Successful Insertion Research Articles

Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: protocol for a stratified randomized controlled trial.

Performing spinal anesthesia in elderly patients with spine degeneration is challenging for novice practitioners. This stratified randomized controlled trial aims to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) performed by novice practitioners in elderly patients. This prospective, single-center, stratified, blocked, parallel randomized controlled trial will include 168 patients (aged ≥ 65years) scheduled for elective surgery involving spinal anesthesia. All spinal punctures will be performed by anesthesiology interns and residents trained at Huadong Hospital. Patients will be randomly assigned to the MRasp group (n = 84) or the LGsp group (n = 84). Based on each intern/resident's experience in spinal puncture, participants will be stratified into three clusters: the primary group, intermediate group, and advanced group. The primary outcome will be the comparison of the rate of successful first-attempt needle insertion between the MRasp group and the LGsp group. Secondary outcomes will include the number of needle insertion attempts, the number of redirection attempts, the number of passes, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. A stratified subgroup analysis will also be conducted for interns/residents at different experience levels. The findings from this trial establish the effectiveness of MRasp by novice practitioners in elderly patients. This trial may provide experimental evidence for exploring an effective visualization technology to assist in spinal puncture. Chinese Clinical Trials Registry ChiCTR2300075291. Registered on August 31, 2023. https://www.chictr.org.cn/bin/project/edit?pid=189622 .

A Prospective Randomised Comparative Study of Baska Mask and I-Gel for Airway Management in Elective Surgeries: Focus on Airway Sealing Pressure, Insertion Time, and Haemodynamic Response

Introduction: General anesthetic procedure requires a safe and open airway. Endotracheal intubation is the gold standard for airway management; it is being replaced by supraglottic airway devices because they are easy to introduce, better tolerated and results in a lesser haemodynamic response. As both the Baska mask and I-gel have a non-inflatable self-sealing mechanism, these two devices were compared in our study in terms of time taken for insertion, airway sealing pressure, the number of attempts, hemodynamic changes, and complications. Methods: A Prospective comparative study was conducted on 90 patients (45 in each group), aged 18-60 years, undergoing elective surgeries under general anesthesia at Tertiary care Hospital, Madurai. Patients were randomized into two groups using the computer generated statistical software STATA version14 (Texas, USA): Group B: Airway was secured by insertion of Baska mask. Group I: Airway was secured by insertion of I Gel. Following assessments were done to evaluate the SAD: Time taken to insert the device, airway sealing pressure, rate of successful insertion, number of attempts, Haemodynamic parameters, laryngopharyngeal morbidity. Data were analyzed using Student t-tests and chi-square tests, with p < 0.05 considered significant. Results: The mean airway sealing pressure of the Baska mask (26.1+6.1 cmH2O) was significantly higher than that of the I-gel (23.1± 5.9 cmH2O) with a P value of 0.019 which was statistically significant. In our study the time taken to insert the device, for Baska mask it was 18.9+4.1 seconds and for the I gel it was 17.2±5.1 seconds with a P value of 0.089 which was statistically insignificant. In our study there was no statistical difference between Baska mask and I-gel groups in regards to hemodynamic changes (Heart rate and Mean arterial pressure). This may be due to the same stress response produced by the both devices. Conclusion: Baska mask is superior to I-gel in positive pressure ventilation under general anaesthesia for short surgical procedures with statistically significant higher airway sealing pressure though it has comparable time of insertion, haemodynamic changes and laryngopharyngeal morbidity.

Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first-pass success in adults with obesity? A systematic review.

Preprocedural ultrasound (PPU) reduces the risk of technical failure in non-obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first-pass needle insertion success for neuraxial anesthesia in patients with obesity. We conducted a systematic review without meta-analysis, due to the small number of included studies. The study protocol was registered (PROSPERO: CRD42022368271). We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library from January 1, 1980 to October 1, 2022 for peer-reviewed randomized controlled or observational studies comparing PPU versus landmark techniques in patients with body mass index >30 kg/m2. The quality of evidence was assessed using the revised Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations Assessment, Development, and Evaluation approach. There were nine randomized controlled studies, comprising 866 patients having lumbo-sacral neuraxial techniques. Three studies utilized a small handheld ultrasound device called Accuro™ and six utilized non-handheld ultrasound devices. Certainty of evidence was low for improving the first-pass success rate. There was evidence (moderate certainty) that PPU decreased number of passes, increased first insertion attempt success, and reduced number of insertion attempts. There was no evidence that PPU affected identifying time, needling time, or overall procedural time. There was no evidence that PPU influenced procedural failure rate (very low certainty evidence) and insufficient evidence to suggest that artificial intelligence-supported handheld devices were superior to conventional ultrasound devices. In patients with obesity, there is evidence of very-low to moderate certainty that PPU improves markers of insertion success, with no indication of increased adverse effects. PPU should be used to reduce attempts. Further studies adhering to standardized outcome definitions are required for definitive recommendations. The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022368271).

Comparative Study Of Proseal Laryngeal Mask Airway Versus Cuffed Endotracheal Tube In Patietns Undergoing Laparoscopic Cholecystectomy Under General Anesthesia

Background: LC is a surgical technique that uses a set of cameras and specially designed instruments to remove the gallbladder through a series of small abdominal incisions. Due to their low invasive nature, laparoscopic surgeries are considered day care procedures. As a result, patients undergoing laparoscopic procedures now get less invasive airway management, such as PLMA, rather than ETT. Nowadays, SADs are frequently employed in the control of airways, falling somewhere among tracheal tubes and face masks both in terms of structural placement and degree of invasiveness. These devices provide a hands-free approach to seal an airway against gas. The two most often utilized methods for managing airways are endotracheal intubation and LMA ProSeal The present study aimed to compare the efficacy and safety of ProSeal LMA with Endotracheal Tube in patients undergoing Laparoscopic Cholecystectomy under general anaesthesia. To compare ProSeal LMA and Endotracheal tube with respect to intra-operative haemodynamic responses in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Materials and Methods: The study was carried out at the Department of Anaesthesiology, Katihar Medical College & Hospital, Katihar, Bihar, study was done for 1 Year, 60 individuals were enrolled, Group S (Study Group) with 30 patients received ProSeal LMA (PLMA) with an introducer and Group C (Control Group) with 30 patients received a cuffed Endotracheal Tube (ETT). Every variable was subjected to statistical analysis within the same individual and between 2 treatment categories using a suitable biostatistical methodology. Results:. The PLMA required fewer attempts for successful insertion compared to ETT (1.63±0.49 vs 2.03±0.89, p=0.034). NGT insertion was quicker with PLMA compared to ETT. The PLMA group showed lower EtCO2 levels at multiple time points compared to the ETT group. The PLMA group had a lower incidence of sore throat and nausea but a higher incidence of airway trauma compared to the ETT group. The PLMA group had a higher rate of device removal without complications (93.3% vs 80%) and smooth postoperative recovery (90% vs 80%) compared to the ETT group. Conclusion: In conclusion, our study demonstrates that the ProSeal Laryngeal Mask Airway (PLMA) offers several advantages over the conventional cuffed Endotracheal Tube (ETT) in patients undergoing laparoscopic cholecystectomy under general anesthesia. The PLMA was associated with easier insertion, more stable hemodynamics, effective ventilation, and a smoother postoperative course

No reimbursement policy and implantable loop recorders in the real world setting

Abstract Background Prolonged heart rhythm evaluation is indicated in patients with suspected arrhythmias. Routine electrocardiographic Holter monitoring is often associated with poor adherence and may lead to little to no clinically relevant findings. Implantable loop recorders (ILRs) are small, subcutaneous cardiac devices providing semi-continuous electrocardiographic recording. Despite strong evidence supporting their effectiveness, ILRs are yet to be fully reimbursed by the National Health Fund- the public insurer in Poland. Purpose We aimed to investigate the feasibility, as well as the diagnostic yield of ILRs in a real world setting of a tertiary cardiovascular center. Methods We retrospectively analyzed data of consecutive patients admitted for ILR implantation between March 2013 nad November 2023. Hospitalization and procedural costs were covered by the clinic's statutory and hospital funds and not by the National Health Fund, the public payer. All patients were remotely monitored for device follow-up. Baseline demographic characteristics, as well as data regarding observation period, clinical outcomes and safety were collected. Results Data for 51 ILR implants in 50 patients was assessed. Insertion success rate was 100% on first attempt with no complications. Mean age was 54,43 ±18,56 years old. 52,94% of patients were female. Coronary artery disease was present in 21,57% patients, hypertension in 50,98%, diabetes in 13,73%. The indications for ILR implantation were unexplained syncope (n= 42; 82,35%), palpitations (n= 16; 31,37%), ischemic stroke of unknown origin (n= 6; 11,76%), monitoring of ventricular arrhythmia (n= 2; 3,92%). Mean time between occurrence of first symptoms and ILR implantation was 80,86 ±112,95 months. Mean monitoring period was 1067,62 ±668,89 days. 23 (45,1%) patients had an actionable event detected. Mean time to clinical outcome was 190,34 ±514,85 days. Based on the obtained recordings, in 13 (25,49%) patients a cardiac electronic device was implanted and 6 (11,76%) underwent an electrophysiological procedure. Time to intervention was 435,17 ± 542,9 days and 338,8 ± 273,44 days, respectively. ILR prompted medication modification in 14 (27,45%) patients. Antiarrhythmic drugs were modified in 6 (11,76%) patients. Oral anticoagulation was initiated in 3 (5,88%) patients. Mean time to any pharmacotherapy modification was 654,68 ± 604,32 days. Skin infections occurred in 2 patients, leading to early device removal. Conclusions This is the first study to present a comprehensive evaluation of ILR patients in Poland, along with a substantial observation period. We report a high prevalence of treatable cardiac conditions in patients with previous unsuccessful diagnostic work up. In the light of the upcoming favourable changes in governmental healthcare policy, demonstrating evidence supporting ILR application in everyday clinical practice is crucial for advocating their wider utilization and reimbursement.

Comparing the Functional Analysis of Baska® Mask with I-gel in Short Surgeries - A Prospective Randomized Trial.

We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel. The study design involves prospective randomized controlled trial. The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP). Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher's exact test. Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001). For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.

Wire-in-needle versus conventional syringe-on-needle technique for ultrasound-guided central venous catheter insertion in the internal jugular vein: the WIN randomized trial.

There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance. We tested the hypothesis that the wire-in-needle technique reduces the time to successful guidewire insertion in the internal jugular vein compared with the syringe-on-needle technique in adults. We randomized 250 patients to the wire-in-needle or syringe-on-needle technique. Our primary endpoint was the time to successful guidewire insertion in the internal jugular vein. Two hundred and thirty eight patients were analyzed. The median (25th percentile, 75th percentile) time to successful guidewire insertion was 22 (16, 38) s in patients assigned to the wire-in-needle technique and 25 (19, 34) s in patients assigned to the syringe-on-needle technique (estimated location shift: 2s; 95%-confidence-interval: - 1 to 5s, p = 0.165). CVC insertion was successful on the first attempt in 103/116 patients (89%) assigned to the wire-in-needle technique and in 113/122 patients (93%) assigned to the syringe-on-needle technique. CVC insertion-related complications occurred in 8/116 patients (7%) assigned to the wire-in-needle technique and 19/122 patients (16%) assigned to the syringe-on-needle technique. The wire-in-needle technique-compared with the syringe-on-needle technique-did not reduce the time to successful guidewire insertion in the internal jugular vein. Clinicians can consider either technique for ultrasound-guided CVC insertion in adults.

AQUISIÇÃO E DESENVOLVIMENTO DAS COMPETÊNCIAS DE LEITURA E ESCRITA

The process of acquiring and developing reading and writing skills constitutes a fundamental and extremely relevant stage for the student’s social insertion and academic success, especially in societies that value written language. This study aims to contribute to deepening knowledge about the methods of acquiring and developing reading and writing in children during the literacy process. The importance of this knowledge in the training of new educators is emphasized, as well as the challenges associated with the educational process. The purpose of this article is to understand the process of acquiring and developing reading and writing skills. To this end, a qualitative methodological approach was adopted, which included an exploratory and careful review of the literature, selecting relevant works that allowed the organization and synthesis of ideas according to their importance, aiming to establish the central ideas for solving the research problem. In this context, the discussion is not limited to choosing between literacy or literacy, but rather the harmonization of these two processes, guaranteeing students the appropriation of the alphabetic-spelling system and the ability to use the language in social practices of reading and writing. It is observed, therefore, that the most effective and productive pedagogical action is the one that integrates, in a simultaneous and articulated way and literacy.

Safety and efficacy of thermo-expandable metallic stent in ureteral stricture following gynecological malignancy surgery and radiotherapy: a single center experience with 33 cases.

The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors. In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed. The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4% (SD = 5.2%) in eight months, 77.4% (9.1%) in 12 months and 67.7% (SD = 12%) in 29 months, while the cumilative survival rate was 87.5% (SD = 11.5%) in 29 months. The stent patency was 81.48% and later complications of stent indwelling were 5/27, including refractory urinary tract infection (UTI) in three cases, stent migration, and stent intolerance respectively. The creatinine levels, hydronephrosis degree, and glomerular filtration rate improved after the operation, and the first two indicators were statistically significant. Memokath stent is a safe and effective treatment for ureteral stricture after surgery and radiotherapy with or without chemotherapy for gynecological tumors.

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

Vein Visualisation Technology for Peripheral Intravenous Access in Paediatric Patients: A Clinical Decision-Making Tool.

The aim of this study is to develop a clinical decision-making tool to guide utilisation of vein visualisation technologies and enhance chances of successful peripheral intravenous catheter (PIVC) insertion, using data collected from a vascular access team in a large paediatric medical centre in the United States. Quantitative two-phase, cluster analysis design. The study consisted of the following two phases: (1) a quantitative retrospective chart review to evaluate clinician utilisation and preference for vein visualisation technologies and (2) a quantitative prospective design, including a post-discharge retrospective chart review, to confirm utilisation of vein visualisation technologies and factors influencing clinician decision-making. A total of 16 groups were created based on the cluster analysis and expert clinician input. The results of first-attempt success analyses identified optimal device recommendations for each of the 16 patient groups. For patients older than 2 years old, the NIR device was more likely to result in first-attempt success regardless of BMI or access site and the NIR device was most optimal for almost all categories of paediatric patients regardless of BMI or access site. The transilluminator was found to be the most optimal device to use with younger patients (< 2 years old) who are underweight. Vein visualisation technology is recommended by professional nursing organisations to improve PIV access. Yet, adoption of this useful technology to aid selection of an optimal vein for insertion and visualisation during insertion is limited. This is the first study to develop a clinical decision-making tool for vein visualisation technology in PIVC insertion. Vein visualisation technology allows for a rapid, thorough assessment of patients' vasculature to determine an optimal site for PIVC placement beyond what is visible to the naked eye or achievable using traditional methods. The tool was designed to guide healthcare professionals towards successful first attempt PIVC insertions, thereby improving patient outcomes and efficiency of care. None.

Vasopressor or advanced airway first in cardiac arrest?

BackgroundWhile resuscitation guidelines emphasize early vasopressor administration and advanced airway management, their optimal sequence remains unclear. We sought to determine the associations between vasopressor-airway resuscitation sequence and out-of-hospital cardiac arrest (OHCA) outcomes in the Pragmatic Airway Resuscitation Trial (PART). MethodsWe analyzed data from the PART trial. For each patient we determined times of first vasopressor administration (epinephrine or vasopressin), and successful advanced airway insertion (laryngeal tube or endotracheal tube). We classified each case as vasopressor-first or advanced airway-first. We used Generalized Estimating Equations to determine associations between vasopressor-airway sequence and outcomes (72-hour survival, return of spontaneous circulation (ROSC) on emergency department arrival, survival to hospital discharge, hospital survival with favorable neurologic status) and CPR outside of recommended parameters (chest compression fraction <0.8, chest compression rate <100 or >120 per min, or ventilation rate <8 or >12 breaths/min), adjusting for confounders. ResultsOf 3,004 patients in the parent trial, we analyzed 2,404, including 1,821 vasopressor-first and 583 advanced airway-first. Median intervention times: ALS arrival-to-vasopressor 8 min (IQR 6–11) and ALS arrival-to-airway 11 min (8–15). Compared with airway-first, vasopressor-first sequence was not associated with 72-hour survival (adjusted OR 0.96; 95% CI: 0.71–1.31), ROSC (0.83; 0.66–1.06), hospital survival (1.09; 0.68–1.73), or hospital survival with favorable neurologic status (0.97; 0.53–1.78). Vasopressor-first sequence was not associated with non-compliance with recommended CPR performance parameters. ConclusionsVasopressor-airway resuscitation sequence was not associated with OHCA outcomes or CPR quality.

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study.

Children and their families have reported peripheral intravenous catheter (PIVC) insertion as the most stressful part of their emergency department (ED) encounter, with some enduring multiple attempts without a successful insertion. The purpose of this study was to identify factors associated with abandonment of paediatric PIVC insertion. A retrospective cohort study was conducted at the Gold Coast University Hospital. All patients 16 years of age and younger, presented in 2019 with a PIVC insertion attempted in the ED were eligible. The electronic medical records were screened by two reviewers to identify those who required a PIVC insertion. Logistic regression analysis was performed to assess variables associated with PIVC insertion abandonment. Of 6394 records screened, 2401 (8.3%) had a PIVC insertion attempted, with 99 (4.1%) being abandoned. Age <12 months was the strongest predictor of PIVC abandonment at a rate of 11.3% (38/336), with a >10-fold increased risk for infants less than 3 months old and 3-12 months old; adjusted odds ratio (95% confidence interval) 12.4 (5.1-30.2) and 14.8 (5.8-37.4), respectively. Indications of 'infection' or 'rehydration' were associated with a decreased likelihood of abandonment when compared to 'investigation only' in multivariate modelling (odds ratio (95% confidence interval): 0.181 (0.099-0.332) and 0.262 (0.100-0.686), respectively). This study suggests the rate of PIVC insertion abandonment in children is relatively infrequent. However, more than one in 10 children aged <12 months had PIVC attempts without successful insertion. PIVC abandonment was less likely when there was an indication that necessitated PIVC insertion, such as a serious bacterial infection.

Comparison of Tracheal Intubation Using the Air-Q ILA and LMA Blockbuster Among Adults Undergoing Elective Surgery: A Randomized Controlled Trial.

Air-Q intubating laryngeal airway (ILA) is associated with a 58-77% success rate in blind intubation. The newer laryngeal mask airway (LMA) blockbuster is specially designed to facilitate easier endotracheal intubation and may have a higher success rate. The current study aimed to compare the success rate of endotracheal intubation using the Air-Q ILA and LMA blockbuster. After ethics committee approval and informed written consent, 140 adult patients with normal airways who were scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were recruited for this randomized controlled trial. Blind endotracheal intubation was performed using the Air-Q ILA in group A and the LMA blockbuster in group B with special maneuvers and/or tubes in the second attempt. Fibreoptic bronchoscope (FOB) guidance was used in the third attempt if required. The primary outcome was the success rate of intubation without FOB assistance. The number of attempts for supraglottic airway (SGA) insertion, the time taken for SGA insertion, and the overall intubation time was also noted. The success rate of intubation without FOB guidance was significantly higher in group B than in group A [91.4% vs 55.7%; relative risk (RR) 1.68; (95% confidence interval (CI) 1.34, 2.11); p<0.0001]. The number of attempts for SGA insertion was similar in groups A and group B [87% vs 90%; RR 1.03; (95% CI-0.92, 1.16); p=0.60]. The times for successful SGA insertion and endotracheal intubation were also similar between the groups. The LMA blockbuster offers a significantly higher success rate for endotracheal intubation without FOB guidance than the Air-Q ILA in adult patients with normal airways. However, an increased success rate was achieved with the use of a specially designed flexible endotracheal tube and maneuvers.

Comparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.

The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. PubMed, EMBASE, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing I-gel and Fastrach SGD in adult patients undergoing intubation. The primary outcome was the first-pass success rate for tracheal intubation. Secondary outcomes were tracheal intubation time, SGD insertion time and success, and complications. We computed risk ratios (RRs) to assess binary end points and weighted mean differences (WMDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome and its subgroup analysis (P < .05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes (P < .01 was considered statistically significant). This study included a total of 14 RCTs encompassing 1340 patients. The results indicated a significant difference in the first-pass success rate favoring Fastrach (RR, 0.81; 95% CI, 0.67-0.98; P = .03; I² = 91%). In the subgroup analysis, when a flexible scope was utilized through I-gel, providers achieved a better tracheal intubation first-pass success rate (RR, 1.05; 95% CI, 1.01-1.11; P = .03; I² = 0%), compared with the Fastrach. Overall intubation success rates (RR, 0.92; 99% CI, 0.82-1.04; P = .08, I² = 92%) and time (WMD - 1.03 seconds; 99% CI, -4.75 to 2.69; P = .48; I² = 84%) showed no significant difference irrespective of the device used. There was no significant difference regarding device insertion time by the providers (WMD -6.48 seconds; 99% CI, -13.23 to 0.27; P = .01; I2 = 98%). Success rates of the providers' initial SGD insertion and complications such as sore throat (RR, 1.01; 99% CI, 0.65-1.57; P = .95, I² = 33%) and blood presence post-SGD removal (RR, 0.89; 99% CI, 0.42-1.86; P = .68, I² = 0%) showed no significant difference. Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.

The Effectiveness of the Gnana Laryngeal Mask Airway II (GLA-II) With Novel Suction Tubing in Gastrointestinal (GI) Cases.

The Gnana laryngeal mask airway II (GLA-II) is a supraglottic airway device similar to the classic laryngealmask airway, except it has an additional suction port. This suction port allows for the removal of secretions and saliva. A previous version of the Gnana laryngeal airway 4 was made of silicone, while this newer version is made of polyvinyl chloride (PVC), which is more affordable. This study aimed to demonstrate the effectiveness and tolerability of this PVC-designed GLA-II and evaluate its ability to suction secretions. The prospective cohort study included 100 gastrointestinal (GI) cases to determine the effectiveness and toleration of the GLA-II. The American Society of Anesthesiologists (ASA) class 1-3 patients were evaluated with a Mallampati airway score for GI-related procedures. After anesthesia induction with propofol, the GLA-II was inserted, and the time for successful insertion was recorded. All cases were completed within 62 minutes. During this time, the secretion volumes were also measured. One hundred patients were included in the study: 52% were males and 48% were females. Thirty-four patients were scored as ASA class 1 or 2, while 66 were scored as ASA class 3. The GLA-II insertion was successful on the first attempt in 92 patients, and a second attempt was necessary for six patients. It was unsuccessful in two patients. The average time for successful insertion was 28.3 ± 4.3 seconds. The average amount of saliva suctioned was 9.3 ± 2.6 mL. There were no intraoperative or postoperative complications during these cases. The PVC GLA-II device is distinguished by its ability to allow suctioning during placement. With an adequate epiglottic seal, it can be safely and successfully inserted in a short period of time. More research should be conducted to explore the use of GLA-II devices in other settings, such as emergencies and life-saving scenarios.

SP6.3 - Comparison of three new wireless non-radiation techniques for localization of non-palpable breast cancer - an updated systematic review and pooled meta-analysis

Abstract The method for finding non-palpable breast cancers has evolved due to technological advancements. New wire-free techniques have made implantation and retrieval easier with improved oncological outcomes. Although some evidences are available as to reduced requirement for re-operation with wireless techniques when compared to wire, in current clinical practice, the choice of selection amongst wireless technique depends on clinician preference and there is a lack of consensus. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non radiation localisation techniques, such as Magseed (Magnetic seed), Radiofrequency identification tag (RFID) and Savi-scout reflector localization from published literature over the last 3 years. Literature search as per PRISMA guidelines revealed twenty-six studies from 2020 to 2022 involving 6275 innovative agents analysing the 3 groups were identified. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10 -15%) and a re-excision rate of 11.29% (95%CI, 9 -14%) for all 3 innovative technique combined whereas studies that compare innovative techniques with wire, showed higher positive margin rate of 14.87% (95% CI, 12-18%) and re-excision rate of 16.23% (95% CI, 14-18%) for wire localization, along with considerable heterogeneity. In sub group analysis with Kruskal-Wallis test, there were no statistical significance for margin (p 0.797) and re-operation (p 0.464) rates between each group. Consolidated insertion and retrieval success for innovative group were 98.13% and 99.13% respectively. To establish the best localization approach, future RCT's will be required to assess quantitative cost-effective analyses.

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

The impact of preoperative ureteral stent duration on retrograde intrarenal surgery results: a RIRSearch group study.

A JJ stent placed before retrograde intrarenal surgery (RIRS) may ease the procedure. However, it is important to note that a prolonged duration of double J stent (DJS) placement before RIRS may increase the risk of postoperative urinary tract infection (UTI). Various publications have established this association, although the duration of the DJS before surgery is scarce. Our study investigates the relationship between the pre-stenting period and postoperative UTI and establishes a cut-off period to minimize this risk. We included a total of 500 cases with preoperative DJS prior to RIRS. The patients were divided into five groups according to their preoperative stenting duration (Group 1: 0-15 days; Group 2: 16-30 days; Group 3: 31-45 days; Group 4: 46-60 days; Group 5: >60 days). Demographic and clinical data of the patients, stone properties, operation data, perioperative and postoperative complications (including fever and UTI), hospitalization time, and stone-free rates (SFR) were compared. The groups contained 53, 124, 102, 63, and 158 patients. The demographics of the patients in each group were similar. There was no statistically significant difference between DJS duration, perioperative/postoperative complications, and SFR, except for the ureteral access sheath (UAS) insertion rate. (p = 0.001). The postoperative fever/UTI rate was the lowest in Group 1 (p = 0.046) compared to other durations. Stent duration does not impact SFR. Longer stents enhance UAS insertion success but increase postoperative infection risk. Our results suggest that RIRS should be performed within two weeks, ideally 20 days following stent insertion, to minimize postoperative infection risk.