Guedel Airway Research Articles

Diprivan ® et anesthésie locorégionale chez l'enfant de plus trois ans

Preparation for anaesthesia (at least 1 hour prior to surgery): Topical anaesthesia at venepuncture sites and at the site of the block. Possible premedication (rectal midazolam: 0.3 mg.kg-1). Anaesthetic induction: Insertion of venous cannula; i.v. injection of 3-4 mg.kg-1 propofol, mixed with 0.05% lidocaine; Control of child's ventilation conditions: tolerance of the face mask, Guedel airway, laryngeal mask; tracheal intubation would be easy if necessary and would not require muscle relaxants; In cases where the child is distressed or where venous access cannot be obtained, it is sometimes preferable to resort to inhalational induction with halogenated anaesthetics prior to venepuncture. Initial maintenance anaesthesia (performing the block): Propofol given as a continuous infusion of 13 mg.kg-1.h-1, after a bolus injection of 1.3 mg.kg-1 (alternative solution: maintaining anaesthesia using halogenated agents); Positioning of the patient and performing the block technique with relatively concentrated local anaesthetic solutions (to avoid differential blocks). Maintenance anaesthesia during the procedure: Propofol given as a continuous infusion in reduced doses: 2 to 5 mg.kg-1.h-1; Alternatively: halogenated anaesthesia at low concentrations (equivalent to 0.25 to 0.5 vol % of halothane). Recovery: Particularly rapid and pleasant recovery, with a minimum of side effects; In cases of day-case surgery, patient discharge has virtually never to be postponed.

Diprivan ® et sismothérapie

Anaesthesia for Electroconvulsive Therapy (ECT) is characterized by short repeat anaesthetic procedures, performed outside an operating theatre. The efficacy of ECT relies upon the occurrence of tonoclonic convulsions. Propofol seems to be the intravenous induction agent of choice for ECT. Its pharmacokinetic properties ensure a rapid and deep anaesthesia, of short duration, with a minimum of side effects, and a rapid recovery of good quality, suitable for short repetitive procedures. As low doses of propofol are used, a rapid injection is required to obtain the hypnotic effect. These low doses also have the advantage of not affecting the convulsion threshold and therefore the efficacy of ECT. Clear upper airways and prevention of tongue biting are ensured by inserting a Guedel airway after loss of consciousness and before the electric shock. Intravenous administration of 10-20 micrograms.kg-1 atropine prevents from bradycardia, related to initial vagal stimulation induced by the electric shock. Its action is potentiated by the anticholinergic effect of tricyclic antidepressants. Its use is also justified when suxamethonium is given to prevent patient's movements and possible ECT-related trauma. Only suxamethonium is suitable for these procedures because of its pharmacokinetic properties (rapid onset and short duration of action). The suggested doses for this indication range from 0.5 to 1 mg.kg-1. When contraindicated, suxamethonium may be replaced by a benzodiazepine, in order to achieve an acceptable degree of muscle relaxation. There may then be an effect on the convulsion threshold.

Insertion of the laryngeal mask airway--a prospective study of four techniques.

The standard insertion technique (ST 0) for laryngeal mask airway insertion was compared to three alternative techniques in 120 patients. The alternative techniques included insertion using the standard approach, but with the cuff either semi-inflated (ST 0.5) or fully inflated (ST 1.0), and a non-standard approach using a back-to-front technique (like a Guedel airway) and with the cuff fully deflated (T 180). Successful insertion was judged by fibreoptic positioning (P < 0.02) and that confirmed that the ST 0 and T 180 were superior to ST 0.5 and ST 1.0 in terms of fibreoptic positioning (P < 0.02) and that insertion with the cuff deflated (ST 0 and T 180) resulted in fewer insertion failures than with the cuff inflated (ST 0.5 and ST 1.0) (P < 0.05). Insertion with the LMA back-to-front with the cuff deflated produced similar fibreoptic and functional results to the standard technique. In 23%, however, there was some residual rotation of 25-90% to the coronal plane.

Training nursing staff in airway management for resuscitation

The place of the laryngeal mask in emergency airway management by nonanaesthetists has yet to be established. We have compared the tidal volume achieved by nurses during hand ventilation using standard resuscitation equipment with a facemask, with or without a Guedel airway, and following placement of a laryngeal mask in the same patients. The tidal volumes measured while using the laryngeal mask were significantly greater (p < 0.01) than those measured during facemask ventilation.

EFFECT OF THE LARYNGEAL MASK AIRWAY ON LOWER OESOPHAGEAL SPHINCTER PRESSURE IN PATIENTS DURING GENERAL ANAESTHESIA

We have studied the tone of the lower oesophageal sphincter (LOS) in 40 adults undergoing routine body surface surgery and allocated randomly to receive anaesthesia either by face mask and Guedel airway or by laryngeal mask airway. In the laryngeal mask group there was a mean (SEM) decrease in barrier pressure (LOS minus gastric pressure) of 3.6 (1.4) cm H2O, compared with a mean increase of 2.2 (1.2) cm H2O in the face mask group (P < 0.005).

COMPARISON OF THE USE OF THE LARYNGEAL MASK AND FACE MASK BY INEXPERIENCED PERSONNEL

Ten junior doctors with no postgraduate anaesthetic experience attempted to ventilate the lungs of 50 anaesthetized patients, using either a laryngeal mask or a Guedel airway and face mask. Success was defined as the production of two successive tidal volumes exceeding 800 ml within 40 s. The failure rate was significantly greater using the laryngeal mask compared with the face mask (P < 0.05) and the average time was significantly longer with the laryngeal mask than with the face mask (P < 0.01). The results from this investigation suggest the laryngeal mask airway cannot be recommended as a resuscitation device for use by inexperienced operators.

REGURGITATION OF GASTRIC CONTENTS DURING GENERAL ANAESTHESIA USING THE LARYNGEAL MASK AIRWAY

We have investigated the incidence of regurgitation of gastric contents during general anaesthesia administered via a laryngeal mask airway (LMA) or face mask and Guedel airway in 56 patients with no risk factors for regurgitation. Patients swallowed a gelatin capsule containing methylene blue 10 min before induction of anaesthesia. Fibreoptic laryngoscopy in the LMA group or conventional laryngoscopy in the face mask group was performed at the end of surgery. Dye was observed within the laryngeal mask in seven of 28 patients (25%). No patients in the face mask-Guedel airway group regurgitated dye (P = 0.005). There was no evidence of aspiration of dye.

AIRWAY OBSTRUCTION ASSOCIATED WITH THE USE OF THE GUEDEL AIRWAY

Soft tissue lateral neck radiography was used in 22 male patients older than 60 yr, to determine the cause of pharyngeal airway obstruction during anaesthesia, before and after insertion of a Guedel airway. In six of the patients, the airway was radiologically and clinically clear with the head in the neutral position. Nine patients showed obstruction of the airway by a "shelf" of tongue, but seven were cleared clinically by dorsiflexion at the atlanto-occipital joint, and the remaining two by the Esmarch-Heiberg manoeuvre. In four of the 22 patients, the Guedel airway was lodged in the vallecula in the neutral position. This was cleared clinically by dorsiflexion at the atlanto-occipital joint in all these patients. In three patients the Guedel airway was obstructed by the epiglottis, but this was cleared by dorsiflexion at the atlanto-occipital joint in two; in the third patient, the Guedel airway slipped into the vallecula after dorsiflexion at the atlanto-occipital joint and remained there despite the Esmarch-Heiberg manoeuvre. There was only one instance in 66 trials of a clinically obstructed airway without an apparent radiological cause. However, there were 10 instances in 66 trials of a clinically clear airway with an apparent radiological cause for obstruction.

Laryngeal Mask Airway and Tracheal Tube Insertion by Unskilled Personnel

Abstract After a short training programme 11 naval medical trainees inserted a laryngeal mask airway (LMA) and a tracheal tube (ETT) in random order in a total of 110 anaesthetized patients. They were allowed 40 seconds for each attempt. Success was defined as the detection of expired carbon dioxide within 40 seconds of Guedel airway removal which subsequently rose to an end-tidal value of at least 4 kPa, together with satisfactory lung expansion and ventilation, without other airway intervention by the anaesthetist. One hundred and four LMA insertions were successful compared with 56 ETTs (p

Laryngeal mask airway and tracheal tube insertion by unskilled personnel

AbstractAfter a short training programme 11 naval medical trainees inserted a laryngeal mask airway (LMA) and a tracheal tube (ETT) in random order in a total of 110 anaesthetized patients. They were allowed 40 seconds for each attempt. Success was defined as the detection of expired carbon dioxide within 40 seconds of Guedel airway removal which subsequently rose to an end-tidal value of at least 4 kPa, together with satisfactory lung expansion and ventilation, without other airway intervention by the anaesthetist. One hundred and four LMA insertions were successful compared with 56 ETTs (p&lt;0.01). All first attempts at LMA insertion were successful, whereas satisfactory ETT placement was progressive. Insertion was also quicker with the LMA (20 seconds) than with the ETT (35 seconds) (p&lt;0.01). Further studies are indicated to assess the value of the LMA in emergencies.

Laryngeal mask airway and tracheal tube insertion by unskilled personnel

After a short training programme 11 naval medical trainees inserted a laryngeal mask airway (LMA) and a tracheal tube (ETT) in random order in a total of 110 anaesthetised patients. They were allowed 40 s for each attempt. Success was defined as the detection of expired carbon dioxide within 40 s of Guedel airway removal which subsequently rose to an end-tidal value of at least 4 kPa, together with satisfactory lung expansion and ventilation, without other airway intervention by the anaesthetist. 104 LMA insertions were successful compared with 56 of ETTs (p<0·01). All first attempts at LMA insertion were successful, whereas satisfactory ETT placement was progressive. Insertion was also quicker with the LMA (20 s) than with the ETT (35 s) (p<0·01). Further studies are indicated to assess the value of the LMA in emergencies.

Cardiovascular response to insertion of Brain's laryngeal mask

This study was designed to investigate the cardiovascular effects related to insertion of the Brain laryngeal mask airway and to compare these effects with those after insertion of a Guedel oral airway. Arterial pressure and heart rate in 100 patients were measured using an Ohmeda 2300 Finapres arterial pressure monitor. Arterial pressure decreased significantly (p less than 0.001) and heart rate increased significantly (p less than 0.001) after induction of anaesthesia with 2.5 mg/kg of propofol. A significant increase in arterial pressure (p less than 0.02) and in heart rate (p less than 0.001) followed insertion of the laryngeal mask and the Guedel airway, with no difference between the two groups at any time. The changes in arterial pressure and heart rate returned to 'at insertion' levels within 60 seconds of the stimulus.

Anaesthesia for fibreoptic bronchoscopy in children

AnaesthesiaVolume 45, Issue 3 p. 248-249 Free Access Anaesthesia for fibreoptic bronchoscopy in children S.T. Khoo, S.T. Khoo National University Hospital, Singapore OSIISearch for more papers by this author S.T. Khoo, S.T. Khoo National University Hospital, Singapore OSIISearch for more papers by this author First published: March 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14702.xCitations: 8AboutReferencesRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Grossman E, Jacobi AM. Minimal optimal endotracheal tube size for fiberoptic bronchoscopy. Anesthesia and Analgesia 1974; 53: 475– 6. 2 Patil V, Stehling LC, Zauder HL, Koch JP. Mechanical aids for fiberoptic endoscopy. Anesthesiology 1982; 57: 69– 70. 3 Zornow MH, Mitchell MM. Foreign body aspiration during fiberoptic-assisted intubation. Anesthesiology 1986: 64: 303. Citing Literature Citation StatementsbetaSmart citations by scite.ai include citation statements extracted from the full text of the citing article. The number of the statements may be higher than the number of citations provided by Wiley Online Library if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.SupportingSupporting0MentioningMentioning3ContrastingContrasting0Explore this article's citation statements on scite.aipowered by Volume45, Issue3March 1990Pages 248-249 Citation StatementsbetaSmart citations by scite.ai include citation statements extracted from the full text of the citing article. The number of the statements may be higher than the number of citations provided by Wiley Online Library if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.SupportingSupporting0MentioningMentioning3ContrastingContrasting0Explore this article's citation statements on scite.aipowered by ReferencesRelatedInformation RecommendedOrotracheal fibreoptic intubation for rapid sequence induction of anaesthesiaJ. J. Pandit, R. M. Dravid, R. Iyer, M. T. Popat, AnaesthesiaA fibreoptic laryngoscope for paediatric anaesthesiaS. R. WRIGLEY, A. E. BLACK, V. S. SIDHU, AnaesthesiaComparison of the Williams Airway Intubator and Ovassapian Fibreoptic Intubating Airway for fibreoptic orotracheal intubationK. B. Greenland, M. C. Lam, M. G. Irwin, AnaesthesiaA modified Guedel airway for continuous oxygenation and suctioning during fibreoptic bronchoscopyC. Ayoub, M. M. Itani, A. Lteif, A. Baraka, AnaesthesiaA new technique for fibreoptic intubation in childrenM. A. HASAN, A. E. BLACK, Anaesthesia

Influence of mask design on bag-mask ventilation

Adequate positive pressure ventilation in the field or emergency department continues to represent a major challenge. A new face mask design that recently has been introduced consists of a low-pressure "balloon" through which a Guedel airway is attached and extended proximally through the mask to allow the attachment of a ventilation bag. The mask is designed to seal the nares and mouth when pressed against the face. Ventilation is achieved through the airway which extends through the mask to just above the epiglottis. We designed a study to evaluate ventilating volumes and mask leak with this mask design, and to compare these parameters with those achieved with standard masks. Thirty volunteers with varied experience in bag-mask ventilation were chosen to ventilate a specially adapted ventilation manikin connected to a test lung that was capable of simulating varied compliances. Spirometers measured volumes delivered to the ventilating bag and lung, and mask leak could be calculated from these readings. A constant rate of 12 ventilations per minute was maintained by each volunteer for two minutes. Volunteers ventilated the test lung using three masks in random sequence: the SealEasy mask (Respironics Inc, Monroeville, PA), a Laerdal mask (old type), and a transparent Robertshaw mask with inflatable black rim. The average tidal volume delivered by the SealEasy mask was consistently higher than either of the other two. Significantly (P less than .05) higher volumes were delivered with the SealEasy mask when compared to the Laerdal, and significantly lower mask leaks were seen when the SealEasy was compared to both.(ABSTRACT TRUNCATED AT 250 WORDS)

Simplified technique of bronchographic intubation.

Catheter placement in the trachea is frequently the most difficult part of bronchography. By using a Guedel airway as a guide for a No. 12F Rob Nel (red Robinson) catheter, we have bypassed some of the difficulties encountered with other bronchographic techniques. This method is simple and allows physicians who infrequently perform bronchography to complete it with ease and minimal discomfort to the patient.