Insertion Technique Research Articles

Sven Ivar Seldinger (1921-1998): The Founding Father of Interventional Radiology.

Sven Ivar Seldinger, a Swedish radiologist, laid the cornerstone of modern interventional radiology in 1953 with the introduction of his innovative technique for catheter insertion. This technique, known as the Seldinger technique, represents a pivotal advancement in medical procedures, offering a safer, less invasive method for vascular access. The elegance and effectiveness of this technique not only refined angiography and other catheter-based interventions but also heralded the birth of interventional radiology as a major therapeutic specialty. This article delves into Seldinger's life, the genesis of his technique, its profound impact on medical practice, and his enduring legacy that continues to resonate across numerous medical specialties today. By pioneering minimally invasive approaches to treatment, Seldinger's innovation has significantly alleviated patient risk and discomfort, broadening the spectrum of therapeutic options available in modern medicine.

L-PRF como alternativa para tratamento de Comunicações Bucossinusais: uma revisão integrativa

Oroantral communication is defined as a direct access between the sinus cavity and the oral cavity. This condition is often accidentally caused during the dental extraction of a tooth whose roots are closely associated with the floor of the maxillary sinus, in addition to oral pathologies and even traumas. The technique of using the L-PRF membrane associated with flaps is widely used for extensive communications and has several advantages. The present study aims to analyze the efficacy of L-PRF in the treatment of existing oroantral communications in the most current literature. An integrative literature review was conducted to list and analyze the efficacy of L-PRF in tissue healing when obtaining the closure of oroantral communications. Scientific articles from 2014 to 2023, published in full in Portuguese and English, were selected and excluded were literature reviews and systematic reviews, articles in languages other than Portuguese and English, repeated articles in the databases, and articles that deviated from the theme proposed in the guiding question chosen. The data search was conducted in Google Scholar, LILACS, and PubMed, through the combination, using the Boolean operator “AND,” of the descriptors in English: “Oroantral Communication,” “L-PRF,” “Maxillary Sinus.” A total of 205 articles were found, but only 9 satisfactorily met the listed criteria. After a careful analysis, it was observed that the authors suggest that the use of the L-PRF membrane insertion technique for tissue healing involved in oroantral communication associated with sutures or flaps for its closure is feasible, effective, and widely spread in modern Dentistry.

To Assess Knowledge and Practice among Nurses Regarding Prevention of Catheter-Associated Urinary Tract Infection

Background:Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection among patients with indwelling urinary catheters. The role of nursing staff is crucial in preventing these infections through proper knowledge and practices. Objective:To assess the knowledge and practices among nurses regarding the prevention of catheter-associated urinary tract infections in a tertiary hospital in Lahore, Pakistan. Methods:This descriptive cross-sectional study was conducted among 164 nurses from various departments, including medical, surgical, and gynecological units. Nurses with more than one year of experience were included, while student nurses and head nurses not directly involved in patient care were excluded. Data were collected through a survey assessing knowledge and practices related to CAUTIs. The sample size was determined using Solvin's formula. Ethical approval was obtained, and participants gave informed consent. The data were analyzed using IBM SPSS Statistics Version 25.0 for descriptive statistics, including frequencies and percentages. Results:The majority of participants were female (85.4%), and most were aged between 31 and 35 years (50%). About 51.2% of the nurses had 6 to 10 years of experience, and 46.2% had received prior information or training on catheter-related urinary tract infections. The majority of participants (92.8%) knew that CAUTIs result from prolonged catheter use, and 95.7% were aware that aseptic technique with sterile equipment is crucial for catheter insertion. However, only 67.4% used a sterile technique for insertion, and 79.3% did not perform daily catheter care. The overall knowledge level was low for 29.3% of participants, moderate for 43.5%, and high for 16.3%, while the practice level was poor for 52.2% and good for 37%. Conclusion:Nurses demonstrated moderate knowledge but poor practices in preventing catheter-related urinary tract infections, indicating the need for targeted interventions and educational programs to bridge the gap and enhance patient care.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns – a retrospective clinical study

ObjectivesTo assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality.Material and methodsIn a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan–Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed.ResultsThe cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration.ConclusionsBoth CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management.Clinical relevanceCIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial

Abstract Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility. Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance. Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups. Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.

Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study.

This study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections. We conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017-2019) in a large tertiary-level neonatal intensive care unit in Qatar. A total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions. The study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.

Evaluation of a Safety-Engineered Peripherally Inserted Intravenous Catheter With Multiple Access Blood Control: Clinician Acceptability and Ease of Use

Highlights Abstract Aim: Acceptability of a new safety-engineered peripherally inserted intravenous catheter (PIVC) with multiple access blood control (MBC) was evaluated in this observational study by experienced volunteer clinicians on healthy volunteers. Methods: Clinicians and healthy volunteers were recruited for this study. Observers documented study procedures, including if there was any blood leakage from the catheter hub at various times during hub connections and disconnections and how many attempts it took a clinician to get a successful stick. Clinicians responded to yes-or-no and Likert-scale questionnaires describing their experiences with PIVC with MBC after each procedure. Questionnaire data were summarized by frequency and percent of responses; analyses were conducted using binomial statistics. Results: Overall, clinicians considered PIVC with MBC to be acceptable (93.6% agreement). Clinicians were able to easily remove the catheter protective cap, insert the catheter, visualize primary and secondary flashbacks, easily remove the needle from the catheter hub and determine if the safety clip was activated after withdrawing the needle. In addition, they were able to connect or disconnect and flush extension sets. Clinicians did not have to change their insertion technique, found the catheter easy to insert, and believed the catheter would protect them from blood exposure during insertion of the catheter and subsequent hub accesses (agreement ranged from 82.3% to 98.9%). Conclusions: No blood leakage was observed from the catheter hub at any time during the procedures. Overall, clinicians found the new PIVC with MBC to be acceptable, easy to use, and functioned properly.

Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518

INTRODUCTION: Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs. METHODS: All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test. RESULTS: A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020. CONCLUSION: Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.

6301667 Different anaesthetic techniques for cervical cerclage insertion and their influence on patient outcomes

6301667 Different anaesthetic techniques for cervical cerclage insertion and their influence on patient outcomes

Pseudo-tunneling procedure for PICC-ports catheters insertion in patients with small veins at the middle third of the arm.

Axillary vein in the brachial tract or Basilic vein in the proximal third of the arm usually present a diameter wide enough to receive a catheter of 5 Fr. Therefore, a peripherally inserted central catheters with port (PICC-Ports) cannot be positioned in these areas. Pseudo-tunneling procedure allows the positioning of the Port in the middle part of the arm without using tunnelers during insertion of PICC with Port in patients who present deep veins of the arm too small to receive a PICC-Port catheter. The aim of this study was to present our experience with pseudo-tunneling procedure during the positioning of the PICC-Port, while using a particular variation of the technique already described for PICCs and midline. From January to December 2023, 103 PICC-Ports were placed in adult patients. Ninety catheters were tunneled from the puncture of the axillary vein at the proximal arm point, while we used this new technique in 42 patients by the same trained team of Vascular Access Unit at ASST Spedali Civili Hospital of Brescia. All procedures were successfully performed at the first attempt. No insertion related complications were observed. Our data suggest pseudo-tunnelling is a safe and effective technique for PICC-Ports insertion avoiding central venous catheterization, even in patient with small vein at the arms.

Synthesis of Dendrimer-Like Molecules with Partial Carbon Chain via Iterative Single Unit Monomer Insertions.

Carbon-chain dendritic polymers hold unique properties and promising applications. However, synthesizing carbon-chain dendrimers, beyond conjugated ones, remains a challenge. Here, the use of the iterative single unit monomer insertion technique for synthesizing 2.5 generation partial-carbon-chain dendrimers (G2.5) is described, utilizing bismaleimide as the core, a maleimide-trithiocarbonate conjugate as the branching unit, and indene as the spacer unit, following a divergent growth strategy. The optimized conditions for synthesizing the maleimide-trithiocarbonate branching unit are a bismaleimide to trithiocarbonate ratio of 5:1 and a reaction time of 30 min. The structures are verified using 1H nuclear magnetic resonance, gel permeation chromatography, and matrix-assisted laser desorption/ionization-time of flight mass spectra. A four-arm star polymer is then synthesized using the G2.5 as the core. This synthesis of a partial-carbon-chain dendrimer establishes a foundational step toward creating all-carbon-chain ones and may open new application avenues in material science.

A New, Safe, and Effective Technique for Percutaneous Insertion of a Peritoneal Dialysis Catheter.

A properly functioning peritoneal catheter is an essential element of effective peritoneal dialysis (PD). Currently, there are three techniques available for PD catheter placement, which include open surgery, laparoscopic surgery, and percutaneous catheter placement (PCP). Currently, no particular catheter placement approach has been proven with certainty to provide superior outcomes. We present a new modified PCP method with the use of the Veress needle covered with an intravascular catheter (IC) and preliminary clinical results of PD catheter placements with this new technique. The endpoints used in the study were 1-year technical survival of the catheter, and the incidence of early (1 month) mechanical as well as infection complications. The catheter was implanted in 24 patients. The catheter survival rate was 100%; however, in two cases, the catheters were removed due to complications not associated with PD treatment. No early mechanical complications such as bleeding, hematoma, perforations, internal organ damage, exit site leaks, or hernia in the place of insertion were observed. Similarly, no early infectious complications were observed. During the 1-year follow-up, no catheter migration occurred. Our results showed that the new PCP technique is a safe and easy procedure that minimizes the occurrence of both mechanical and infectious complications and ensures good catheter survival.

An Adaptive Steganography Insertion Technique Based on Cosine Transform

In the last couple decades, several successful steganography approaches have been proposed. Least Significant Bit (LSB) Insertion technique has been deployed due to its simplicity in implementation and reasonable payload capacity. The most important design parameter in LSB techniques is the embedding location selection criterion. In this work, LSB insertion technique is proposed which is based on selecting the embedding locations depending on the weights of coefficients in Cosine domain (2D DCT). The cover image is transformed to the Cosine domain (by 2D DCT) and predefined number of coefficients are selected to embed the secret message (which is in the binary form). Those weights are the outputs of an adaptive algorithm that analyses the cover image in two domains (Haar and Cosine). Coefficients, in the Cosine transform domain, with small weights are selected. The proposed approach is tested with samples from the BOSSbase, and a custom-built databases. Two metrics are utilized to show the effectiveness of the technique, namely, Root Mean Squared Error (RMSE), and Peak Signal-to-Noise Ratio (PSNR). In addition, human visual inspection of the result image is also considered. As shown in the results, the proposed approach performs better, in terms of (RMSE, and PSNR) than commonly employed truncation and energy based methods.

The Insertion and Management of Gastrostomies in Children in the United Kingdom – A Survey of Practice

BackgroundGastrostomy insertion is one of the most frequently performed procedures by specialist paediatric surgeons. We aimed to determine practice across the United Kingdom (UK) and in particular to identify areas where there was consistency or variation in practice between practitioners and centres. MethodsA structured survey was distributed to all consultant practitioners who insert gastrostomies in the UK. Practice surrounding a range of aspects of gastrostomy care including insertion technique, device use, post-operative management and subsequent care were determined. ResultsOf total 135 practitioners who insert gastrostomies, responses were received from 103 (76%) with responses received from all UK centres. There was variation between centres in the provision of pre-operative information, and between practitioners in preferred device, insertion techniques, post-operative feeding practice and change/removal procedures. The most frequently preferred device for primary gastrostomy insertion was a Freka® PEG (36%) button device (30%), CorFlo™ PEG (21%), or G-tube (10%). Laparoscopy was always used when inserting either PEG or button device by over 50% of respondents and selectively used by the majority of the remainder. Feeds were started between 1 and 24 h post-insertion, most practitioners (64%) plan a minimum one night hospital stay but a third plan for more than one night. ConclusionThere is considerable variation in practice for most stages of the pathway for children having a gastrostomy. Further work is warranted to understand the relationship between different practices and patient outcomes, resource use and cost and subsequently to develop best practice guidelines. Level of Evidence3.

Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests.

(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.

External Fixation Before Planned Conversion to Internal Fixation in Orthopaedic Trauma: Controversies and Current Trends.

External fixation is a widely used technique for a myriad of bone fractures and pathologies in all extremities. Despite its widespread use, controversies and unknowns still exist. This review article seeks to discuss current literature surrounding pin insertion technique, pin-site care, intraoperative use during conversion to definitive fixation, the relationship of pin sites to definitive fixation, and pin-site management after removal for temporary external fixation.

Metronome-guided cochlear implantation for slower and smoother insertions of lateral wall electrodes

IntroductionAchieving a slow and smooth electrode array insertion is paramount for preserving structural and functional integrity during cochlear implantation. This controlled study evaluates the efficacy of a metronome-guided insertion technique in enhancing the smoothness and speed of electrode array insertions.MethodsIn a prospective cohort study, patients undergoing cochlear implant surgery between 2022 and 2023 with lateral wall electrode arrays were included. Metronome guidance was delivered through an acoustic signal via headphones during electrode array insertion in cochlear implantation and compared to a control group without metronome-guidance.ResultsIn total, 37 cases were evaluated, including 25 conventional insertions and 12 metronome-guided insertions. The results indicate that metronome-guided insertions were significantly slower (− 0.46 mm/s; p < 0.001) without extending the overall procedure time. This can be attributed to fewer paused sections observed in the metronome-guided technique. Moreover, metronome-guided insertions exhibited superior performance in terms of insertion smoothness and a reduced number of re-gripping events.ConclusionsThe findings support the recommendation for the systematic application of metronome guidance in the manual insertion of cochlear implant electrode arrays, emphasizing its potential to optimize surgical outcomes.

Comparative evaluation of three types of fiber orientation techniques on fracture resistance of endodontically treated premolars restored with composite resin: An in vitro study

ABSTRACT Introduction: A new technique of fiber reinforcement (horizontal + base fiber [HBF]) in the restoration of endodontically treated teeth (ETT) with composite resin was proposed. Aim: This study aims to compare three different types of fiber orientation techniques on fracture resistance of ETT. Materials and Methodology: Sixty intact extracted human maxillary premolars were assigned to five groups (n = 12). Group 1 intact teeth (control). The teeth in Groups 2–5 received endodontic treatment and a MOD cavity preparation and restored with composite resin with polyethylene fiber at different positions. Group 2: No fiber group (NF), Group 3: Occlusal fiber group (OF), Group 4: Horizontal fiber group (HF), and Group 5: HBF group. After thermocycling, the specimens were loaded using a universal testing machine until fracture and the fracture patterns were analyzed. Statistical Analysis: The data were analyzed statistically using analysis of variance with Tukey’s post hoc test (fracture load) and Chi-square test (fracture patterns). Results: Fiber-reinforced groups (OF, HF, HBF) showed significantly higher fracture resistance compared to NF group (P &lt; 0.05). No significant differences in fracture resistance were observed between (a) fiber-reinforced groups (OF, HF, HBF) and intact teeth (P &gt; 0.05) (b) amongst the fiber-reinforced groups (OF, HF, HBF) (P &gt; 0.05). With regard to fracture patterns, no significant differences were observed between the study groups (P &gt; 0.05). Conclusion: Restoring ETT with different techniques of fiber reinforcement resulted in the improvement of the fracture resistance comparable to that of intact teeth. The newly proposed technique of fiber insertion might be considered as an alternative to earlier techniques for the reinforcement of ETT.

A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients.

Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.

Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy

ABSTRACT Objectives A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques. Methods In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed. Results OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups. Conclusion The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion. Clinical trial registration www.ctri.nic.in identifier is CTRI/2022/10/046269