Insertion Attempts Research Articles

I-GEL versus LMA classic: Comparison of two supraglottic airway devices in short surgical procedures

Background: Supraglottic airway devices are more efficient than endotracheal intubation in management of difficult airway and hemodynamic response. Aims and Objectives: This study was undertaken for to compare laryngeal mask airway (LMA) Classic and I-Gel in terms of ease of insertion, insertion attempts, time taken for insertion, hemodynamic change, and adverse events after administering muscle relaxants for airway management in short surgical procedures. Materials and Methods: A total of 120 patients of American Society of Anaesthesiologist 1 and II, aged between 18 and 50 years with Malampatti score 1 and II posted for elective short surgical cases were randomly allotted into two groups (n=60 in each), Group A for LMA Classic and Group B for I-gel. Patients were pre oxygenated with 100% O2 and pre-medicated. After induction and proper muscle relaxation, LMA Classic or I-GEL was inserted. The time and number of insertion attempts were assessed. Heart rate, Blood pressure, SpO2 recorded at the time of insertion, 1, 3, 5, and 10 min following insertion. The recorded results were analyzed statistically. Results: The mean insertion time of Group A was 34.80±3.193 and Group B was 21.72±1.975. P<0.001 and in Group B all patients were successfully intubated at first attempt whereas in Group B 23.33% patients required second attempts. Hemodynamic changes were also less with Group B. Conclusion: I-Gel has better hemodynamic stability. Ease of Insertion, insertion attempts and time taken for insertion are more convenient for I-Gel than LMA Classic after administering muscle relaxants.

Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction.

Insertion of the laryngeal mask airway (LMA) without muscle relaxant requires adequate obtundation of airway reflexes, which may otherwise lead to incorrect or failed LMA placement. This study compared topical lignocaine spray vs. intravenous (IV) fentanyl, during propofol induction for insertion of the ProSeal™ LMA (PLMA). This was a prospective, randomized, double blind study, in ASA I or II patients, for elective or emergency surgery. Seventy patients (n = 70) who fulfilled the inclusion criteria were randomly assigned to receive IV fentanyl 2 mcg/kg or topical lignocaine spray 40 mg, prior to anesthesia induction with IV propofol (2–2.5 mg/kg). ProSeal™ LMA insertion condition was regarded optimal in the absence of adverse responses (gag, cough, laryngospasm and body movements), and successful LMA placement at the first attempt. Hemodynamic parameters were recorded and patients were assessed for sore throat and hoarseness post operatively. Seventy patients were analyzed. The number of patients with optimal PLMA insertion conditions were comparable between the groups (60% vs. 57%, P = 0.808). All hemodynamic parameters were comparable between groups with the exception of heart rate. Sympathetic obtundation of heart rate was greater with IV fentanyl than topical lignocaine (P < 0.05). The proportion of patients with postoperative sore throat significantly increased with the number of insertion attempts (P < 0.05). Topical lignocaine spray to the pharynx is as effective, and may be an alternative to IV fentanyl, during propofol induction for PLMA insertion. Success rate and optimal insertion condition at the first attempt, propofol requirement, blood pressure, adverse events and airway complications were comparable. Heart rate obtundation was less with topical lignocaine spray but remained within clinically acceptable values.

Dual- vs. Single-Plane Ultrasonic Scan-Assisted Positioning during Lumbar Spinal Puncture in Elderly Patients: A Randomized Controlled Trial.

The purpose of this study was to investigate the ability of single- versus dual-plane ultrasound scan-assisted spinal anesthesia techniques to improve the success rate and efficacy of spinal anesthesia in elderly patients undergoing lower extremity surgery. A total of 120 elderly patients undergoing lower extremity surgery were randomly assigned to either receive single-plane (Group A) or dual-plane ultrasonic scan-assisted spinal anesthesia (Group B). The primary outcome analyzed by this study was first-attempt success rate. Secondary outcomes analyzed included number of needle insertion attempts, needle redirections, locating time, procedural time, total time, puncture depth, quality of ultrasound images, level of block, adverse reactions, and complications. The first-attempt success rate was significantly higher in Group B compared to Group A (88.3% vs. 68.3%, p = 0.008). In comparison with Group A, the number of needle insertion attempts (1 (1–2) vs. 1 (1–1), p = 0.005) and needle redirections (2 (1–3) vs. 1 (0–2), p < 0.001) were both significantly lower in Group B; Group B also had a shorter procedural time (249.2 ± 30.1 vs. 380.4 ± 39.4 s, p < 0.001) but a longer locating time (250.1 ± 26.2 vs. 137.8 ± 13.5 s, p < 0.001). The dual-plane ultrasonic scan-assisted spinal anesthesia technique warrants consideration for application in elderly patients.

Prevalence of peripheral venous cannula-related colonization and infections in pediatric intensive care unit

Background: Intravenous (IV) access exposes patients to risk of catheter-related infections. The source of infection is either microbial colonization of the cannula or contamination of the hub or drugs. The study objectives were to estimate the prevalence of the peripheral venous cannula (PVC)-related infection and the factors associated with colonization and the antibiotic sensitivity pattern of the organisms causing infection. Subjects and Methods: It was a cross-sectional study which included infants and children who required an indwelling PVC. Visual infusion phlebitis (VIP) score was recorded for insertion site changes. Cannula tip and blood were sent for culture and antibiotic sensitivity. Catheter-related bloodstream infection was diagnosed based on bacterial growth in both the cannula tip and blood culture. Results: Out of the 256 children recruited in the study, 57% were males and 13% were undernourished. The most common primary illness was respiratory disease. Cannula tip growth was noted in 8.5%. The PVC colonization rate was 37.9/1000 catheter days. Multivariate analysis showed significant association between the primary illness, multiple attempts for insertion, longer duration of IV fluid use, retention of cannula beyond 96 h, and higher VIP scores &gt;2 and cannula colonization. Conclusions: Apart from strict adherence to infection prevention techniques, disposal of cannula after one failed attempt, changing IV cannula after 96 h, inspection of cannula site to identify phlebitis early, and removal of the cannula when the VIP score is &gt;2 may help to minimize cannula-related colonization and infection.

Role of Endotracheal Tube Cuff Deflation in Facilitating Passage of Nasogastric Tube.

BackgroundNasogastric tube insertion is a routinely performed technique in anesthetized and intubated patients. However, failure leads to repeated insertion attempts causing injury, which makes the situation cumbersome. Therefore, we introduce a simple technique of deflating endotracheal tube cuff for nasogastric tube insertion in such patients.MethodsEighty adult patients scheduled for elective abdominal surgeries were randomly allocated into two groups, Group A (nasogastric tube insertion without endotracheal cuff deflation) and Group B (nasogastric tube insertion with endotracheal tube cuff deflation) along with lateral pressure application at cricoid in both groups. The number of attempts required, overall success rate, the time taken, rescue maneuvers, and incidence of complications were compared between the groups.ResultsIn Group B, the total success rate for nasogastric tube placement was significantly higher than in Group A (80% vs 55%, p=0.016). Group B had a 55% first attempt success rate, but only 25% of patients in Group A had a first attempt success rate (p=0.014). The overall time for successful nasogastric tube placement was longer in Group A than in Group B (65.4 ± 28.72 seconds vs 43.5 ± 25.37 seconds, p=0.0005). The differences in nasogastric tube kinking and coiling between Group B and Group A were not statistically significant (20% vs 22.5%, 10% vs 27.5%, p = 0.78 and 0.08, respectively). Mucosal bleeding was substantially higher in Group A than in Group B (30% vs 10%, p=0.025, respectively).ConclusionsThis study showed that endotracheal tube deflation significantly increased the first-attempt success rate, overall successful placement of the nasogastric tube in intubated patients, and incidence of complications like mucosal bleeding decreased.

A new maneuver for classical laryngeal mask airway insertion: Prospective randomized study

Background/Aim: Laryngeal mask airway (LMA) has been frequently used for airway management. But the satisfaction of the insertion and trauma at insertion remain problems. We present a new insertion maneuver for classical LMA (cLMA) with a partially inflated cuff and examine its success and complication rate.&#x0D; Methods: In 4 months, 158 patients who were classified as ASA I–III and older than 18 years old and were planned for LMA were included in this study consecutively (according to the study design, one patient was excluded during the study). Emergency cases, patients with any contraindications with LMA, patients who were expected to undergo surgery for more than 2 h, patients with preoperative respiratory tract infection or sore throat, patients undergoing oral or nasal surgery, and patients with aspirated oropharyngeal secretions after removal of LMA was excluded from the study. Age, gender, height, weight, ASA scores, comorbidities, and the duration of anesthesia and surgery of the patients were recorded. One-hundred-fifty-seven consecutive patients were randomized into two groups by a coin toss [control group (group C) and study group (group S)]. The groups were compared in terms of LMA insertion success, the number of insertion attempts, the presence of blood on the LMA or in secretions, and postoperative sore throat. Classical Laryngeal Mask Airway was inserted with Brain’s standard technique in group C and with the new technique in group S. In the new technique, the head and neck of the patient were supported in a straight position, the mouth was opened, cLMA was held with a dominant hand from the tube part and inserted until the tip touches to the oropharynx. The index finger of the non-dominant hand was inserted into the mouth to pass by the cLMA and reach the tip of the cLMA. The tip of cLMA was directed to the caudal by the index finger. Then, cLMA was inserted by the guidance of the index finger until it reached the triangular base of the oropharynx.&#x0D; Results: There was no statistically significant difference in terms of demographic data and placement success; placement success was better in the study group (100% versus 98.6% and P = 0.45). Similarly, the count of attempts was better in the study group. The mean attempt number was 1.11 in group S and 1.28 in group C (P = 0.02). Also, blood on LMA was seen to be more common in group C (P = 0.04). There were no statistical differences in sore throat, but it was less seen in group S.&#x0D; Conclusion: The new maneuver was better than the standard technique and easy to use in daily practice.

A comparative study of awakening characteristics after propofol based total intravenous anaesthesia and sevoflurane based volatile induction and maintenance anaesthesia in short surgical procedure

To maintain hemodynamic parameters and rapid emergence is a challenge for anaesthesiologist in emerging era of early recovery. The aim of this study was to assess recovery characteristics of propofol and sevoflurane for induction as well as maintenance of anaesthesia in short surgical procedures. Sixty patients were assigned randomly into two groups. Group P patients were induced with 2mg/kg propofol intravenously followed by infusion of 12mg/kg/hr for 10mins, 10mg/kg/hr for 20 mins and 8mg/kg/hr till end of procedure. Group S patients were induced with 8% sevoflurane in 4L/min nitrous oxide and 2L/min oxygen mixture and maintained with 3.5% sevoflurane with spontaneous breathing. LMA was inserted in all patients. LMA insertion time and insertion attempt were observed. Time from end of procedure to first spontaneous movement, spontaneous eye opening, removal of LMA, followed verbal commands and became fully oriented to time and place, time to achieve Aldrete score ≥9 (phase I recovery) and time to achieve PADSS score ≥9(phase II recovery) were noted. Phase 1 recovery time was less in sevoflurane group as compared to propofol group. Phase 2 recovery time was less in propofol group as compared to sevoflurane group. They were statistically significant. Incidence of both nausea and vomiting was significantly higher in the sevoflurane group. We concluded that sevoflurane provides rapid induction with LMA insertion condition comparable with propofol. Sevoflurane provides early phase I recovery where as home readiness is early with propofol. Sevoflurane can be a suitable alternative to propofol for induction and maintenance.

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.

Trans-illumination Devices: Improving IV Insertion Accuracy and Success Rates

<h3>Background Information</h3> Difficult Venous Access (DVA) patients are a frequent cause of increased preoperative pain scores, increased delays in Preop to OR times, and decreased patient satisfaction with their perioperative experience. Expert vascular access nurses (EVANs) have had little effect changing these key issues. Use of Trans-Illumination Devices (<b>TID</b>s) has demonstrated promising results in alieving some of these issues without increased risk to the patient. <h3>Objectives of Project</h3> The TID pilot was designed to improve patient safety, comfort and satisfaction while decreasing delays in the preoperative area relating to DVA patients. Staff satisfaction with TIDs data was measured through feedback on ease of use, procedure type, and success rates. <h3>Process of Implementation</h3> Staff education was required for the use of the ACCU VEIN red light LED TID. Training included a review of the equipment, proper distancing, settings, and cleaning for patient safety. Real time training was performed on live patients with verbal consent in the Prep and PACU. Data collection included patient Vascular Access Difficulty Level (VADL), number of insertion attempts, and the procedure performed. Post training satisfaction surveys were sent to nursing and clinical technicians to provide feedback on use of the TID. <h3>Statement of Successful Practice</h3> The ACCU VEIN TID was used on 70 patients. VADL A (55) and VADL B (15). It successfully reduced the number of insertion attempts in the DVA population (1^st attempt=62, 2nd attempt=8). Calls for Anesthesia or EVANs were zero. The device gave real time information regarding the location and quality of veins being accessed. Reduction in number of insertion attempts decreased pain and improved patient satisfaction with IV starts. Staff graded the ACCU Vein ease of use (100%), being helpful (90%), and that they would use the device again (99%). <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Use of TIDs in areas where venous access is frequent will improve the quality of patient care and reduce the wait times associated with IV insertion of the DVA patient. Prep/PACUs, Infusion Centers, Emergency Departments, Phlebotomy, and IV therapy would all benefit having TIDs as standard equipment.

Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study

The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion. A multicenter randomized control study. At 5 tertiary care level hospitals. Three hundred sixty-three adult patients undergoing elective cardiac surgery. The patients were randomized into 2 groups-the conventional group (C group; n=177) and the VL group (n=186) for TEE probe insertion. The primary endpoint of the study was the incidence of oropharyngeal injury, which was defined as blood at the tip of the TEE probe at the end of surgery and/or evidence of injury on VL examination at the end of surgery. The secondary endpoints of the study were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. There was a higher incidence of injuries in the C group (n=26; 14.7%) compared to the VL group (n=14; 7.5%; p=0.029). The number of attempts for probe insertion was significantly lower in the VL group (p=0.0023). The most common relation between the esophageal inlet and the larynx was posterolateral (n=88; 47%), followed by posterior (n=77; 41%) and lateral (n=21;12%). The use of VL was associated with a lesser incidence of injury compared to the conventional technique, and its use for this purpose is recommended. The use of VL for probe insertion resulted in fewer attempts compared with the conventional technique. Significant variations do exist in the relation between the esophageal inlet and the larynx, and direct visualization with VL may contribute to better safety.

Straight-tip guidewire versus J-tip guidewire for central venous catheterisation in neonates and small infants: A randomised controlled trial.

Central venous catheterisation in neonates and infants is challenging because of the small size of the vessels. The curve of the J-tip guidewire causes difficulty when inserting because of the larger radius and the tilted angle of the J-tip. We hypothesised that a straight-tip guidewire can facilitate guidewire insertion and improve the first-attempt success rate of central venous catheterisation. A randomised controlled study. This study was performed between September 2018 and July 2021 in tertiary care children's hospital. We enrolled infants weighing less than 5 kg undergoing general anaesthesia. Patients were randomly allocated to the straight-tip or J-tip groups. Ultrasonography-guided catheterisation was performed using the assigned guidewire. The primary outcome was the first-attempt success rate of central venous catheterisation. The secondary outcomes included the number of guidewire insertion attempts, the time required for successful guidewire insertion, and total time for central venous catheter placement. Eighty-eight patients were studied. The straight-tip group showed a higher first attempt success rate than the J-tip group (86.3 vs. 61.3%, P = 0.007, odds ratio 4.0, 95% confidence interval (CI), 1.4 to 11.4]. Guidewire insertion attempts were higher in the J-tip group than in the straight group ( P = 0.002, odds ratio 9.6, 95% CI, 7.9 to 92.9). Although the guidewire insertion time was longer in the J-tip group ( P = 0.003, median difference 23.0 s, 95% CI, 7.0 to 48.0), the total catheterisation time was similar owing to the additional guidewire change process in the straight-tip group ( P = 0.676). In neonates or infants weighing less than 5 kg, central venous catheterisation using a flexible straight-tip guidewire can improve the first-attempt success rate compared with a J-tip guidewire. ClinicalTrials.gov, identifier: NCT03530618.

A Randomized comparative study to observe the safety and efficacy of I gel and blockbuster laryngeal mask airway used in patients undergoing short surgical procedure under general anesthesia

Background and Aims: Blockbuster laryngeal mask airway (LMA), a newer supraglottic airway device, provides a quick and reliable seal of the airway, making it useful for positive pressure ventilation. This randomized comparative study was undertaken to compare the safety and efficacy of I-gel and Blockbuster LMA used in short surgical procedures under general anesthesia. Materials and Methods: Hundred patients of either sex aged between 18 and 60 years belonging to the American Society of Anesthesiologist physical Status I and II undergoing general anesthesia were randomized into two groups of 50 patients each, using either I-gel (Group IG) or Blockbuster LMA (Group BB). After standard monitoring and induction of anesthesia, LMA was inserted according to their randomized groups and adequate ventilation was achieved. The primary objectives were grading of ease of insertion and time taken for successful insertion of device, while number of attempts for insertion, oropharyngeal seal pressure (OSP), hemodynamic changes, and adverse effects such as blood staining of device, injury of lips, tongue and teeth, postoperative hoarseness of voice and sore throat were secondary objectives. Data were analyzed using SPSS version 3.0.0.34. Results: The ease of insertion was graded as very easy in 46 patients in Group BB and 26 patients in Group IG (P &lt; 0.001). The mean time for insertion was less with Group BB (24.30 ± 3.91 s) as compared to Group IG (29.50 ± 12.5 s) (P &lt; 0.0001). 48 patients in Group BB while 37 patients in Group IG (P = 0.008) were required one attempt for insertion. The average OSP was 22.59 ± 1.44 cmH2O in Group BB as compared to 20.88 ± 2.22 cmH2O in Group IG (P &lt; 0.0001). Hemodynamic changes were comparable at different time intervals. Complications such as blood stain of device and sore throat were more with I-gel. Conclusions: The Blockbuster LMA is an effective alternative to I-gel with faster, easier insertion, required a smaller number of attempts, high airway sealing pressure with stable hemodynamic, and less incidence of blood staining and postoperative sore throat.

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies.

To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US). Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies. In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) 'Escalation' is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward-'measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use. DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.

Comparison of Fully Deflated with Partially Inflated Technique for Ease of Insertion of Laryngeal Mask Airways in Adults

Objective: To compare the frequency of ease of insertion of the laryngeal mask airway (LMA) between fully deflated and partially inflated laryngeal mask airway, in anesthetized mechanically ventilated adult patients undergoing different non-emergency short-term surgical and gynecological procedures. Methodology: A total of 104 patients were recruited in this RCT. Using computer generated random numbers, patients were allocated to two groups: fully deflated LMAs in A and partially inflated LMAs in B. Pre-operative assessment was done and informed consent was taken. All subjects were 20–40 years of age, ASA-I and ASA- II, planned for short surgical and gynaecological cases (elective) that required general anaesthesia with mechanical ventilation. Premedication with 2 mg midazolam IV was done 30 minutes before the start of the operation. Monitors were attached. One 18G cannula was maintained. IV fluids were administered to each patient as per patient’s and procedure's requirements. Pre-oxygenation was done with 100% oxygen with a face mask for three minutes. Glycopyrrolate IV 0.2mg/kg and nalbuphine IV 0.15mg/kg were given to all at induction by an anesthetist. Results: In Group A, 98% of patients had ease of insertion while 2% of patients didn’t have ease of insertion, whereas in Group B 90% of patients had ease of insertion and 10% of patients didn’t. Ease of insertion was measured by the number of attempts (first attempt insertion – ease of insertion). Conclusion: Our study concludes that the fully deflated technique is superior as compared to the partially inflated technique in terms of easier insertion in Laryngeal mask airways.

Ultrasound Can Determine Joint Distraction During Hip Arthroscopy but Fluoroscopic-Guided Portal Placement Is Superior

PurposeTo compare joint distraction measured on ultrasound (US) with joint space width (JSW) measured on fluoroscopy in hip arthroscopy and to determine whether ultrasound guidance is as safe and effective as fluoroscopy, the current gold standard, for establishing arthroscopic portals.MethodsCadaveric whole-body specimens were positioned supine and subjected to 60 lbs. of unilateral axial traction using a distal femoral Steinman pin. Joint distraction was measured via JSW on fluoroscopic and ultrasound images. A single, fellowship-trained orthopaedic surgeon established anterolateral arthroscopy portals via ultrasound or fluoroscopic guidance in a randomized sequence. Total procedure time, number of times the spinal needle pierced the capsule, and iatrogenic chondral or labral injury were recorded.ResultsTwelve full-body specimens (20 hips) underwent distraction, and 17 hips underwent portal placement with fluoroscopic (n = 8) or ultrasound (n = 9) guidance. JSW measured on ultrasound was significantly less laterally (13.0 vs 9.2 mm, P < .001), apically (16.7 vs 9.2 mm, P < .001), and medially (17.9 vs 9.2 mm, P < .001). Successful portal entry was achieved in every specimen. Average procedure time was 133 ± 51 seconds for the fluoroscopy group and 371 ± 260 seconds for the ultrasound group (P = .026). Fluoroscopic guidance required significantly less needle insertion attempts at 1.13 compared with 3.33 attempts for ultrasound (P = .022). Labral damage was greater in the ultrasound group at 66.67% compared with 12.50% for fluoroscopy (P = .0497).ConclusionsJoint distraction measured on ultrasound can be used to subjectively determine if the joint is adequately distracted in hip arthroscopy. Ultrasound-guided portal placement was associated with more needle insertion attempts, iatrogenic injury of the labrum, and overall procedure time in comparison to fluoroscopic guidance.Clinical RelevanceFluoroscopy is the gold standard to confirm adequate joint distraction, aid in establishing arthroscopy portals, and evaluate resection of the femoral head during hip arthroscopy but exposes the patient to ionizing radiation, requires additional operators in the operating room, and involves the need for a heavy lead shield. Alternatives to fluoroscopy are needed, but ultrasound has not proven superior in our cadaveric model.

EMS Use and Success Rates of Intraosseous Infusion for Pediatric Resuscitations: A Large Regional Health System Experience

Objective Access of intraosseous (IO) compartments is a commonly used technique that is an invaluable asset in emergency resuscitation. Prehospital IO success rates using semi-automatic insertion devices vary between 70 and 100% of pediatric patients. There are limited data on time to insertion and duration of IO function in the prehospital setting. Recent studies limited to the pediatric emergency department (PED) setting have also suggested that IOs may be less successful in the infant population. We explored the use of IO access for pediatric resuscitation, encompassing the prehospital and pediatric emergency department (PED) settings. Methods This is a retrospective review of emergency medical services (EMS) patient care reports and PED data of patients aged 0–17 years old and transported by regional ground EMS agencies in Southwestern Ontario, Canada from 2012 to 2019. Mean and median time to first insertion and IO function (from insertion to IO failure, IV access, transfer to ICU, or death) were calculated. Results Successful prehospital IO access was achieved in 83.7% of patients. The median time required to achieve IO access was 4 min (IQR 3-7) and mean duration of IO function was 27.6 min (SD: 14.8). Patients less than 1 year old had fewer functional IOs (25.9% vs. 75.0%), more insertion attempts (2 vs. 1), and shorter duration of IO function (18.8 vs. 32.2 mins) than the older age group (p < 0.05). Conclusions This is the first study to provide time to IO access and IO duration in the prehospital setting, and the first prehospital evidence to suggest inferior IO function in infants <1 year old, compared to other ages. This highlights unique challenges for infants that have implications for the PED, interfacility transport, and critical care settings.

Olimpismo: The Olympic Movement in the Making of Latin America and the Caribbean

Olimpismo: The Olympic Movement in the Making of Latin America and the Caribbean

Techniques to Improve Peripheral Intravenous Catheter Placement

Techniques to Improve Peripheral Intravenous Catheter Placement

MP14-18 ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE IMPROVES SUCCESS IN GAINING PERCUTANEOUS ACCESS FOR NEPHROLITHOTOMY BY NOVICES

You have accessJournal of UrologyCME1 May 2022MP14-18 ROBOTIC-ASSISTED ELECTROMAGNETIC GUIDANCE IMPROVES SUCCESS IN GAINING PERCUTANEOUS ACCESS FOR NEPHROLITHOTOMY BY NOVICES Mitchell Humphreys, Kevin Wymer, Ben Chew, Janet Zhen, Fuad Elkhoury, Sri Sivalingam, Matthew Dunn, and Michael Borofsky Mitchell HumphreysMitchell Humphreys More articles by this author , Kevin WymerKevin Wymer More articles by this author , Ben ChewBen Chew More articles by this author , Janet ZhenJanet Zhen More articles by this author , Fuad ElkhouryFuad Elkhoury More articles by this author , Sri SivalingamSri Sivalingam More articles by this author , Matthew DunnMatthew Dunn More articles by this author , and Michael BorofskyMichael Borofsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) offers advantages over retrograde intrarenal surgery for large stone burdens. However, gaining optimal access into the renal collecting system can be challenging and requires advanced training. A minority of PCNL access is currently performed by urologists in the USA. In this study, we evaluate the success of gaining percutaneous renal access in a cadaveric model when using a novel robotic-assisted electromagnetic (EM) guidance platform, compared to fluoroscopic guidance, among individuals that do not regularly perform their own PCNL access. METHODS: Seven novices (individuals who use IR for access, or gain percutaneous access <24 times/year, or have gained access <30 times after training) were asked to use robotic-assisted EM guidance provided by the Monarch® Platform, Urology (Auris Health, Inc., Redwood City, CA) to obtain upper pole, mid-kidney, and lower pole access in a modified-supine position vs. the same tasks in a prone position using fluoroscopy in a cadaveric model. The number of puncture attempts, accuracy (papilla/fornix, infundibulum, or miss), and time to achieve access was compared. Participants were also surveyed on their confidence in gaining access (Likert scale 1-5, 5 as the best score). Statistical comparisons were made using paired t-tests. RESULTS: Novices had increased overall success in gaining percutaneous access using robot-assisted EM navigation compared to fluoroscopy-guided (100% vs. 57%), with greater accuracy (papillary or forniceal) (100% vs. 29%) (Figure 1). Robotic-assisted EM guidance decreased the average number of insertion attempts per calyx (1.24±0.10 vs. 2.98±0.65, p<0.05), and also the time to achieve access (6.92±0.66 min vs. 16.90±3.21 min, p<0.05). Lastly, novices expressed a greater sense of ease [5(3.3-5) vs. 2.5(1-3)] and confidence [5(3.3-5) vs. 2(1-3)] in gaining access using EM- vs. fluoroscopy-guided navigation. CONCLUSIONS: Percutaneous access using robotic-assisted EM-guidance provided by the Monarch® Platform improved access success, time, accuracy, and confidence among study participants. These initial data suggest this novel enabling technology can benefit urologists to routinely gain their own access for PCNL. Source of Funding: Johnson & Johnson © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e239 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell Humphreys More articles by this author Kevin Wymer More articles by this author Ben Chew More articles by this author Janet Zhen More articles by this author Fuad Elkhoury More articles by this author Sri Sivalingam More articles by this author Matthew Dunn More articles by this author Michael Borofsky More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risk factors for postoperative sore throat associated with i-gel™, a supraglottic airway device.

ABSTRACTi-gel™ is a supraglottic airway device widely used for airway management during general anesthesia as an alternative to tracheal intubation. It sometimes results in a sore throat postoperatively; however, the risk factors for a postoperative sore throat caused by i-gel remain unclear. Here, we clarify the risk factors for a postoperative sore throat associated with i-gel insertion. We retrospectively reviewed the data of 426 adult patients who received general anesthesia with i-gel at our institution from January 2018 to December 2019. The incidence of postoperative sore throat and intraoperative data (size of i-gel, number of insertion attempts, total insertion time, and dose of the neuromuscular blocker and opioid) were evaluated. Logistic regression analysis was performed to identify the risk factors. Postoperative sore throat following i-gel insertion occurred in 24/426 patients (5.6%). The insertion time was significantly associated with the incidence of postoperative sore throat in the univariate analysis, but not in the multivariate analysis (P=0.519). Increased doses of neuromuscular blockers before i-gel insertion (odds ratio [OR], 5.46; 95% confidence interval [CI], 1.50–19.80; P=0.001) and reduced doses of intraoperative fentanyl (OR, 0.51; 95% CI, 0.28–0.93; P=0.028) were risk factors in the univariate and multivariate analyses. In the subgroup that used neuromuscular blockers before i-gel insertion, only an increased dose of neuromuscular blocker (OR, 17.2; 95%, CI 1.06–280; P=0.046) was an associated risk factor in the univariate and multivariate analyses. Overall, increased doses of neuromuscular blockers before i-gel insertion could contribute to the development of postoperative sore throat.