Ease Of Insertion Research Articles

Survey on Patient Satisfaction with the Usability and Formulation of Budesonide Rectal Foam Following a Change in Head and Applicator Shape and Properties

Budesonide Rectal Foam (BF) was introduced in 2017 and changed in November 2022 upon request, addressing the challenges encountered with liquid rectal formulations indicated for ulcerative colitis (UC). This formulation is an important agent in the treatment of rectal to sigmoid colon lesions in moderate UC. As the characteristics of the formulation of the rectal formulation are thought to influence patient satisfaction, a survey was conducted on the formulation and patient satisfaction among patients who used BF before and after the change. The survey spanned from January 2023 to May 2023. As the primary endpoint, the same patients were evaluated on the Visual Analogue Scale (VAS) for patient satisfaction. Significant variations in formulation usability and patient satisfaction were observed in 20 eligible patients before and after the change (p<0.05). Patient satisfaction with the formulation was strongly correlated with formulation usability, ease of pushing the head, and ease of insertion (r>0.7). The change in packaging was thought to improve the usability of the formulation and patient satisfaction. The formulation's usability and ease of insertion had a clear influence on satisfaction with the rectal formulation.

COMPARISON OF USING J TIP GUIDE WIRE VS STRAIGHT TIP GUIDE WIRE DURING PUNCTURE AND TRACT FORMATION IN PCNL

Percutaneous nephrolithotomy (PCNL) is a widely used surgical technique for removing large or complex kidney stones. The choice of guide wire during puncture and tract formation may influence the procedure's ease, safety, and success. Objective: This study aimed to compare J-tip guide wire versus straight-tip guide wire during puncture and tract formation in PCNL, focusing on ease of use, safety, and clinical outcomes. Methods: A comparative study was conducted at CMH, Lahore, from April 2024 to July 2024. A total of 89 patients were randomly assigned into two groups: Group A, using the J tip guide wire (n=45), and Group B, using the straight tip guide wire (n=44). Data were collected on ease of insertion, complication rates, procedural duration, and success rates. Statistical analysis was performed using SPSS software, with p&lt;0.05 considered statistically significant. Results: The average age of patients in Group A was 52.3 ± 10.4 years and in Group B, 50.7 ± 11.2 years. Group A demonstrated significantly better ease of insertion with a mean score of 8.7 ± 0.9 compared to 7.5 ± 1.2 in Group B (p=0.003). Complication rates were lower in Group A (4.4%) versus Group B (22.7%, p=0.024), with fewer minor traumas (4.4% vs. 15.9%, p=0.048). The procedure duration was shorter in Group A (25.4 ± 5.1 minutes) compared to Group B (30.2 ± 6.3 minutes, p=0.001). The success rate was higher in Group A (97.8% vs. 90.9%), although this difference was not statistically significant (p=0.092). Conclusion: The J tip guide wire shows significant advantages over the straight tip guide wire in PCNL procedures, offering improved ease of use, reduced complication rates, and shorter procedural duration. These findings suggest that the J tip guide wire is valuable for enhancing PCNL outcomes.

Clinical Performance Evaluation of Ambu AuraGain versus I-gel in Obese Female Patients Undergoing Short-duration Surgeries for Breast Cancer: A Randomised Controlled Trial

Background and Aims: Supraglottic airway devices (SADs) secure and maintain airways in patients undergoing breast cancer surgery. I-gel and Ambu AuraGain (AAG) are two common second-generation SADs used. However, data comparing their efficacy are limited in adult obese breast cancer patients. This study was planned with the primary objective of comparing the oropharyngeal leak pressure (OLP) of these two SADs at 1 min after insertion. Methods: A total of 80 patients scheduled for breast cancer surgery were recruited and randomised into two groups: Group A (AAG) and Group I (I-gel). The insertion time of the SADs, the number of insertion attempts, the OLP at 1 min after insertion, the ease of insertion, the fibre-optic bronchoscopy view (FOB), the ease of suction catheter placement, additional manipulation during insertion and maintenance, the OLP at 30 min after insertion and complications, etc., were assessed. Results: OLP was significantly higher (P &lt; 0.05) in Group I compared to Group A at 1 min and 30 min after the SAD placement. Ease of insertion and FOB view score were significantly better in Group I than in Group A (P &lt; 0.05). Moreover, patients in Group A reported a higher incidence of sore throat compared to Group I patients (P &lt; 0.05). Conclusion: The I-gel demonstrated superior sealing pressures and mitigated sore throat significantly compared to the AAG in obese female patients undergoing breast cancer surgery. Furthermore, as confirmed by FOB, its enhanced perilaryngeal positioning underscores its efficacy over the AAG in this patient demographic.

In vitro evaluation of the biocompatibility and bioactivity of a SLM-fabricated NiTi alloy with superior tensile property

Because nickel-titanium (NiTi) alloys have unique functions, such as superelasticity, shape memory, and hysteresis similar to bone in the loading-unloading cycles of their recoverable deformations. They likely offer good bone integration, a low loosening rate, individual customization, and ease of insertion. Due to the poor processability of NITI, traditional methods cannot manufacture NiTi products with complex shapes. Orthopedic NiTi implants need to show an adequate fracture elongation of at least 8%. Additive manufacturing can be used to prepare NiTi implants with complex structures and tunable porosity. However, as previously reported, additively manufactured NiTi alloys could only exhibit a maximum tensile fracture strain of 7%. In new reports, a selective laser melting (SLM)–NiTi alloy has shown greater tensile strain (15.6%). Nevertheless, due to the unique microstructure of additive manufacturing NiTi that differs from traditional NITI, the biocompatibility of SLM-NITI manufactured by this new process requires further evaluation In this study, the effects of the improved NiTi alloy on bone marrow mesenchymal stem cell (BMSC) proliferation, adhesion, and cell viability were investigated via in vitro studies. A commercial Ti-6Al-4V alloy was studied side-by-side for comparison. Like the Ti-6Al-4V alloy, the SLM-NiTi alloy exhibited low cytotoxicity toward BMSCs and similar effect on cell adhesion or cell viability. This study demonstrates that the new SLM-NiTi alloy, which has exhibited improved mechanical properties, also displays excellent biocompatibility. Therefore, this alloy may be a superior implant material in biomedical implantation.Graphical

Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review.

Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons' confidence in their use.

Exploring Menstrual Hygiene Practices and Awareness of Menstrual Cups Among Nursing Professionals: A Cross-Sectional Survey.

Menstrual hygiene management poses significant challenges globally, with widespread reliance on disposable sanitary pads contributing to health risks and environmental degradation. Sustainable alternatives like menstrual cups offer promising solutions but face barriers to adoption, including myths and misconceptions. Educational interventions are crucial in promoting eco-friendly menstrual hygiene practices. A descriptive cross-sectional survey was conducted at All India Institute of Medical Sciences (AIIMS), Nagpur (Central India) among nursing officers from January to February 2022. A structured questionnaire assessed the demographic characteristics, menstrual hygiene practices, knowledge of menstrual cups, and attitude towardtheir use. Of the 101 participants, the majority were between the age group of 25 and 40 years (71, 70.3%) and were educated up to a Bachelor of Science degree in nursing (79, 78.21%). Overwhelmingly, 97 (96.03%) of the nursing officers used non-biodegradable sanitary pads. Frequent need to change and staining were cited as common difficulties. Although 97 (96.04%) of the participants had heard ofmenstrual cups, knowledge gaps existed regarding suitability for nulliparous women, material composition, cost, and lifespan. Despite expressing a desire for better alternatives by 56 (55.4%) participants, only one (0.99%) reported current menstrual cup usage, with 60 (59.4%) participants indicating future readiness to use. Discovering nurses' menstrual hygiene habits, this study sheds light on their reliance on disposable pads over menstrual cups. Improving the acceptability of menstrual cups hinges on addressing current knowledge gaps such as their feasibility for use by nulliparous women, ease of insertion, cost, and environmental sustainability. Despite hurdles like misinformation, participants show openness to embracing new options with the right guidance and education.

To Evaluate the Impact of Pneumoperitoneum on Oropharyngeal Seal Pressure of Proseal™ LMA and Baska™ mask in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract Background: Newer supraglottic airway devices (SGADs) are becoming more and more popular as a means of maintaining the airway during laparoscopic procedures. The present study’s aim was to compare the impact of pneumoperitoneum on the oropharyngeal seal pressure (OPSP) of Proseal™ laryngeal mask airway (PLMA) and Baska™ Mask (BM) in patients undergoing laparoscopic cholecystectomy. Methods: We enrolled 60 American Society of Anesthesiologists physical Status I and II patients and randomised to either the PLMA group or the BM group. After induction of anaesthesia using a standardised protocol, one of the SGADs was inserted. The primary outcome was the effect of pneumoperitoneum on the OPSP of the two devices. The secondary outcomes were the time required for insertion of the airway devices, OPSP, fibre-optic view of the vocal cord, ease of insertion and any laryngopharyngeal morbidity. Results: The demographic parameters were comparable between the study groups. The insertion time was 18.034 ± 7.73 and 18.7 ± 6.96 s for the PLMA group and BM group, respectively (P = 0.7255). The OPSP in each group was not significantly impacted by pneumoperitoneum, although it remained the same throughout the procedure. Compared to the PLMA group, OPSP was higher in the BM group at all three time intervals (5 min after the insertion of the device [T1], 10 min after pneumoperitoneum [T2] and 5 min after the revoking of pneumoperitoneum [T3]). Conclusion: Pneumoperitoneum had no effect on OPSP in either group. Significantly higher OPSP was noted in the BM group (both before and following pneumoperitoneum) compared to the PLMA group.

Implant Guide X - An Extraoral Guide for Optimal Implant Placement in Orthodontics

Orthodontic mini-screws provide absolute skeletal anchorage and can be placed in various sites according to needs. The advantage of these implants is their ease of insertion and removal, as well as the ability to immediately withstand forces. Placing mini-screws too close to the root surface can result in insufficient bone remodeling due to occlusal forces transmitted through the teeth to the implant, leading to implant failure. The conventional method of placing interradicular implants often led to incorrect positioning, causing perforation of the dental root and subsequent loss of vitality, osteosclerosis, and dentoalveolar ankylosis. To address these issues, numerous intra-oral implant placement guides have been developed. In our study, we developed a prototype of an extra-oral detachable metal mesh grid that can be attached to the parallelogram x-ray positioner (RIN XCP). This prototype promises increased accuracy and utility in implant placement.

Clinical Performance of I-gel® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison.

Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.

Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial.

Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.

Stabilised Hyaluronic Acid (sHA) gel as a novel marker for breast cancer tumour bed cavity: Surgical feasibility

IntroductionConsistent delineation of the breast conserving surgery (BCS) tumour bed (TB) for breast cancer remains a challenge for radiation oncologists. Accurate delineation allows for better local control and reduces toxicity when planning partial breast or TB boost radiation therapy (RT). MethodsIn the operating theatre (OT) breast surgeons inserted stabilised hyaluronic acid (sHA) gel as small drops approximately one cm into the walls surrounding the resection cavity. Surgical feasibility was determined by the rate of successful sHA gel insertion procedure, the ease of insertion as rated by surgeons, the time required for insertion procedure, the quantity used, and any adverse events (AE) relating to sHA gel insertion. ResultsThirty-five patients were enrolled. All patients underwent sHA gel insertion successfully. The procedure added a median of 2.8 min to the OT time and was rated as ‘easy’ in 89 % of patients. There were no immediate AE in OT. Five (14 %) patients experienced a grade 2 or higher AE. Three of the five patients were prescribed oral antibiotics for breast infection. Two of the five patients experienced a grade 3 AE – haematoma which required evacuation in OT day 1 post-BCS, and infected seroma which required drainage and washout in OT 2 months post-BCS. All five patients recovered and underwent the planned adjuvant therapies for their BC. The AE data reflects common risks with standard BCS and are not clearly attributed to sHA gel insertion alone. ConclusionWe show that sHA gel is surgically feasible as a marker to help define the TB cavity for post-BCS adjuvant MRI-based RT planning.

Management of anchor loss with the use of infrazygomatic implants – A case series

The mesial tipping of the first molar marks the onset of anchorage loss, and changes in the angulation of the first molar are closely related to anchorage loss. Despite the various treatment strategy, different patients show different tendencies towards anchorage loss, which influences the treatment results and must be managed. The quest for search for an ideal intraoral anchorage device has led orthodontists to micro-implants or temporary anchorage devices (TADs), which offer to solve one of the greatest dilemmas of “anchorage control. The use of miniscrews has been increased recently due to their ease of insertion and removal, reasonable cost, biocompatibility and capability to withstand orthodontic forces The introduction of the mini screw and infrazygomatic implant has provided orthodontists with a solution to the significant challenge of "anchorage control." This case series describes the successful management of anchor loss with the infrazygomatic implant(IZC) that occurred during premolar extraction space closure in a Class I and Class II malocclusion patients with severely proclined maxillary incisors.

Comparison of weight-based and pinna size method for ProSeal laryngeal mask airway size selection in children receiving general anesthesia: A randomized clinical study.

Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size-based method is a promising new technique for accurate size selection. A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures. A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups (P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively (P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y (P = 0.180). The two groups were comparable as per the number of attempts needed for insertion (P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups. Pinna size-based estimation of LMA size is an effective alternative method to weight-based selection.

Split Nasopharyngeal Airway, a Tracking Tool for Fibreoptic Nasotracheal Intubation: A Randomised Controlled Study

Introduction: Managing a challenging airway in awake, sedated, or anaesthetised patients has made Fibreoptic Intubation (FOI) using a flexible Fibreoptic Bronchoscope (FOB) a mainstay in clinical practice. Aim: To evaluate and compare fibreoptic nasotracheal intubation with or without Split Nasopharyngeal Airway (SNPA) as a conduit, focusing on time taken, ease of insertion, and haemodynamic changes. Materials and Methods: This randomised controlled study was conducted at the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India, on 80 patients who were randomly allocated into two groups: Group CL (the control group without SNPA) and Group NP (with SNPA). Both groups were induced with general anaesthesia, and nostrils were prepared for FOB. In Group CL, a well-lubricated FOB was inserted into the selected nostril without using SNPA, and endotracheal intubation was performed. In Group NP, an appropriately sized SNPA was lubricated and inserted into the selected nostril. The fiberscope was passed through the SNPA, the vocal cords were visualised, and the SNPA was removed before railroading the preloaded tube through the vocal cords to confirm correct placement. The time taken for bronchoscopy and intubation, ease of insertion, haemodynamic parameters, and bleeding were recorded in both groups. The data was coded, entered, and analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. A significance level was set at a p-value ≤0.05. Results: Demographic data, including age and gender distribution, mean weight, height, Body Mass Index (BMI), and airway parameters such as Mallampati grading, neck circumference, inter-incisor distance, and ASA grading, were standardised. There was no significant difference between the CL and NP groups regarding these parameters. The time taken for FOB and intubation in Group CL was 2.59±0.96 minutes and 3.61±1.04 minutes, respectively, compared to 1.87±0.91 minutes and 2.51±0.86 minutes in Group NP (p-value=0.001). The time taken to visualise the glottis was also shorter in the NP group (6.70±13.97 minutes) compared to the CL group (24.02±13.06 minutes), which was significant. Fibreoptic bronchoscopy was considered easy in 16 patients (40%) in Group CL and 27 patients (67.5%) in Group NP (p-value=0.04). The increase in mean arterial blood pressure was significantly higher in Group CL than in Group NP just after the insertion of the FOB into the nasopharynx (p-value=0.05). Conclusion: Fibreoptic nasotracheal intubation through an SNPA is less time-consuming and results in easier intubation. It causes less trauma to the nasal passage and leads to fewer haemodynamic variations in terms of mean arterial pressure and heart rate. Hence, SNPA is a better method for facilitating FOI compared to intubation without it.

Efficacy of misoprostol in reducing the time and easiness the insertion of Levonorgestrel-releasing intrauterine device; Randomized controlled trial

Background: intrauterine devices (IUDs) have gained significant popularity as a prevalent form of reversible contraception. Levonorgestrel-releasing intrauterine devices (LNG-IUDs) have been found to be safe and cost-effective over an extended period. Furthermore, their efficacy is comparable to that of tubal sterilization. Aim: The aim of our study to reveled the effect of vaginal misoprostol on timing and the easiness of insertion of (LNG-IUDs) in previous cesarean sections women. Materials and method: One-hundred and eighty patients with a previous cesarean section attending for Mirena LNG-IUD insertion. This Randomized controlled trial set in Outpatient clinic in Department of Obstetrics and Gynecology, Faculty of Medicine, Helwan University Hospital at BADR city from March 2021 to March 2022. The current research assessed the effectiveness of 400mcg vaginal misoprostol 6 hours before LNG-IUD insertion in women who had only had a cesarean section before. Results: one hundred- eighty patients included in our Randomized control trial. Our results; There was statistically insignificant terms of anticipated pain, Pain after 20 min and satisfaction p-value&gt;0.05.While, we found a statistically significant difference in Ease of insertion, Pain at insertion and Insertion time &lt;0.001. Moreover, there was no statistically significant nausea, vomiting, shivering, fever, and need additional analgesia p-value&gt;0.05. Conclusion: misoprostol is safe and effective in insertion the LNG-IUD because of the significant result in reduction of pain, timing and easiness of insertion.

Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study.

To evaluate patient satisfaction on gynaecological examination with metal, plastic and biobased plastic vaginal specula, and to investigate whether patients are willing to compromise on comfort for a more sustainable healthcare system. Cross-sectional study: population-based survey. Gynaecological outpatient clinics in five Dutch hospitals. Patients during general gynaecology consultation hours. A survey containing two questions about patient demographics, four about comfort and five about sustainability and healthcare was distributed. Comfort score (scale 1-10). (1) temperature, size and ease of insertion, (2) willingness to compromise for a more sustainable healthcare system. In all, 196 patients completed the survey. Biobased plastic vaginal specula scored significantly higher on comfort than the metal ones (mean 8.03 ± 1.65 versus 7.26 ± 1.51 respectively; P < 0.001). The biobased plastic vaginal speculum is significantly the most comfortable on temperature, whereas the metal speculum is the least comfortable (P < 0.007). Most patients are willing to compromise on comfort or are open to the reuse of disposables to contribute to a more sustainable healthcare. The majority of patients (77%) urge healthcare organisations to combat climate change. There is a small but statistically significant difference in favour of a biobased plastic speculum regarding comfort score, although it might be questioned whether this is clinically relevant. Furthermore, patients are willing to compromise on comfort for a more sustainable healthcare, which should be a contributing factor in speculum selection.

Prospective Clinical Evaluation of the Singularity™ Air Laryngeal Mask in Adult Patients

A laryngeal mask is one of the most widely used airway management devices. The SingularityTM Air is a second-generation laryngeal mask whose shaft angle can be adjusted after insertion. Since the device’s performance has been assessed on mannequins only, this study aimed to evaluate SingularityTM Air’s effectiveness in the clinical setting. The prospective single-center cohort study included 100 adults undergoing elective surgery under general anesthesia and suitable for airway securing with a laryngeal mask. The primary endpoint was the oropharyngeal leak pressure, and the secondary endpoints were the ease of insertion and the patient’s comfort. Laryngeal mask insertion was successful in 97%, and mechanical ventilation was possible in 96% of patients. After insertion, the median (IQR) oropharyngeal leak pressure was 25 (18–25) cm H2O, which remained stable at 25 (25–25) cm H2O after 20 min. The median (IQR) time for successful manual bag ventilation was 42 (34–50) seconds. Nineteen patients complained of side effects (e.g., sore throat, difficulty swallowing), but none persisted. The SingularityTM Air performed well in a clinical setting, and its oropharyngeal leak pressure was comparable to that of other masks reported in the literature. The time for successful manual ventilation was slightly longer, and patients reported more temporary side effects.

Comparison of oropharyngeal leak pressure of LMA Protector and LMA ProSeal in anaesthetised paralysed patients - A randomised controlled trial.

In the present study, we hypothesised that the laryngeal mask airway (LMA) Protector would provide higher oropharyngeal leak pressure (OLP) than LMA ProSeal. Thus, we planned this study to compare the clinical performance of LMA Protector and LMA ProSeal in terms of OLP as a primary objective and insertion characteristics as secondary objectives. Ninety patients of either gender, aged 18-70 years, were randomised into groups PS (LMA ProSeal) and P (LMA Protector). Following anaesthetic induction, the device was inserted as per group allocation. OLP of both devices was taken as a primary objective. Secondary objectives such as insertion time, ease of insertion, number of attempts required, fibre-optic view grading, amount of air (mL) required to get a cuff pressure (CP) of 60 cm H2O, and CP adjustment required and complications, if any, were also noted. Data were analysed using coGuide statistics software, Version 1 (BDSS Corp. Bangalore, Karnataka, India). The median (interquartile range) OLP was significantly higher with LMA protector than with LMA ProSeal [33.00 (27.0, 36.0) versus [29.50 (26.0, 32.0) (P = 0.009)]. First-attempt success rate was 95.4% (42/44) in group PS and 93% (40/43) in group P. Insertion time, ease of insertion, and fibre-optic view grading were not different between the groups. Gastric tube placement failed in one patient in group PS and in three patients in group P (P = 0.606). The median amount of air (mL) required to get a CP of 60 cm H2O was 26.5 (20, 28) in group PS and 12 (8,13) in group P (95% confidence interval [CI] =10.808-14.575) (P < 0.001). At all time points, CP was significantly higher, and more CP adjustments were needed in group PS than in group P (P < 0.001). Incidence of blood staining and post-operative sore throat at 1 and 24 h were not different between the groups. LMA Protector provided a significantly higher OLP and less requirement of CP adjustments but comparable first-attempt success rate, mean insertion time, fibre-optic view, and gastric tube insertion as compared to LMA ProSeal.

Comparison of clinical performance of Baska mask and Ambu AuraGain in patients undergoing surgery: A single-blinded, randomised comparative trial.

The Baska mask (BM) and the Ambu AuraGain (AAG) have shown promising results in recent trials but have not been compared. Therefore, we aimed to compare the clinical performance of the BM and the AAG for airway management of adult patients. In this randomised comparative study, patients aged 18-60 years and with an expected surgical duration of less than 2 h were enroled. Patients were randomly allocated to AAG (Group A, n = 37) and BM (Group B, n = 37) for airway management. After induction of anaesthesia, an allocated supraglottic airway device (SAD) was inserted. Oropharyngeal leak pressure (OLP), time taken to insert SAD, number of insertion attempts, leak fraction (LF), first-attempt success rate, overall success rate, ease of insertion, fiberoptic view of the glottis, and complications were compared. The data were analysed using Student's t-test, Mann-Whitney U test, and Fisher's exact tests. Baseline and demographic characteristics were comparable. OLP (31.32 ± 2.59 versus 27.54 ± 1.32 cmH2O) was higher (P < 0.001), and LF (6.19% ± 1.20% versus 7.24% ± 1.72%) was lower (P = 0.003) in the BM group. First-attempt and overall success rate, time taken to insert, number of insertion attempts, ease of insertion, and fibreoptic view of glottis through the SADs were statistically similar between groups. However, the incidence of sore throat (P = 0.007) and cough (P = 0.028) was higher with AAG. Clinical performance of BM was better than AAG as the former had higher OLP, lower LF and complications.

Ease of Internal Jugular Venous Cannulation by Anterior V/S Posterior Approach: A Randomized Interventional Study

Background: Percutaneous cervical central venous cannulation is now common practice during Perioperative care in major surgical procedures, critically ill patients in intensive care units for long term hyperalimentation and for rapid restoration of blood volume in cases of acute blood loss. Proper route of insertion is essential for its success. The objective of this study is to compare procedural parameters and complications associated with anterior and posterior approaches for Internal Jugular Venous cannulation.&#x0D; Methods: Our study was conducted as a prospective randomized interventional trail in 60 patients undergoing scheduled cardiac surgeries requiring Right internal jugular venous cannulation in a tertiary level hospital after obtaining clearance from ethics committee, patients were randomly allocated into two groups either Anterior approach (Group A; n=30) or Posterior Approach (Group B; n=30). Number of attempts, time for identification of IJV, duration of cannulation, ease of insertion, complications were compared in both the groups.&#x0D; Results: The number of attempts (p value 0.036), mean time taken for vein identification (p value 0.0003), catheterization time (p value &lt;0.001), incidence of arterial puncture and hematoma are less with posterior approach, ease of threading is comparable among both the group. There were no statistically significant intergroup differences with respect to the Age, Sex, ASA grade.&#x0D; Conclusion: The posterior approach is better than anterior approach for Internal Jugular Vein Cannulation, as it improves the success rate, permits easy threading of catheter, reduces access time and duration of cannulation, complications like arterial puncture, hematoma, pneumothorax are lesser in posterior approach.