Laryngeal Mask Airway Insertion Research Articles

The Relationship Between the Triple Airway Maneuver Insertion Technique and The Success Rate of Laryngeal Mask Airway Installation in Elective Surgery

Background: The Laryngeal Mask Airway (LMA) is a widely utilized supraglottic airway device by anesthesiologists in selective procedures, particularly in cases where intubation is not feasible or when managing a difficult airway. Complicating factors such as a short neck and large tongue can hinder LMA insertion, necessitating the use of the Triple Airway Maneuver (TAM). This technique involves a combination of head elevation, anterior mandible lift, and mouth opening to facilitate airway clearance. Purpose: This study was to evaluate the relationship between the TAM technique and the success rate of LMA insertion during elective surgeries at Dr. Soedirman Kebumen General Hospital. Methods: A cross-sectional, analytic study was conducted in June 2024, involving 52 respondents selected via purposive sampling. Data were collected using observation sheets. Findings: The findings revealed that the majority of respondents were aged 17-25 years (38.5%) and had a body mass index of 18.5-25.0 (73.1%). Non-smokers constituted 73.1% of the sample, while 46.2% had occupations involving repetitive neck movements. The TAM group achieved 45 successful LMA insertions, with 44 succeeding on the first attempt and 1 on the second, compared to 7 successful insertions in the non-TAM group. However, Kendall’s tau c test (p=0.056) indicated no statistically significant relationship between TAM and LMA insertion success rates, and the correlation coefficient (0.385) suggested a weak relationship. Conclusions: the TAM technique does not significantly influence the success rate of LMA insertion

Comparison of the ED50 of Ciprofol Combined With or Without Fentanyl for Laryngeal Mask Airway Insertion in Children: A Prospective, Randomized, Open-Label, Dose-Response Trial.

This study aimed to estimate the effect of different doses of fentanyl on the median effective dose (ED50) of ciprofol for attenuating the airway and motor response to laryngeal mask airway (LMA) insertion response in healthy children. 90healthy preschool patients undergoing inguinal hernia repair surgery were randomly assigned to one of three groups: C0 (ciprofol+saline), C1 (ciprofol + fentanyl 1µg/kg), C2 (ciprofol + fentanyl 2µg/kg). Anesthesia was induced with either prepared fentanyl or saline, followed by ciprofol. The dose of ciprofol for each patient was determined using the up-and-down sequential study design. The primary outcome was the ED50 of ciprofol required for smooth LMA insertion in the three groups. Additionally, the time to loss of consciousness and any perioperative adverse events were recorded. Compared with the C0 group, the ED50 (95% confidence interval) of ciprofol in the C1 and C2 groups were significantly lower (1.81 [1.73-1.90]mg/kg versus 0.67 [0.64-0.71]mg/kg and 0.48 [0.42-0.54] mg/kg, respectively; P<0.05). Additionally, the ED50 of ciprofol in the C2 group was lower than that in the C1 group (0.42 [0.42-0.54] mg/kg vs 0.67 [0.64-0.71]mg/kg; P<0.05). Furthermore, the time to loss of consciousness in the C1 and C2 groups decreased by 60% and 53%, respectively, compared to the C0 group. There were no significant differences in the incidence of drug-related hypotension after anesthesia induction among the three groups. No adverse events of hypoxia, bradycardia, or injection pain were observed in any groups. In healthy, non-obese Chinese children undergoing elective inguinal hernia repair surgery, fentanyl 1µg/kg and 2µg/kg before ciprofol injection significantly reduced the ED50 of ciprofol for attenuating LMA response, with minimal occurrence of severe side effects.

COMPARISON OF TOPICAL AND INTRAVENOUS LIGNOCAINE IN PATIENTS UNDERGOING LARYNGEAL MASK AIRWAY INSERTION UNDER PROPOFOL: A RANDOMIZED CONTROLLED TRIAL

Laryngeal mask airway (LMA) insertion is a common technique used in general anesthesia, but it may induce airway reflexes such as coughing, gagging, and laryngospasm. Lignocaine, whether administered topically or intravenously, is often used to suppress these reflexes. However, the comparative efficacy of these two routes remains unclear. Objective: This study aims to compare the effectiveness of topical versus intravenous lignocaine in facilitating LMA insertion and minimizing airway complications in patients undergoing propofol anesthesia. Methods: A randomized controlled trial was conducted on 62 patients undergoing elective surgeries under general anesthesia at a tertiary care hospital. Patients were randomly assigned into two groups: Group A (n = 31) received 40 mg of topical lignocaine aerosol, while Group B (n = 31) received intravenous lignocaine 1.5 mg/kg. Both groups were induced with propofol (2 mg/kg) prior to LMA insertion. Primary outcomes included the number of LMA insertion attempts, airway responses (coughing, gagging, laryngospasm), and hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) recorded at baseline and 1, 2, and 3 minutes post-insertion. Results: LMA insertion on the first attempt was successful in 93.5% of patients in the topical lignocaine group compared to 74.2% in the intravenous group (p = 0.03). Airway reflexes were significantly lower in the topical group, with coughing, gagging, and laryngospasm rates of 6.5%, 16.1%, and 9.7%, respectively, compared to 32.3%, 45.2%, and 29.0% in the intravenous group (p &lt; 0.05). Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, showed no significant differences between the two groups at baseline or post-insertion. Conclusion: Topical lignocaine significantly improves conditions for LMA insertion compared to intravenous lignocaine, resulting in fewer airway complications while maintaining similar hemodynamic stability. Therefore, topical lignocaine is recommended for optimizing LMA insertion during propofol anesthesia.

Effect of Different Insertion Methods on LMA Protector-Related Complications: A Prospective Randomized Double-Blind Clinical Trail.

The authors compared the effect of 2 insertion methods, namely the conventional laryngeal mask airway (LMA) insertion and the index finger-assisted LMA insertion, on the incidence of complications associated with LMA Protector insertion. The authors enrolled 300 patients, who underwent painless bronchoscopy. The patients ranged in age between 18 and 75 and were classified as American Society of Anesthesiologists grade I to III. They were randomly divided into 2 groups: a control group of 150 patients and an assisted group comprising 150 patients. LMA was inserted using the conventional and index finger-assisted insertion methods in both groups, respectively. The primary outcome was postoperative complications, such as oral mucosal injury and pharyngeal pain. Secondary outcomes included the success rate of first-time insertion, the incidence rate of inverse folding of LMA tips, oropharyngeal leak pressure (OLP), and other postoperative complications. Compared with the conventional LMA insertion method, index finger-assisted LMA insertion can significantly reduce the incidence rate of oral mucosal injury and pharyngeal pain, with fewer insertion failures. There was a statistically significant difference between the 2 groups in the visual field grading before adjustment for LMA alignment (P<0.0001). The conventional insertion method increased the likelihood of inverse folding of LMA tips. When the conventional insertion method was utilized, there was a significant difference in airway pressure and tidal volume before and after alignment under a fiberoptic bronchoscope (P<0.0001), but no significant difference in visual field grading and respiratory mechanics-related indicators. Index finger-assisted insertion can significantly reduce the incidence rate of LMA Protector-related complications and inverse folding of LMA tips.

Video laryngoscopy improves ProSeal™ laryngeal mask airway position by anesthesia residents: A randomized controlled, double-blind study

BackgroundThe insertion of ProSeal laryngeal mask airway (LMA) using a blind digital technique is difficult for inexperienced performers and malpositioning of the device can impair ventilation and may lead to complications. AimThis study aimed to compare the proper ProSeal LMA position inserted by anesthesia residents between video laryngoscopy-assisted and blind digital insertion techniques. MethodsA total of 138 patients aged 18–80 years, ASA I and II undergoing elective surgery, were randomly allocated to the digital or video laryngoscopy-assisted group. Anesthesia residents performed ProSeal LMA insertion. The primary outcome was the proportion of a proper LMA position evaluated by a blinded assessor using the fiber-optic scores. Secondary outcomes included first attempt success rate, duration of insertion, incidence of desaturation during insertion, peak airway and oropharyngeal leak pressure, gastric tube placement difficulty, hemodynamic disturbance, and airway complications at 1 and 24 h after surgery. ResultsPatients in the video laryngoscopy group demonstrated a significantly higher proportion of proper LMA position than those in the digital group (53/68 [78 %] vs. 24/67 [36 %]; RR 2.18 [95%CI 1.54–3.07]; P < 0.001). Using the video laryngoscopy-guided insertion improved the fiber-optic scores by 7.11 folds (95%CI 3.53–14.32; P < 0.001) compared with the digital technique. Patients in the video laryngoscopy group showed higher sealing pressure, easier gastric tube placement, but longer insertion time. There was no significant difference in the peak airway pressure, first-attempt success rate, hemodynamic changes, and airway complications between groups. No desaturation occurred during the study. ConclusionUsing a Macintosh-shaped blade video laryngoscope facilitates novice anesthesiologists in achieving improved ProSeal LMA positioning without compromising airway or hemodynamic complications. The optimal ProSeal LMA position also provides a higher oropharyngeal sealing pressure and easier gastric tube placement.

Study of effect of head elevation in PROSEAL laryngeal mask airway insertion at a tertiary hospital

Background &amp; Aims: Proseal Laryngeal Mask Airway (PLMA) is a supra-glottic airway device that prevents gastric insufflation and pulmonary aspiration. In the present study, we intend to determine the effect of head elevation in PLMA insertion. Methodology: The present study was a single-center, comparative, interventional study, conducted in patients of 18-60 years of age, either gender, American Society of Anaesthesiologists (ASA) grade I-II, patients posted for elective surgical procedures under general anaesthesia. 123 adult patients were randomized into three groups using a random number table. Group C: No head elevation (No pillow), Group LP: 4 cm head elevation (4 cm pillow), and Group HP: 8 cm head elevation (8 cm pillow). Results: PLMA insertion at first attempt was successful in 30 patients (73.17%) in Group C, 40 patients (97.56%) in Group LP &amp; 22 patients (53.66 %) in Group HP, the difference was statistically significant (P &lt;0.001). The mean insertion time of LMA in Group C, Group LP, and Group HP was found to be 21.90 ± 4.48s, 16.12 ± 5.35s, and 25.14 ± 8.79s respectively which was significantly less in Group LP when compared with Group C and Group HP (P&lt; 0.001). The ncidence of blood staining on PLMA was significant in Group HP (20 patients) as compared to Group C (3 patients) &amp; Group LP (2 patients), the difference was statistically significant (P &lt;0.001). Conclusion: A head elevation by a pillow of height of 4 cm was effective for PLMA insertion in adult patients when compared with an 8 cm pillow.

Comparison of Anesthetics for Laryngeal Mask Airway Insertion: A Network Meta-Analysis.

This study aimed to establish which anesthetic agents are associated with minimized adverse outcomes during laryngeal mask airway (LMA) insertion. Databases were searched for randomized controlled trials (RCTs) with American Society of Anesthesiologists I or II adult patients (≥15 years of age) receiving general anesthesia (GA) with an LMA. Propofol only was the comparator to other anesthetics used during LMA insertion. The primary outcome was prolonged apnea, and secondary outcomes were adverse airway events, LMA insertion failure, inadequate depth of anesthesia, and hemodynamic events. A network meta-analysis was conducted to estimate the treatment effects (odds ratios, 95% credible intervals, and surface under the cumulative ranking curve [SUCRA]). A total of 28 anesthetic combinations used on 4695 patients for GA induction and LMA insertion were examined across 53 RCTs. Overall, there was an apnea incidence rate of 33.3% (849 of 2548) with a mean time of 3.74 ± 3.56 minutes (n = 3091). Propofol + dexmedetomidine had the highest overall summed score of SUCRA ranks in reducing adverse outcomes (apnea incidence: SUCRA = 37%, apnea time: SUCRA = 66%, airway adverse event: SUCRA = 67%, insertion failure: SUCRA = 73%, inadequate depth of anesthesia: SUCRA = 84%). In comparison among all propofol combinations, propofol alone ranked lowest for overall summed score of SUCRA in reducing adverse outcomes (apnea incidence: SUCRA = 47%, apnea time: SUCRA = 71%, airway adverse event: SUCRA = 9%, insertion failure: SUCRA = 20%, inadequate depth of anesthesia: SUCRA = 9%). All anesthetic combinations, other than those with thiopental, reduced adverse outcomes as compared with propofol alone. The combination of propofol and dexmedetomidine infused over 10 minutes ranked as the most effective for reducing adverse outcomes during LMA insertion.

The Role of Magnesium Sulfate to Facilitate Classical LMA Insertion, in Spontaneous Breathing Anesthesia

Background: Laryngeal Mask Airway (LMA) is a noninvasive supraglottic device that requires Smooth insertion and correct positioning of an LMA requires adequate through mouth opening and sufficient depth of anesthesia to prevent complications such as gagging, coughing, swallowing, head and limb movements and laryngospasm. Propofol is consider the induction agent of choice for LMA insertion but when used alone it provides less than satisfactory LMA insertion conditions. Aim of the study: Is to find The role Of Magnesium Sulfate to facilitate classical LMA insertion ,in spontaneous breathing anesthesia. Patients and method: A prospective randomizes clinical trial study was carried out in General Surgery theatres of Baghdad Teaching Hospital. A 40 patients where included and they were undergoing minor elective surgery, divided into two groups equally, magnesium group (M group, n=16) and control group (C group, n=18), 6 cases were dropped from the study(2 from C group and 4 from M group). All patients were premeditated with Ranitidine 50mg, Metoclopramide 10mg and Dexamethasone 8mg. Then patient would receive either a 100ml of (0.09% N/S) for the C group, or 30mg/Kg of Magnesium Sulfate in 100ml of (0.09% N/S) for the M group. Results: that there were no significant differences between M group (n=16) and C group (n=18) in the age, weight and duration of surgery where p value was (0.571, 0.791 and 0.351 respectively). Also there was no improvement in LMA insertion condition in M group in compares to C group regarding number of insertion attempt where p value was non-significant(0.498),nor did it influence the easiness of LMA grading were P value was found to be(1,0.112 and 0.471 for grades I,II and III respectively),but an accidental finding that M group had a shorter time duration from skin closure until LMA removal which was significant (p=0.021). Conclusion: We concluded that giving magnesium sulfate infusion at 30 mg/Kg prior to induction, does not improve LMA insertion condition in spontaneous breathing anesthesia.

Dose-response study of propofol combined with two different doses of esketamine for laryngeal mask airway insertion in women undergoing hysteroscopy

ObjectiveTo prospectively determine the median effective dose (ED50) of propofol for inhibiting a response to laryngeal mask airway (LMA) insertion when combined with different doses of esketamine in female patients. MethodsA total of 58 female patients (aged 20–60 years, ASAⅠ–Ⅱ) scheduled for elective hysteroscopy were enrolled and randomly divided into 2 groups, one of which was administered 0.2 mg/kg of esketamine (K1 group, n = 28) and the other 0.3 mg/kg of esketamine (K2 group, n = 30). The 2 groups received the corresponding doses of esketamine intravenously, followed by an intravenous injection of propofol (injection time was 30 s). The initial dose of propofol was 2 mg/kg, and the dose ratio of propofol in the adjacent patients was 0.9. If a positive reaction occurred due to LMA insertion, the dose ratio in the next patient was increased by 1 gradient; if not, the dose ratio was decreased by 1 gradient. The ED50, 95 % effective dose (ED95) and 95 % confidence interval (CI) of propofol for inhibiting a response to LMA insertion in the 2 esketamine groups were calculated using probit analysis. ResultsThe ED50 of propofol for inhibiting a response to LMA insertion in female patients was 1.95 mg/kg (95 % CI, 1.82–2.08 mg/kg) in the K1 group and 1.60 mg/kg (95 % CI, 1.18–1.83 mg/kg) in the K2 group. The ED95 of propofol for inhibiting a response to LMA insertion in female patients was 2.22 mg/kg (95 % CI, 2.09–2.86 mg/kg) in the K1 group and 2.15 mg/kg (95 % CI, 1.88–3.09 mg/kg) in the K2 group. ConclusionPropofol combined with 0.3 mg/kg of esketamine has low ED50 and ED95 effective doses for inhibiting an LMA insertion response in female patients undergoing hysteroscopy and surgery. There were no significant adverse effects, but the additional dose of propofol and airway pressure were significantly higher than those in the group administered 0.2 mg/kg of esketamine. Based on the results, we recommend the combination of propofol with 0.2 mg/kg esketamine for optimal conditions during LMA insertion in women undergoing hysteroscopy.

A comparison of the time course of action and laryngeal mask airway insertion conditions with different doses of mivacurium for day-case urologic surgery in children: a prospective cohort study.

To investigate the time course of action of different doses of mivacurium and determine the appropriate dose for laryngeal mask airway (LMA) insertion for day-case urologic surgery in children. A total of 105 patients who enrolled in this study between March 2021 and December 2021 were randomised into 3 groups: Group A (mivacurium 0.15 mg/kg, n = 35), Group B (mivacurium 0.20 mg/kg, n = 35) and Group C (mivacurium 0.25 mg/kg, n = 35). The different doses of mivacurium were injected before LMA insertion. The primary outcomes included the grading of conditions for the LMA insertion-18 score, onset time, recovery index and the duration that mivacurium was effective. Secondary outcomes included pulse oxygen saturation, mean blood pressure, heart rate and the incidence of adverse events. The score of the conditions for LMA insertion in Group A was significantly lower than in Groups C and B (p < 0.005). There was a significant difference in the onset time between Groups B and A (p < 0.005). There was no significant difference in the overall incidence of adverse reactions between these groups (p > 0.05). Anaesthesia with 0.2 mg/kg of mivacurium can effectively shorten the onset time and facilitate insertion of the LMA in children undergoing day-case urologic surgery.

Effective dose of propofol combined with intravenous esketamine for smooth flexible laryngeal mask airway insertion in two distinct age groups of preschool children

BackgroundThere is limited research on the combined use of propofol and esketamine for anesthesia induction during flexible laryngeal mask airway (FLMA) in pediatric patients, and the effective dosage of propofol for FLMA smooth insertion remains unclear. We explored the effective dose of propofol combined with intravenous esketamine for the smooth insertion of FLMA in two distinct age groups of preschool children.MethodsThis is a prospective, observer-blind, interventional clinical study. Based on age, preschool children scheduled for elective surgery were divided into group A (aged 1–3 years) and group B (aged 3–6 years). Anesthesia induction was started with intravenous administration of esketamine (1.0 mg.kg− 1) followed by propofol administration. The FLMA was inserted 2 min after propofol administration at the target dose. The initial dose of propofol in group A and group B was 3.0 mg.kg− 1 and 2.5 mg.kg− 1, respectively. The target dose of propofol was determined with Dixon’s up-and-down method, and the dosing interval of propofol was 0.5 mg.kg− 1. If there was smooth insertion of FLMA in the previous patient, the target dose of propofol for the next patient was reduced by 0.5 mg.kg− 1; otherwise, it was increased by 0.5 mg.kg− 1. The median 50% effective dose (ED50) for propofol was estimated using Dixon’s up-and-down method and Probit analysis, while the 95% effective dose (ED95) was estimated through Probit analysis. Vital signs and adverse events during induction were recorded.ResultsEach group included 24 pediatric patients. Using Dixon’s up-and-down method, the ED50 of propofol combined with esketamine for smooth insertion of FLMA in group A was 2.67 mg.kg− 1 (95%CI: 1.63–3.72), which was higher than that in group B (2.10 mg. kg− 1, 95%CI: 1.36–2.84) (p = 0.04). Using Probit analysis, the ED50 of propofol was calculated as 2.44 (95% CI: 1.02–3.15) mg.kg− 1 in group A and 1.93 (95% CI: 1.39–2.32) mg.kg− 1 in group B. The ED95 of propofol was 3.72 (95%CI: 3.07–15.18) mg.kg− 1 in group A and 2.74 (95%CI: 2.34–5.54) mg.kg− 1 in group B. In Group B, one pediatric patient experienced laryngospasm.ConclusionThe effective dose of propofol when combined with intravenous esketamine for smooth insertion of FLMA in children aged 1–3 years is 2.67 mg.kg− 1, which is higher than that in children aged 3–6 years (2.10 mg. kg− 1).Trial registrationChinese Clinical Trial Registry Center (Registration Number: ChiCTR2100044317; Registration Date: 2021/03/16)

Impact of Oropharyngeal Stimulation during Laryngeal Mask Insertion on Cardiovascular Response in adult patients. A Double-blind Clinical Trial Study.

Laryngeal mask airway (LMA) insertion has been found to reduce cardiovascular responses when compared to laryngoscopy and intubation. This research aimed to examine the impact of various techniques employed for LMA insertion on cardiovascular response. This randomized, double-blind clinical trial included 90 elective surgery candidates divided into three groups of 30. All patients underwent similar anesthesia. The LMA was inserted using the classical technique, 180° rotation technique, and face-to-face triple maneuver technique (FFTMT). The cardiovascular responses, the success rate of LMA placement, and other outcomes were documented and compared among the three methods. The study revealed that the blood pressure of patients 10 minutes after LMA insertion using the rotational technique was higher than the standard technique (p=0.019). The pulse rate in the third (p=0.044, p=0.024) and fifth minutes (p=0.028, p=0.048) following the insertion of LMA demonstrated higher values when utilizing the FFTMT than the standard and rotational technique groups, respectively. Moreover, the incidence of sore throat following surgery in the FTFTM group was slightly greater than that observed with the standard and rotation techniques (p=0.389 and p=0.688, respectively). The findings of the present investigation indicated that implementing the classic technique for LMA placement resulted in a more consistent blood pressure (BP) and pulse rate (PR) response than the 180° rotation and FFTMT. Furthermore, the classical method exhibited a marginally lower success rate in terms of LMA insertion than the alternative methods.

Application of Laryngeal Mask Airway (LMA) in Medium and Short Period Traumatic Orthopedic Surgeries

Objective:Application of Laryngeal Mask Airway (LMA) as a ventilation method has been rarely explored in short and medium period orthopedic operations. In this study, we evaluated ventilatory efficacy of LMA in patients admitted to Ho Chi Minh City Orthopedic and Rehabilitation Hospital, Vietnam via a number of patient indicators including changes of pulse, blood pressure, airway pressure, SpO2 and pressure of CO2 at the end of an exhaled breath (EtCO2).&#x0D; Method: A total of 154 emergency and elective surgery cases with anesthesia were selected for the study.&#x0D; Result: One minute after LMA insertion to discontinuation of anesthetic, we recorded slower pulse of patients but only twenty-six cases (16.9%) required intravenous administration of atropine. Blood pressure of patients dropped after 1 minute following LMA insertion but then recovered afterward and only nine cases (5.8%) needed administration of ephedrine.&#x0D; Conclusion: After surgery, only eleven (7.15%) patients experienced oral mucosal bleeding but no further special treatment was used.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 207-213

Comparison of remimazolam tosylate and propofol in patients undergoing general anesthesia using a laryngeal mask airway without muscle relaxants

It has been reported that anesthesia using propofol can frequently induce hypotension. Herein, we designed this study to compare the incidence of hypotension induced by propofol or remimazolam during laryngeal mask airway (LMA) anesthesia without muscle relaxants. 95 patients aged 18 to 65 years undergoing LMA anesthesia without muscle relaxants were randomly allocated to two groups. After 0.2 µg/kg sufentanil, Group P received a bolus dose of 2 mg/kg propofol followed by a continuous propofol infusion, while Group R received a bolus dose of 0.3 mg/kg remimazolam followed by a continuous remimazolam infusion. The primary outcome was hypotension, defined as systolic blood pressure falling below 90 mmHg during anesthesia. Secondary outcomes included other adverse events. The success rate of initial LMA insertion, LMA insertion conditions, LMA removal time and changes in bispectral index (BIS) and hemodynamics during anesthesia induction, were also assessed. The results showed that the incidence of hypotension was not significantly different between the two groups (47.9% in group P and 36.2% in group R, p = 0.246). However, the BIS and heart rate during induction of anesthesia were significantly higher in group R than in group P (p &lt; 0.05). Also, hiccups were more common in group R than in group P (14.9% vs. 2.1%, p = 0.031), and the LMA removal time was significantly longer in group R than in group P (12 min vs. 8 min, p = 0.001). We did not find a significantly lower incidence of hypotension in patients undergoing LMA anesthesia without muscle relaxants when comparing remimazolam to propofol, potentially related to the study’s small sample size, and conducting a large-scale study using similar conditions could be inappropriate due to the risk of remimazolam-induced hiccups.

Comparing the Efficiency of Laryngeal Mask Airway and Endotracheal Tube Insertion in Airway Management in Patients Planning for Elective Orthopedic Surgery under General Anesthesia: A Randomized Clinical Trial.

The present study compared respiratory parameters between the two methods of airway establishment, ETT and LMA, for patients scheduled for orthopedic surgery with general anesthesia. This randomized double-blinded clinical trial was conducted on patients scheduled for elective orthopedic surgery under general anesthesia, in Bandar Abbas, Iran, from January 2021 to December 2021. Using a random allocation table, the study participants were randomly divided into two groups, to employ either ETT (n=48) or LMA insertion (n=48). The study's ultimate goal was to assess the respiratory parameters in 1, 3, 5, 10, and 15 minutes following intubation. At all-time points, the average of peak airway pressure (P peak) and P plateau parameters in the ETT group was much higher than the EMA group (p<0.001 in all comparisons). The value of dynamic lung compliance in the LMA group was significantly higher than the ETT group in all considered time periods (p<0.001 in all comparisons). The upward trend in the value of this index was significant only in the LMA group (p=0.030). There were no significant differences in arterial oxygen saturation and end-tidal carbon dioxide levels between the two groups (p>0.05). In terms of arterial oxygen saturation stability and at the same time providing respiratory dynamic compliance, the LMA device outperformed the ETT.

Exploring the ED50 and ED95 of Remimazolam for Laryngeal Mask Airway Insertion During General Anesthesia in Pediatric Strabismus Correction Surgery.

Remimazolam, known for its rapid onset, quick metabolism, and short recovery time from sedation, offers significant advantages in clinical anesthesia. Previous studies have primarily investigated its application in adult surgical anesthesia, with less focus on its utilization in pediatric patients. Therefore, we aimed to explore the 50% effective dose (ED50) and 95% effective dose (ED95) of remimazolam for laryngeal mask airway (LMA) insertion during general anesthesia in pediatric strabismus correction surgery and investigate its dose-response relationship, thereby providing valuable reference data for safer and more rational clinical use of remimazolam. This study included 32 patients aged 3-12 years undergoing strabismus correction surgery at Ningbo Aier Guangming Eye Hospital in 2024. The dosage of remimazolam was determined according to the Dixon 'up-and-down' sequential method: the starting induction dose was 0.2 mg/kg, with a step dose of 0.05 mg/kg. In cases of positive anesthetic effect, the subsequent patient received a reduced step dose, while in cases of negative anesthetic effect, the next subject received an increased step dose. The trial was terminated upon observing seven "positive-negative" crossover points. Furthermore, the ED50 and ED95, along with their 95% confidence intervals (95% CI) were calculated using the Probit regression analysis. Additionally, vital signs of the patients, such as peripheral oxygen (SpO2), heart rate, and blood pressure, along with the incidence of adverse events, were monitored. The ED50 of remimazolam for LMA insertion in pediatric strabismus correction surgery was 0.300 mg/kg (95% CI 0.276-0.323 mg/kg), and the ED95 was 0.369 mg/kg (95% CI 0.324-0.414 mg/kg). Throughout the surgery, SpO2, heart rate, and blood pressure remained stable without any significant fluctuations. The ED50 and ED95 of remimazolam for LMA insertion in pediatric strabismus correction surgery are 0.300 mg/kg and 0.369 mg/kg, respectively. This study demonstrates that remimazolam is both safe and effective for LMA insertion during general anesthesia in pediatric strabismus correction surgery.

Effect of Intranasal Remifentanil versus Lidocaine on Facilitation of Laryngeal Mask Airway Insertion and Cardiovascular Response: A Double-blind Clinical Trial Study.

This study aimed to assess and compare the effects of intranasal administration of lidocaine and remifentanil on the condition of LMA insertion and cardiovascular response. From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg, the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its insertion were investigated. In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try (p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference was observed. In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the cardiovascular response to LMA insertion, but it did not outperform lidocaine.

Conditions for Insertion of the Laryngeal Mask Airway in an Innovative Method vs the Classic Method.

A laryngeal mask airway (LMA) is a simple and non-invasive device used to establish the airway and maintain ventilation and oxygenation during short-duration medical procedures. This study aimed to compare the placement of an LMA using an innovative technique vs the classic method. This clinical trial was conducted at Faiz Hospital in Isfahan. Out of 110 candidates for elective eye surgery, 10 patients were excluded from the study as they did not meet the inclusion criteria. Ultimately, 100 patients were randomly allocated to 2 groups of 50 each. One group underwent LMA insertion using the classic method, while the other group underwent insertion using the face-to-face triple maneuver technique (FFTMT). Data, including laryngeal mask insertion conditions, hemodynamic responses, and clinical complications, were collected, entered into SPSS version 26, and analyzed. There were no significant differences between the 2 groups in terms of laryngeal mask placement time (P = 0.061), number of attempts to place the LMA (P = 0.059), oropharyngeal leak pressure (OLP; P = 0.942), frequency of hoarseness (P > 0.99), or laryngospasm (P > 0.99). However, it is noteworthy that FFTMT appeared to provide easier placement of the LMA (P < 0.0001), required fewer attempts, and offered better quality of ventilation with a lower presence of blood on the cuff (P = 0.038). Conversely, the FFTMT group had a higher frequency of sore throat (P < 0.0001). The performance of LMA using FFTMT is comparable to the classic method. In procedures under general anesthesia where the surgeon has access to the patient's head and neck (such as cataract surgery), airway management with LMA using FFTMT (while maintaining the patient's sterile covering) appears to be effective in case of an emergency.

Comparison of Standard and Lateral Methods of Laryngeal Mask Airway Insertion in the Management of Pediatrics Airway

Background: The Laryngeal Mask Airway (LMA) has traditionally become an alternative device for airway management. This clinical trial compared two standard and lateral techniques in inserting laryngeal masks in pediatric airway management.&#x0D; Methods: This single-blind clinical trial study was conducted on pediatrics aged 2-6 years who were candidates for elective inguinal herniorrhaphy with ASA I and II under general anesthesia. The pediatrics were randomly assigned to either the standard or lateral methods according to the random number table. The time required to insert LMA and airway pressure as well as the number of attempts to insert in both groups were measured. Data analysis was performed using SPSS version 25; the significance level was less than 0.05.&#x0D; Results: Chest movement and mean airway pressure had no significant difference in both groups (p&gt;0.05). The mean LMA insertion time in the lateral and standard methods was 22.94±7.89 and 65±15.27 seconds, respectively (p=0.001). There was no case of mucosal damage in the lateral method, but ten children had mucosal damage in the standard technique (p=0.001). In the lateral method, LMA was inserted for the first time in 32 pediatrics (94.1%) and two pediatrics (5.9%) in the second time but in the standard group, LMA was inserted in the second time in 11 pediatrics (32.4%) (p=0.006).&#x0D; Conclusion: The lateral method for inserting LMA is practically easy, requires less effort, and has the least complications. Another advantage of the lateral method compared to the standard technique is that inserting a finger into the pharyngeal cavity is unnecessary.

A COMPARISON OF MIDAZOLAM AND MINI DOSE SUXAMETHONIUM TO FACILITATE LARYNGEAL MASK AIRWAY INSERTION DURING PROPOFOL ANESTHESIA

This study aimed to compare the effectiveness of two different drug combinations used for general anesthesia during laryngeal mask airway (LMA) insertion. One group received Propofol-Midazolam (PM), and the other Propofol-Suxamethonium (PS). The study assessed pre-insertion conditions like mouth opening, gagging, coughing, patient movements, and laryngospasm, as well as hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) in both groups. It also studied patient responses after LMA insertion, including apnea, cyanosis, desaturation (SpO₂ &lt; 90%), aspiration/regurgitation, and airway injury. The primary objectives of the study were to compare the ease and success of LMA insertion when using Propofol with Midazolam and Propofol with low-dose suxamethonium and to compare variations in hemodynamic and the occurrence of complications during and after LMA insertion. The study included 110 male and female patients aged 18-40, classified as ASA 1 &amp; 2, and scheduled for surgery under general anesthesia. The patients were randomly assigned to the PM and PS groups, and non-probability sampling was employed. In the PM group, patients were given intravenous midazolam (0.04 mg/kg) four minutes before induction with propofol (2.5 mg/kg), while in the PS group, patients received suxamethonium (0.1 mg/kg) 30 seconds after induction with propofol (2.5 mg/kg). Nalbuphine (0.1 mg/kg) was administered to all patients as an analgesic before surgery. The adequacy of anesthesia was assessed by the loss of response to verbal commands and the absence of excitatory movements. Patients were evaluated for their response to LMA insertion attempts, including the absence of excitatory movements, mouth opening, and the number of attempts required. Patient responses to gagging, coughing, movements, laryngospasm, desaturation, and apnea duration were noted. Hemodynamic changes before induction, as well as before and after LMA insertion, were recorded. Data was entered into SPSS version 15, and the mean standard deviation was calculated for age, weight, SBP, DBP, MAP, HR, SpO₂, and apnea duration. Qualitative and quantitative data were analyzed using the chi-square test and t-test, respectively, with significance set at a p-value &lt; 0.05. Laryngeal masks were successfully inserted into the hypopharynx in the first attempt in 100% of patients in both the PM and PS groups. Gagging and patient movements were observed in only 4 (7.27%) out of 55 patients in the PM group. Hemodynamic variations more significant than 20% from baseline (before anesthesia induction) were compared before and after LMA insertion. Significant differences between the PM and PS groups were observed in SBP, DBP, MAP, and HR (p &lt; 0.05). The apnea duration was 2.10 ± 1.51 minutes in the PM group and 1.01 ± 0.49 minutes in the PS group, with a significant p-value of 0.044. However, there were no cases of SpO₂ falling below 90% in either group. The study concluded that midazolam and a small dose of suxamethonium during propofol anesthesia were comparable in terms of ease and success of LMA insertion. The PM group exhibited better hemodynamic stability than the PS group, except for apnea duration, which was shorter in the PS group. There was no significant difference in SpO₂ levels between the two groups.