Ease Of Insertion Research Articles

Surgical Outcomes of Retropupillary-Fixated Iris-Claw Intraocular Lens

Purpose:To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation.Methods:For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted.Results:One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis.Conclusions:Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

Benefits of Self-administered Vaginal Dinoprostone 12 Hours before Levonorgestrel-releasing Intrauterine Device Insertion in Nulliparous Adolescents and Young Women: A Randomized Controlled Trial.

To assess safety and efficacy of self-administered vaginal dinoprostone 12hours before a 52-mg levonorgestrel intrauterine device (LNG-IUD) insertion in adolescents and young nulliparous women. Randomized controlled trial. Tertiary referral hospital. Nulliparous adolescents and young women aged 18-22years. Participants were randomly assigned into 2 groups; the dinoprostone group (n=65) received dinoprostone 3mg vaginally, and the placebo group (n=65) received placebo tablets vaginally. Primary outcome was pain scores during LNG-IUD insertion measured using a visual analogue scale. Secondary outcomes were pain scores during speculum insertion, tenaculum placement, uterine sounding, and 20minutes postprocedure, ease of insertion, Women's satisfaction score, need for additional analgesics, and side effects. The dinoprostone group had significantly lower pain scores during LNG-IUD insertion (2.83±1.08 vs 3.95±1.63), tenaculum placement (2.97±1.41 vs 4.55±1.53) and sounding of uterus (3.55±1.71 vs 5.12±1.37) compared with the placebo group (P<.001). No significant differences were found between both groups regarding anticipated pain scores (P=.85), pain during speculum insertion and 20minutes postinsertion and insertion duration (P=.53). Women's satisfaction, provider reported ease of insertion, and need for additional analgesia were significantly better among dinoprostone users (P<.001, < .001, and .02, respectively). Side effects and procedure complications were similar for the 2 groups. Self-administered dinoprostone 3mg vaginally 12hours before a 52-mg LNG-IUD insertion in nulliparous adolescent and young women effectively reduced pain during insertion and increased women's satisfaction and ease of insertion reported by clinicians.

A Comparative Study of the Proseal Laryngeal Mask Airway (PLMA) Insertion by Three Different Technique I.E. Introducer, Digital and Stylet

Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia. Proseal Laryngeal Mask Airway (PLMA) is an effective alternative to ETT with inflatable cuff forming pressure seal around laryngeal inlet and permitting ventilation. In view of this, the present study was undertaken to compare the different insertion techniques to insert PLMA in adult patients undergoing elective surgeries. Methodology: Ninety patients scheduled for elective surgical procedures under general anesthesia belonging to ASA grade I and II were included in the study and were randomly divided into three groups with 30 patients in each group. In Group I (n=30), PLMA was inserted using introducer, in Group II (n=30) PLMA was inserted using digit and in group III (n=30) PLMA was inserted using stylet. Groups were compared in relation to number of attempts, insertion time, ease of insertion, orogastric tube insertion and, hemodynamic changes. Results: The success first attempt rate for placement of PLMA was highest with introducer as compared to digit or stylet and the results were statistically significant (p=0.029). The mean time of insertion for PLMA using introducer was 27.03±4.08 seconds which was shortest whereas with digit it was highest 35.27±4.97 (p=0.000) and by using stylet 31.33±3.12 seconds. There was no change in hemodynamic after the insertion of PLMA with either technique. Conclusion: To conclude introducer technique of PLMA insertion was best as compared to digit and stylet technique.

Evaluation of successful insertion of cobra-perilaryngeal airway and laryngeal mask airway supreme by novice anaesthesiologists: Experience from a teaching institute

Background and Aim: Because of its simplicity of insertion, supraglottic airway (SGA) plays an important role in airway management. This study was planned to compare success rate within two attempts at correct placement of Cobra perilaryngeal airway (C-PLA) with laryngeal mask airway Supreme (S-LMA) by novice anaesthesiologists. Secondary objectives included the comparison of time to insertion, ease of insertion and incidence of complications with the device. Methods: The trial was approved by the Institutional Review Board and registered with the Clinical Trials Registry-India (CTRI/2014/08/004913). Fourteen eligible and consenting novice anaesthesiologists were included. Each trainee had to insert each SGA for 5 successful times on the Laerdal airway trainer. After obtaining informed consent, 112 adult patients undergoing elective surgery were randomised to the anaesthesiologists and the SGA device. Induction of general anaesthesia was standardised. Only 2 attempts at insertion of SGA were allowed. Ease of insertion by novices was recorded using a numerical rating scale (NRS) 1 to 10 (10 = easiest). Data were entered into IBM SPSS software version 21.0 (IBM, NY, USA). Categorical data were compared using Chi-square test, while scores were analysed using Mann-Whitney test. Results: There was no difference in success rate between S-LMA (91%) and C-PLA (89%) (P = 0.75). Median time (interquartile range) of insertion for S-LMA was 30 (25–34) seconds and C-PLA was 29 (25–32) seconds (P = 0.53). The incidence of complications was similar for both devices. Novices rated insertion of C-PLA NRS score of 8 (7–9) significantly easier than S-LMA NRS score 7 (5–9) (P = 0.0005). Conclusion: Although the success rate of insertion and time to insertion of C-PLA is similar to S-LMA, novices found C-PLA easier to insert.

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask® versus I-gel™; A randomised clinical study.

Background and Aims:Oropharyngeal seal pressure (OSP) achieved by a supraglottic airway device holds due importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra-cuff soiling and also relates to postoperative morbidity. The primary outcome measure was to assess and compare OSP in different head and neck positions with Baska mask® and I-gel™. Secondary outcome measures were to compare peak inspiratory pressure (PIP), exhaled tidal volume (ETV), ease of insertion, time taken for insertion, number of attempts, intraoperative manipulations, and postoperative airway morbidity with both the devices.Materials and Methods:Seventy consenting adults scheduled for a variety of surgical procedures under general anesthesia were allocated to Group B and Group G using Baska mask® and I-gel™ respectively. All statistical calculations were done using SPSS (Statistical Package for the Social Science). The comparison of quantitative variables between the study groups was done using Student t-test and within the variables was done by paired t-test. For comparing categorical data, Chi-square (χ2) test was performed.Results:OSP was significantly higher in group B than in group G in all head and neck positions (neutral 33 ± 2.8 vs. 23.2 ± 1.8, flexion 35.5 ± 2.5 vs. 25.2 ± 1.6, extension 30.6 ± 2.7 vs. 21.4 ± 1.7, right lateral 32.6 ± 2.8 vs. 23.0 ± 1.5. left lateral 32.6 ± 2.7 vs. 23.1 ± 1.7 cm H2O, respectively) (P = 0.000). PIP increased significantly in group G as compared to group B in flexion. (P = 0.009). Baska mask® had significantly higher ETV in flexion compared to I-gel™. (P = 0.009).Conclusion:Baska mask® may provide a useful alternative to I-gel™ where the glottic seal has precedence over ease of insertion.

Risk factors for peripherally inserted central catheter line-related deep venous thrombosis in critically ill intensive care unit patients.

Introduction:Central venous access using peripherally inserted central catheters is frequently used for patients receiving intravenous medications in the hospital or outpatients. Although there are several benefits of peripherally inserted central catheters, such as ease of insertion, low procedure-related risk and higher patient satisfaction, there are complications associated with peripherally inserted central catheter use. Despite some studies evaluating peripherally inserted central catheter line–related complications, the factors associated with peripherally inserted central catheter–related deep venous thrombosis in critically ill medical-surgical patients are poorly described. The objective of this case-control study was to identify the risk factors associated with peripherally inserted central catheter line–related deep venous thrombosis in critically ill medical-surgical intensive care unit patients in a community hospital.Methods:We abstracted relevant clinical data from 21 cases with symptomatic peripherally inserted central catheter–related deep venous thrombosis and 42 controls with peripherally inserted central catheters but no deep venous thrombosis.Results:Of the factors evaluated, female gender, the use of triple lumen peripherally inserted central catheters, larger outer diameter, and open (vs valve) peripherally inserted central catheters were associated with venous thrombosis. In this retrospective study, we did not identify any association of peripherally inserted central catheter–related deep venous thrombosis with a prior history of deep venous thrombosis, use of alteplase, antiplatelet therapy, prophylactic or therapeutic anticoagulation, international normalized ratio, platelet count and the use of peripherally inserted central catheters for total parenteral nutrition.Conclusion:Our study indicates that the catheter size relative to the diameter of the vein could be an important risk factor for the development of peripherally inserted central catheter–related deep venous thrombosis. The study findings should be confirmed in a larger study designed to identify risk factors of peripherally inserted central catheter–related deep venous thrombosis. In the meantime, the peripherally inserted central catheter lines should be used judiciously in critically ill patients.

Comparison of the Parker flex tip and the unoflex reinforced endotracheal tube for orotracheal fibreoptic intubation in simulated difficult intubation patients.

The choice of endotracheal tube (ETT) is important for successful orotracheal fibreoptic intubation (OFI). The aim of this study was to compare the use of the Parker flex tip (PFT) with the unoflex reinforced (UFR) ETT during OFI. A total of 58 patients who underwent elective surgery under general anaesthesia were randomised to two ETT groups, the PFT group (n = 29) and the UFR group (n = 29), for OFI in simulated difficult intubation patients using a rigid cervical collar. After successful standardised induction and relaxation, OFI and railroading of selected ETT were subsequently performed by a similarly experienced practitioner. Ease of insertion, degree of manipulation, time to successful intubation, post-intubation complications and haemodynamic changes were recorded for both groups. he percentage of easy intubation was comparable between both groups with a slightly higher percentage in the UFR group than the PFT group (69.0% vs. 62.0%; P = 0.599). Degree of manipulation was also comparable between the two groups; the percentage of cases in which manipulation was not required was slightly higher in the UFR group than the PFT group (69.0% vs. 62.1%; P = 0.849). Time to successful intubation was also comparable between the groups, although the time was slightly shorter for the UFR group than the PFT group (56.9 s ± 39.7 s vs. 63.9 s ± 36.9 s; P = 0.488). There were also no significant differences in other parameters. The Parker flex tip ETT was comparable to the unoflex reinforced ETT for OFI in simulated difficult airway patients.

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

Background and Aim:Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices.Materials and Methods:The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device.Results:The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA.Conclusion:This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.

Comparison of laryngeal mask airway &amp; endotracheal intubation in pediatric age group: A cross sectional study

The laryngeal mask airway, it is a supraglottic airway instrument developed by British Anesthesiologist Dr. Archie Brain. Initially it was designed only for the use in the operating room for the purpose of elective ventilation; it is a proved alternative to bag-valve-mask ventilation, freeing the hands of the provider with the benefit of less gastric distention. Initially used primarily in the operating room setting, the laryngeal mask airway has more recently come into use in the emergency situation as a very important device for the treatment of the difficult airway. The objective of the study was To compare the various parameters that occur during laryngeal mask airway insertion and endotracheal intubation for surgical procedures under general anesthesia. In the present study, 18 children’s belongs to age group of 2 to 6 years and 32 children’s belongs to age group of 7 to 10 years. Totally 29 children’s were male and 21 children’s were female. In LMA group, LMA insertion was graded easy in 97% of patient and difficult in 3% cases. In none of the case was LMA insertion impossible (0%). In the ETT group, endotracheal intubation was easy in 85% of patients and difficult in 15% of patients. In none of the patients was endotracheal intubation impossible. In the LMA group, LMA was placed correctly in the first attempt in 94% patients and was placed correctly in the 2nd attempt in 6%. The ETT was placed in the first attempt in 80% patients and was placed correctly in the 2nd attempt in 20%. According to the results of our study, laryngeal mask airway it is device of choice for elective outpatient surgeries in pediatric patients due to its lesser hemodynamic changes and complications, ease of insertion in cases where endotracheal tube insertion gets difficult and also faster insertion.

Randomized Controlled Trial to Compare Baska® Mask versus ProSeal Laryngeal Mask Airway for General Anesthesia with Intermittent Positive Pressure Ventilation.

Introduction:A myriad of supraglottic airway devices (SADs) are developed over time to search the device that conforms to the anatomy of the human respiratory tract noninvasively, but these devices are associated with the risk of aspiration. Baska® mask (BM) is the latest addition to the family of SADs to circumvent the incidence of aspiration.Aims of Study:The aim of the study was to compare the sealing pressure and rapidity of the insertion of BM with ProSeal laryngeal mask (PLM) airway and the incidence of laryngopharyngeal morbidity between two devices.Materials and Methods:A randomized prospective open-label study was done on sixty adult patients of the age group of 18–60 years after approval from the institutional ethical committee and registration of trial in the Clinical Trials Registry. The patients were randomly divided into two groups: Group I (BM) where BM was inserted after the induction of general anesthesia and Group II (PLM) where PLM was inserted after induction. The airway sealing pressure in BM was calculated. The mean time of insertion of respective SAD and the number of successful attempts were also recorded in both groups. For analysis of continuous variables, independent sample Student's t-test was applied, and for categorical variables, Chi-square test was used. P < 0.05 was considered statistically significant.Results:The rate of successful attempts of insertion was comparable in both the groups. The mean insertion time was 14.25 ± 3.82 s in BM group and 22.01 ± 2.64 s in PLM group, which was statistically significant. The airway sealing pressure was 30.25 ± 3.34 cmH2O in BM group and 23.50 ± 4.05 cmH2O in PLM group, which was also statistically significant.Conclusion:BM has better ease of insertion with adequate sealing pressure as compared to PLM airway, thus reducing the chances of aspiration and offering its potential application in securing airway in emergency situations.

Classic laryngeal mask airway insertion with laryngoscope mcgrath and macintosh: A case series

Laryngeal mask airway (LMA) is often performed for airway management. Correct placement of LMA can prevent severe leaks and even obstruction of the airway. Insertion under laryngoscope guidance has been used to achieve the ideal positioning of the LMA. Efficacy of LMA insertion by laryngoscope can be evaluated with cheap, safe, and easy to use method. This case series evaluates LMA insertion with McGrath video laryngoscope and Macintosh laryngoscope. We use 20 cases to evaluate oropharyngeal leak pressure, time taken for insertion, hemodynamic after insertion, first attempt insertion, ease of insertion, and adverse airway event after LMA insertion.

LMA supreme vs I-Gel - A comparison of ease of insertion in short surgical procedures - A prospective randomised single blinded study

LMA supreme vs I-Gel - A comparison of ease of insertion in short surgical procedures - A prospective randomised single blinded study

Comparison of laryngeal mask airway, cuffed and uncuffed tracheal tubes in pediatric patients during general anesthesia

American Heart Association and the International Liaison Committee on Resuscitation have now accepted cuffed tubes as an alternative to uncuffed ones for pediatric airway. Recently laryngeal mask airway (LMA) has become increasingly popular as an alternative device for airway management in children. The present study was undertaken to evaluate and compare LMA, cuffed and uncuffed Endo tracheal tube (ETT) as airway devices in small children during general anesthesia. The study included 150 patients of age 2-6 years undergoing elective surgery under general anesthesia and randomized to one of the three groups depending on airway device insertion i.e. Group C: Cuffed ETT; Group P: Uncuffed ETT; Group L: cLMA. Variables depicting ease of insertion, hemodynamic parameters and airway morbidity were recorded and assessed. The time taken for insertion of airway device as well as total duration of device in situ was statistically similar in the three groups. First attempt success rate was significantly higher in the cuffed ETT group. Change in size of device was required in 4%, 36.0% and 16.0% patients in groups C, P and L respectively. Number of failures in groups C, P and L respectively was 2%, 0% and 4% (p>0.05). Hypertensive tachycardiac response was minimum in cLMA group. All the three groups were comparable with respect to overall airway morbidity. We conclude that all the three devices including cuffed ETT can be used safely in the pediatric age group.

A comparison of two supraglottic airway devices in general anaesthesia: baska mask® vs. I-gel®

Objective: The aim of this was to compare the Baska® mask and the I-gel® airway in paralyzed patients during general anaesthesia in terms of clinical performance, the risk of aspiration, and intraoperative and postoperative characteristics.&#x0D; Material and Methods: The two devices were compared in 100 paralyzed anesthetized adult patients. Primary outcomes of the study were to evaluate the characteristics of the airway devices within respect to the success of first insertion attempt, the insertion time, the ease of insertion, leak volume, and peak airway pressure. The blood staining on the mask, and the presence of gastric reflux or sore throat two hours postoperatively were evaluated. Hemodynamics, end-tidal CO2 and the peripheral oxygen saturation measurements were secondary outcomes.&#x0D; Results: No statistically significant difference was observed between the groups in the criteria of first attempt success rate, ease of insertion, blood staining upon removal of the masks, gastric regurgitation, or sore throat two hours after the procedure. The insertion time was significantly longer for the Baska® mask compared with the I-gel® airway. The leak volume was significantly higher in the Baska® mask patients throughout the surgical procedure. The heart rate and mean arterial pressure measurements were significantly higher in the Baska® mask patients.&#x0D; Conclusions: Both the Baska® mask and the I-gel ® device can be used effectively for selected paralyzed patients under general anaesthesia. The insertion time was significantly longer for the Baska® mask compared with the I-gel® device.

Low-cycle behavior of wood screws under alternating bending

Earthquake-resistant timber structures may be designed accounting either for the dissipative or low-dissipative structural behavior, depending on the relevant ductility class. A timber structure belonging to a given ductility class shall meet specific requirements especially in the type and rotational ductility capacity of connections, since the timber members themselves shall be regarded as behaving elastically. In addition, Eurocode 8 prescribes that only materials and mechanical fasteners providing appropriate low-cycle fatigue behavior may be used in joints regarded as dissipative zones. In this context, the properties of dissipative zones may be determined by tests either on single joints, or on whole structures in accordance with EN 12512. At the same time, the appropriate fastener’s low-cycle behavior is currently deemed to be satisfied if the connectors are sufficiently slender with respect to the thickness of the joined members. Nowadays, this assumption may not be sufficiently reliable because of the actual trends in fasteners technology, which consists in providing heavily hardened connectors in order to achieve higher resistances and ease of insertion into timber. The aim of this study is to investigate the low-cycle behavior of modern wood screws by means of three-point alternating bending tests. The paper describes a new testing apparatus, the related test procedure and assessment criteria specifically designed for this purpose. A preliminary investigation of the low-cycle behavior of different wood screws currently on the market is then carried out and the related test results are discussed.

1170. A Quality Improvement Study to Assess the Effectiveness of a Meaningful Use Protocol in the Reduction of PICC Line Use and Complications

BackgroundThe use of peripherally-inserted central catheters (PICC) has grown substantially over time because of their ease of insertion, cost-effectiveness and relative safety. With increased use; however, there are increased complications including catheter-related bloodstream infections (CLABSI) and PICC line-associated deep vein thrombosis (DVT). To help decrease complications a meaningful use protocol was implemented based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to define appropriate indications for PICC line use. The objectives of this study were (1) to determine the rate of PICC line use at our hospital; (2) to determine rates of complications associated with PICC lines, including CLABSI and DVT; and (3) to compare the metrics listed above before and after implementation of the meaningful use protocol.MethodsWe performed a retrospective chart review of all inpatient admissions before (June 1, 2017 to September 1, 2017) and after the implementation of the meaningful use protocol (June 1, 2018 to September 1, 2018). Patients who had a PICC line inserted at another institution or in the outpatient setting were excluded. We compared the rate of insertion, patient demographics, characteristics of the use of PICC lines and complications from the two periods. Data were analyzed using the chi-squared test, Student’s t-test, the Mann–Whitney U test and the z test for proportions.ResultsWe reviewed 281 patient charts, 166 before the implementation of the meaningful use protocol and 115 after implementation. Overall, the mean age was 55.8 ± 17.9 years, 58.7% male and 54.1% white. There were no significant differences between groups with respect to demographics, comorbidities, source of admission, or complications. Post-implementation there was a significant reduction in lines used for unknown reasons as well as lines used for multiple blood draws (P <0.0001). The overall rate of PICC line use decreased from 23 per 1,000 admissions to 17.2 per 1,000 admissions after the intervention (P = 0.007).ConclusionImplementation of a meaningful use protocol reduced the rate of PICC line use at our institution by 25%. The proportion of lines used for unknown reasons decreased as well. Widespread implementation could have a significant impact on the reduction of PICC line use.Disclosures All authors: No reported disclosures.

Development and Evaluation of Fall Impact Protection Pads Using Additive Manufacturing.

This paper presents the development and evaluation of fall-impact protection pants for elderly women using additive manufacturing. The protective pants were designed incorporating a protective pad in the hip area to reduce the impact of falls on the human body. The protective pad is a 3D mesh structure with a curved surface to fit the human body. Pads printed with flexible thermoplastic polyurethane were combined with foam to create the final pad. The impact-absorbing performance of the pad was verified through physical impact experiments. When dropping a bowling ball onto the protective pad from heights of 15, 20, and 25 cm, the protective pad was found to reduce the impact force by more than 82% in all cases. The impact force was less than the average fracture threshold of 3472 N. A subject group and an expert group evaluated the appearance, pad characteristics, motion functionality, and the wearability of the protection pants. Despite the insertion of a pad, the pants appeared natural and had a good fit. The pads were evaluated as being well-designed in terms of their position, shape, area, thickness, weight, flexibility, ease of insertion, and ease of use. Users were comfortable performing various motions when wearing the designed protective clothing. Therefore, this work can be considered to have developed protective clothing that provides satisfactory impact-protection performance and comfort thereby advancing the possibility of applying additive manufacturing to the creation of functional garments.

2531 LiNA Operascope: Pilot Evaluation of a Single-use Operative Hysteroscopy System

Study Objective To evaluate the performance of a single-use, battery powered, operative hysteroscope in an office setting. Design Performance questionnaire survey with predefined scales (5 = very satisfied, 1 = very dissatisfied) Setting Procedure rooms in 15 US medical center. Patients or Participants Patients undergoing diagnostic and operative hysteroscopy Interventions The LiNA OperaScope is a single-use, battery operated system for see and treat hysteroscopy in the office and hospital setting. The 4.2 mm diameter cannula contains a miniature camera and LED illumination at the distal tip. The catheter tip is pre-curved and 360° steerable by a turning knob on the handle. The center of this turning knob is the insertion channel for hysteroscopic instruments up to 1.86 mm (5.5 Fr). Distention and flushing of the uterine cavity is facilitated with separate in-flow and out-flow channels with individual stopcocks at the handle. The HDMI cable at the bottom of the handle can be connected to an external monitor with HDMI input, or connected to the OperaScope Recording Module for recording of video or pictures to a standard USB drive. Measurements and Main Results 15 gynecologists completed the device performance questionnaire. 93% (14/15) were very satisfied and 7% (1/15) satisfied with the functionality of the device and its ease of insertion. All evaluators were satisfied or very satisfied with the quality of visualization. 93% (14/15) rated patient comfort and tolerability as very satisfying. The performance of the recording module was rated as satisfying by 78% (11/14), very satisfying by 14% (2/14) and neutral by 7% (1/14). All evaluators were overall very satisfied (10/15) or satisfied (5/10) with the device. Conclusion The OperaScope system can provide highly satisfying visualization of the endometrial cavity during diagnostic and operative hysteroscopic procedures.

A Comparative Study of Orotracheal Intubation Guided by Airtraq and McCoy Laryngoscope in Patients with Rigid Cervical Collar In-situ Simulating Cervical Immobilization for Traumatic Cervical Spine Injury

Abstract Background Immobilization of cervical spine is of utmost importance in patients with cervical injury, making intubation a difficult task due to the application of cervical collar. This study was done to assess which laryngoscope (Airtraq or McCoy) is better for intubation and prevents the deleterious effects of hypoxia by comparing the intubation time. Methods A prospective interventional randomized study was undertaken in 60 adult patients of American Society of Anesthesiologists (ASA) grade I and II, aged between 20 and 50 years, scheduled for various surgical procedures requiring tracheal intubation for anesthesia. Patients were randomly allocated to undergo intubation with either the Airtraq (Group A; n = 30) laryngoscope or McCoy (Group B; n = 30). Patients were intubated following the standard anesthetic protocol, and the differences in duration of intubation, changes in the hemodynamic parameters in response to intubation, modified intubation difficulty score, and airway complications between the Airtraq and the McCoy laryngoscope were compared. Results Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. Though the mean time required for successful intubation was less with the Airtraq (25.2 ± 5.11 seconds) than the McCoy laryngoscope (27.3 ± 4.47 seconds); it was statistically insignificant (p = 0.14). Intubation difficulty score and ease of insertion were significantly less in Airtraq laryngoscope when compared with McCoy laryngoscope. Increase in the heart rate and mean arterial pressure was significantly more just after intubation with McCoy in comparison with Airtraq laryngoscope. However, the frequencies of airway complications were similar. Conclusion Intubation time despite being lesser with the Airtraq than the McCoy laryngoscope was statistically insignificant, and overall success rates between the two devices were similar.

Intracervical block for levonorgestrel-releasing intrauterine system placement among nulligravid women: a randomized double-blind controlled trial

Fear of pain during the insertion of intrauterine contraceptives is a barrier to using these methods, especially for nulligravidas. An intracervical block may be easier and more reproducible than a paracervical block; however, this intervention has not been evaluated in nulligravid women to reduce pain with intrauterine contraceptive insertion. To evaluate whether a 3.6-mL 2% lidocaine intracervical block reduces pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion among nulligravidas; and, in addition, to assess whether the intracervical block has any effect on the ease of device insertion and on the overall experience with the procedure. In this randomized double-blind controlled trial, nulligravidas were block-randomized to 1 of 3 arms prior to 52-mg levonorgestrel-releasing intrauterine system insertion: 3.6-mL 2%-lidocaine intracervical block, sham injection (intracervical dry-needling), or no intervention. The primary outcome was pain at levonorgestrel-releasing intrauterine system insertion. Secondary outcomes were pain at tenaculum placement, ease of insertion (assessed by healthcare providers), and the overall experience with the procedure (pain with levonorgestrel-releasing intrauterine system insertion compared with expectations, discomfort level, wish to undergo another device insertion in the future, and recommendation of the procedure to others). Participants' pain was measured with a 10-cm visual analogue scale and a 5-point Faces Pain Scale. Pain was summarized into categories (none, mild, moderate, severe) and also analyzed as a continuous variable (mean and 95% confidence interval). Our sample size had 80% power (α= 0.05) to detect a 15% difference in pain score measured by visual analogue scale (mean [standard deviation] visual analogue scale score= 5.9 [2.0] cm) and an absolute difference of 20% in the proportion of women reporting severe pain at levonorgestrel-releasing intrauterine system insertion among groups. We used a χ2 test and a mixed-effects linear regression model. We calculated the number needed to treat for the intracervical block to avert severe pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion. A total of 302 women were randomized (99 to the intracervical block, 101 to the intracervical sham, and 102 to no intervention), and 300 had a successful device insertion. The intracervical block group had fewer women reporting severe pain than the other groups, both at tenaculum placement (intracervical block: 2% vs sham: 30.2% vs no intervention: 15.2%, P < .0001) and at levonorgestrel-releasing intrauterine system insertion (intracervical block: 26.5% vs sham: 59.4% vs no intervention: 50.5%, P < .0001). The mean (95% confidence interval) pain score reported at levonorgestrel-releasing intrauterine system insertion was lower in the intracervical block group than in the other groups (intracervical block: 4.3 [3.8-4.9] vs sham: 6.6 [6.2-7.0], P < .0001; intracervical block: 4.3 [3.8-4.9] vs no intervention: 5.8 [5.3-6.4], P < .0001). Women from the intracervical block group reported less pain than expected (P < .0001), rated the insertion as less uncomfortable (P < .0001), and were more willing to undergo another device insertion in the future (P < .01) than women in the other groups. The ease of insertion were similar among groups. The number needed to treat for the intracervical block to avert severe pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion was 2 and 4, respectively. A 3.6-mL 2% lidocaine intracervical block decreased pain at tenaculum placement and levonorgestrel-releasing intrauterine system insertion among nulligravidas. It also provided a better overall experience during the procedure.