has failed in certain instances prompting evaluation of alternative techniques. ‘Reverse technique’ is one which is studied and employed successfully in paediatric population. However, this has not been widely studied in adults. Materials and methods: In this randomised, prospective, single blinded study, we compared the standard technique and reverse technique of LMA insertion with respect to success rate, time taken for successful insertion, confirming the final position of LMA by performing a fibreoptic evaluation of the glottic view and incidence of postoperative sore throat in 60 adult patients undergoing surgery under general anaesthesia. Statistical analysis used: Using SPSS 11.5TM software, Independent samples’ test and Chi-square test was applied to the results where appropriate. A p value of &lt; 0.05 was considered as statistically significant. Results: LMA insertion was successful in all patients using standard technique and all but one patient using reverse technique. Insertion was complete with in 30 seconds with the longest being 24.08 seconds in reverse technique group. Grade 1 or 2 glottic view on fibrescopy was obtained in 90.3% patients in the standard technique group as against 100% patients in reverse technique group. There was no significant difference in immediate or delayed incidence of sore throat. Conclusions: Reverse technique of LMA insertion has a comparable success rate with the standard technique in adult patients undergoing general anaesthesia.

To Compare the Intravenous Bolus Dose of Propofol With an Equipotent Dose of Intravenous Thiopentone for the Facilitation of Laryngeal Mask Airway Insertion.

Objectives Insertion of laryngeal mask airway has been facilitated by using a variety of induction agents and their combinations with minimal side effects. The current prospective study is a randomized, double-blind study conducted using induction agents, namely, propofol and its equipotent dose of thiopentone, for laryngeal mask airway insertion, and to compare their side effects in patients undergoing minor surgeries requiring general anaesthesia. Methods This prospective study was carried out at the Anaesthesiology and Critical Care Department of Gauhati Medical College and Hospital (GMCH), Assam, India. The randomized, double-blinded study comprised 80 patients aged 18 to 60 years undergoing minor surgeries (≤45 minutes) under general anaesthesia fitting into the American Society of Anesthesiologists (ASA) physical status I and II and Mallampati score (MPS) 1 and 2. The participants were randomly divided into two groups in a 1:1 ratio. Group A (n= 40) received propofol(2.5 mg/kg), while group B (n = 40) received thiopentone(5 mg/kg) injections for induction of anaesthesia. Pre-medication with midazolam (0.04 mg/kg)injectionand fentanyl (1.5 mcg/kg) injectionwas provided to patients in both groups. Post-laryngeal mask airway insertion, parameters like conditions for insertion, time taken for laryngeal mask airway insertion, overall response,and haemodynamic parameters were recorded. The data analysis was executed using equivalence tests considering a two-sided p< 0.05 as significant. Results Group Ahad a higher and statistically significant ease of insertion (p = 0.029). The mean insertion time was notably different between the two groups (p < 0.001). The difference in the overall response to insertion showed no statistical significance in the two groups. Statistically, a significant difference was found in falls in heart rate and various blood pressure levels between the groups (p < 0.001). Conclusion Propofol at a rate of 2.5 mg/kg was found to be superior to thiopentone at a rate of 5 mg/kg as far as suppression of upper airway reflexes in laryngeal mask airway insertion.

Abstract 226: Long-term Trajectory Of Neurologic Outcome After Severe Traumatic Brain Injury

Objective : Little is known about the time-based trajectories of neurologic recovery after traumatic brain injury (TBI). We sought to determine long-term changes in neurologic status after TBI. Methods: Data source: Resuscitation Outcomes Consortium Hypertonic Saline TBI Trial. Included: adult TBI, GCS≤8; Excluded: shock (SBP≤70, or SBP 71-90 with HR≥108). Primary outcome: Glasgow Outcome Scale-Extended (GOS-E; 1=dead, 8=no disability) determined at: a) hospital discharge and b) 6-months. We analyzed changes in GOS-E between hospital discharge and 6-months using Sankey graphs and the Wilcoxon signed-rank test. We repeated the analysis for the high acuity subset of patients undergoing EMS advanced airway insertion. Results: Among 1,282 TBI, GOS-E at discharge was: dead (GOS-E 1) n=321 (25.0%), unfavorable (2-4) n=664 (51.8%), favorable (5-8) n=220 (17.2%), missing n=77 (6.0%; Figure). GOS-E at 6-months was: dead n=346 (27.0%), unfavorable n=282 (22.0%), favorable n=459 (35.8%), missing n=195 (15.2%). While 7 of 220 (3.2%) with favorable GOS-E at discharge worsened at 6 months (unfavorable or died), 300 of 664 (45.2%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p&lt;0.0001). In the EMS advanced airway subset (n=774), 2 of 96 (7.1%) with favorable GOS-E at discharge worsened to unfavorable (or were dead) at 6 months, while 208 of 433 (48.0%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p&lt;0.0001). Conclusion: Among patients with TBI and unfavorable neurologic status at hospital discharge, almost half will progress to favorable neurologic status at 6 months. Very few TBI victims die or worsen to unfavorable neurologic status by the time of 6-month follow-up. Thus, assessment of long-term neurologic outcome should be considered for studies of TBI.

Effect of Propofol Alone and Propofol+Muscle Relaxant Combination on Laryngeal Mask Airway Insertion and Hemodynamic Parameters During Anesthesia Induction: A Randomized Clinical Trial

Background: Successful insertion of a laryngeal mask airway (LMA) requires deep anesthesia, the proper opening of the mouth, and adequate suppression of upper airway reflexes. Propofol injection can effectively reduce laryngeal reflexes. This study aimed to compare the effectiveness of propofol alone versus propofol plus a muscle relaxant on LMA insertion and hemodynamic parameters during the induction of anesthesia. Methods: This randomized, double-blind clinical study was performed on 70 patients in the age range of 18-65 years who were candidates for surgery in the operating room of Shahid Mohammadi Hospital in Bandar Abbas, Iran in 2020. The patients were randomly divided into two groups of 35. The first group received propofol and normal saline, and the second group received propofol plus cisatracurium. The parameters of ease of LMA insertion, jaw opening, cough and gag reflexes, head and limb movement, laryngospasm, and hemodynamic changes were recorded for investigation. Results: The patients were almost matched in terms of demographic variables. No significant difference was found regarding the ease of LMA insertion and hemodynamic parameters. However, the overall score of ease of LMA insertion was considerably higher in the propofol plus muscle relaxant group (P=0.029). The extubation time was significantly shorter (P&lt;0.001) and the surgery duration was considerably longer (P=0.019) in the propofol plus muscle relaxant group. Conclusion: The findings demonstrated that both techniques were suitable for LMA insertion, and no significant hemodynamic changes were found between the two groups. However, the administration of propofol plus a muscle relaxant was more suitable due to ease of LMA insertion and shorter extubation time.

Comparison of laryngeal mask airway (LMA) insertion with and without muscle relaxant in pediatric anesthesia; a randomized clinical trial

IntroductionThis study aimed to evaluate the effectiveness of using muscle relaxant on the ease of laryngeal mask airway (LMA) insertion and possibility of its related complications. MethodsThis double-blind, randomized clinical trial was performed on 60 children aged 1–4 years with ASA (American Society of Anesthesiology) I or II with upper limb injuries who were candidates for surgery. The patients were randomly allocated to the two groups receiving atracurium group as muscle relaxant (MR) or saline group (S). ResultsRegarding ease of placement, the LMA was inserted in 66.7% and 63.3% of patients straightforwardly in the MR and S groups, respectively. While it was performed with one maneuver in 23.3% and 26.7% of cases in the MR and S groups, respectively (p = 0.955). Moreover, LMA dislodgment in the two groups was 36.7% in the MR group and 20.0% in the S group without a meaningful difference (P = 0.152). The only complication observed in the two groups was laryngospasm, which occurred in 0.10% and 13.3% in the MR and S groups, respectively (p = 0.688). ConclusionIn some pediatric anesthesia, the use of atracurium, as a muscle relaxant had no significant effect on capability of LMA insertion, maintaining airway patency, LMA seal pressure and oxygenation variations. Moreover, it did not have a preventive effect on the occurrence of complications such as laryngospasm.

The Perfusion Index of the Ear as a Predictor of Hypotension Following the Induction of Anesthesia in Patients with Hypertension: A Prospective Observational Study.

Patients with hypertension develop hemodynamic instability more frequently during anesthesia-particularly post-induction. Therefore, different monitoring methods may be required in patients with hypertension. Perfusion index-the ratio of the pulsatile blood flow to the non-pulsatile static blood flow in a patient's peripheral tissues, such as the fingers or ears-can show the hemodynamic status of the patient in a non-invasive way. Among the sites used for measuring the perfusion index, it is assumed that the ear is more reliable than the finger for hemodynamic monitoring, because proximity to the brain ensures appropriate perfusion. We hypothesized that the low value of preoperative ear PI could be a predictor of post-induction hypotension in patients with hypertension. Thirty patients with hypertension were enrolled. The perfusion index and pleth variability index were measured using the ear, finger, and blood pressure, and heart rate was recorded to monitor hypotension. After insertion of the supraglottic airway, 20 patients developed post-induction hypotension. Those who developed hypotension showed a significantly lower preoperative perfusion index of the ear. The preoperative perfusion index of the ear could predict post-induction hypotension in patients with hypertension.

Predictors of neurological outcome after out-of-hospital cardiac arrest: sex-based analysis: do males derive greater benefit from hypothermia management than females?

BackgroundPrevious studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA.MethodsRetrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011–2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome.ResultsIn total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100–120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females.ConclusionsMales had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.

Comparison of the clinical performance of I-Gel and ambu aura gain-supra-glottic airway devices in paediatric patients under controlled ventilation

: I-Gel and Ambu Aura Gain are two novel second generation supra-glottic airway devices available for airway management and can be used safely and effectively in paediatric patients under controlled ventilation with adequate airway seal. The aim of our study was to compare efficacy of I-Gel and Ambu Aura Gain in providing safe and adequate airway seal in paediatric patients under controlled ventilation. A prospective, randomized, single blind clinical study was carried out on total 60 paediatric patients with ASA grade I &amp; II, 3-10 years age, undergoing surgery under general anaesthesia. The patients were randomly assigned into Group I (I-Gel) (n=30) and Group-A (Ambu Aura Gain) (n=30) using randomizer software. I-Gel was inserted using “finger technique” and Ambu Aura Gain with simple insertion technique. We assessed effective airway insertion time, time required for insertion of the device, ease and number of attempts for airway and gastric tube insertion, oropharyngeal leak pressure, haemodynamic parameters and complications. Statistical analysis was done using the MedCalc software, student’s paired t- test, unpaired t-test and chi-square test. Effective airway insertion time (p=0.1671), ease and numer of airway insertion attempts were comparable amongst both groups. Oropharyngeal leak pressure was significantly higher in group I (22.366±1.4735 of H2O) than in group A (20.8±1.01 cm of H2O), p value = 0.0001. Airway seal of Ambu Aura Gain is lesser compared to I-Gel. I-Gel can be used with better safety and efficacy for controlled ventilation in paediatric patients. I-Gel provides higher oropharyngeal seal pressure, which gives higher safety against risk of aspiration and air leak than Ambu Aura Gain, yet oropharyngeal seal pressure of Ambu Aura Gain is adequate that it allows its use during controlled ventilation under general anaesthesia. Hence, both devices can be used alternatively.

LARYNGEAL MASK AIRWAY INSERTION: COMPARISON OF SEVOFLURANE WITH PROPOFOL IN ADULTS

Methods: A cross-sectional observational study was conducted on patients scheduled for vascular, reconstructive, gynaecological, and day care surgeries for whom propofol (P) and sevoflurane (S) were used as induction agent for LMA insertion. All patients who fulfilled the inclusion and exclusion criteria and had given propofol or sevoflurane at various departments during the specified duration were included in the study and data were collected using pre-defined protocol. A total of 100 consecutive patients (50 patients in each group) were included in the study. Objectives: The objectives of the study were to evaluate and compare sevoflurane in one vital capacity breath with propofol in dose of 2 mg/kg for ease of laryngeal mask airway (LMA) insertion in adults. Results: The mean age for sevoflurane (S) group and propofol (P) group was 35.30, standard deviation (SD) 8.74 and 34.88, SD 9.37, respectively. Heart rate (HR) at 2 min, 3 min, and 4 min after induction showed a fall with propofol which was statistically significant. There was statistically significant difference in systolic blood pressure at on 1 min, 2 min, 3 min, and 4 min when compared between the two groups. A statistically significant fall in the systolic blood pressure in Group P was noted when compared to Group S. There was statistically significant difference in diastolic blood pressure at 4 min when compared between the two groups. A fall in the diastolic blood pressure in Group P was noted when compared to Group S at 4 min. There was fall in blood pressure in Group P when compared with Group S and this was significant. Fall in oxygen saturation in 3 and 4 min was significant. However, this fall was not clinically significant, as the values remained above 94%. There was increase in end-tidal carbon dioxide in 1, 2, 3, and 4 min and was statistically significant between the two groups. Sevoflurane took longer time for induction and LMA insertion. Loss of eye lash reflex, jaw relaxation, and LMA insertion were lost earlier with propofol and were statistically significant. The overall LMA insertion was excellent with propofol in 50 patients and with sevoflurane 48 patients had excellent condition and two were satisfactory. Conclusion: In our study, sevoflurane was associated with good hemodynamic stability, but quality of anesthesia provided with propofol was superior. Delayed jaw relaxation with sevoflurane when compared to propofol delayed LMA insertion. The overall insertion was excellent with propofol with all 50 patients as compared to sevoflurane.

The effect of remifentanil on hemodynamic response to laryngeal mask airway insertion in induction of anesthesia with propofol fentanyl or propofol ketamine in cataract surgery

Background. Induction of general anesthesia may cause hemodynamic instability. Remifentanil is often prescribed to suppress the hemodynamic response to anesthesia. The aim of this study was to investigate the effect of remifentanil on hemodynamic response to induction of anesthesia with propofol fentanyl or propofol ketamine and laryngeal mask airway (LMA) insertion. Methods. This double-blind randomized clinical trial study was performed on 44 candidates for cataract surgery in Feyz Hospital, Isfahan, Iran from March to June 2020. Patients were randomly assigned into two groups using random allocation software. The first group received 1 mcg/kg fentanyl and the second group received 0.5 mg/kg ketamine. Also, both groups received 1 mg/kg propofol and 0.5 mcg/kg remifentanil intravenously. Hemodynamic parameters were measured and recorded at study times, and the results were analyzed statistically. Results. The mean age (P=0.199), weight (P=0.050), height (P=0.9), and frequency distribution of gender (0.763) and American Society of Anesthesiologists (ASA) score (0.069) were not significantly different between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in fentanyl group were significantly lower than the ketamine group immediately before LMA insertion, as well as 1, 3, and 5 minutes after LMA insertion (P &lt;0.050). In addition, the mean heart rate (HR) in the fentanyl group decreased significantly at different time (P&lt;0.001), but no significant difference was observed in ketamine group (P=0.056). In addition, the mean HR did not differ significantly between the two groups in any of the follow-up times (P&gt;0.050). Conclusion. Intravenous administration of remifentanil in induction of anesthesia with propofol-ketamine and propofol-fentanyl reduced changes in hemodynamic responses to LMA insertion. This hemodynamic stability was increased by adding remifentanil to the propofol-ketamine combination. Practical Implications. Remifentanil is associated with weakening of hemodynamic responses to LMA insertion in induction of anesthesia with propofol and ketamine or propofol and fentanyl; this effect can be associated with safety in cardiac patients.

Ventilatory Strategy to Prevent Atelectasis During Bronchoscopy Under General Anesthesia: A Multicenter Randomized Controlled Trial (Ventilatory Strategy to Prevent Atelectasis -VESPA- Trial)

Atelectasis negatively influences peripheral bronchoscopy, increasing CT scan-body divergence, obscuring targets, and creating false-positive radial-probe endobronchial ultrasound (RP-EBUS) images. Can a ventilatory strategy reduce the incidence of atelectasis during bronchoscopy under general anesthesia? Randomized controlled study (1:1) in which patients undergoing bronchoscopy were randomized to receive standard ventilation (laryngeal mask airway, 100%Fio2, zero positive end-expiratory pressure [PEEP]) vsa ventilatory strategy to prevent atelectasis (VESPA) with endotracheal intubation followed by a recruitment maneuver, Fio2 titration (< 100%), and PEEP of 8 to 10cm H2O. All patients underwent chest CT imaging and a survey for atelectasis with RP-EBUS bilaterally on bronchial segments 6, 9, and 10 after artificial airway insertion (time 1) and 20 to 30min later (time 2). Chest CT scans were reviewed by a blinded chest radiologist. RP-EBUS images were assessed by three independent, blinded readers. The primary end point was the proportion of patients with any atelectasis (either unilateral or bilateral) at time 2 according to chest CT scan findings. Seventy-six patients were analyzed, 38 in each group. The proportion of patients with any atelectasis according to chest CT scan at time 2 was 84.2%(95%CI, 72.6%-95.8%) in the control group and 28.9%(95%CI, 15.4%-45.9%) in the VESPA group (P< .0001). The proportion of patients with bilateral atelectasis at time 2 was 71.1%(95%CI, 56.6%-85.5%) in the control group and 7.9%(95%CI, 1.7%-21.4%) in the VESPA group (P< .0001). At time 2, 3.84 ± 1.67 (mean ± SD) bronchial segments in the control group vs1.21 ± 1.63 in the VESPA group were deemed atelectatic (P< .0001). No differences were found in the rate of complications. VESPA significantly reduced the incidence of atelectasis, was well tolerated, and showed a sustained effect over time despite bronchoscopic nodal staging maneuvers. VESPA should be considered for bronchoscopy when atelectasis is to be avoided. ClinicalTrials.gov; No.: NCT04311723; URL: www. gov.