Laryngeal Mask Airway Anesthesia Research Articles

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 < 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.

Effects of positive end expiratory pressure during laryngeal mask airway anesthesia on respiratory parameters and abdominal pain in cataract surgery

Introduction: The purpose of this study was to evaluate the effects of positive end expiratory pressure (PEEP) on respiratory parameters and abdominal pain in patients ventilated with a laryngeal mask during cataract surgery. Methods: This clinical trial study included 80 patients in need of cataract surgery (40 in the group without PEEP and 40 in the group with PEEP at 5 cmH2O) who underwent laryngeal mask ventilation during general anesthesia. The parameters of dynamic compliance, pressure peak (Ppeak), tidal volume, SpO2, EtCO2, heart rate, non-invasive blood pressure, and abdominal pain were recorded at intervals of 1, 5, 10, and 20 minutes after the start of anesthesia and were compared between the two groups. Results: Respiratory parameters, heart rate and systolic and diastolic blood pressure were not significantly different between two groups, and only the mean tidal volume at 5, 10, and 20 minutes was significantly higher in the group without PEEP. Conclusion: Application of 5 cmH2O PEEP during ventilation with laryngeal mask in patients undergoing cataract surgery had no significant effect on improving respiratory parameters and pain in the gastric area.

Comparison of volume-controlled and pressure-controlled ventilation during laryngeal mask airway anesthesia in cataract surgery

Introduction: Most patients undergoing eye surgery are elderly adults with underlying cardiovascular diseases. One of the complications during recovery is gastric insufflation, which can cause detrimental effects on cardiovascular patients. The present study compares two methods of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). Methods: The study enrolled 81 patients undergoing cataract surgery (41 in the PCV group and 40 in the VCV group). According to the American Society of Anaesthesiologists (ASA) classes I and II received general anaesthesia and laryngeal mask airway (LMA) ventilation using VCV or PCV. Maximum pressure (Ppeak), dynamic compliance, expiratory tidal volume, Spo2, non-invasive blood pressure, heart rate, and pain in the epigastrium and umbilical region were monitored at intervals of 1, 5, 10, and 20 minutes after the initiation of anaesthesia and the results of two groups were compared. Results: The means of Ppeak and tidal volume in the PCV group as well as the means of dynamic compliance and end-tidal carbon dioxide (EtCO2) in the VCV group were significantly high. The mean diastolic blood pressure was significantly different between two groups at 20th minute. There were no significant differences in heart rate, mean systolic blood pressure, arterial oxygen saturation, or abdominal pain between two study groups. Conclusion: VCV had a lower Ppeak and a higher dynamic compliance, but PCV had a larger tidal volume and lower EtCO2. There were no differences in terms of abdominal and umbilicus pain, as well as hemodynamic parameters, between two groups.

Application of laryngeal mask airway anesthesia with preserved spontaneous breathing in children undergoing video-assisted thoracic surgery.

To investigate the feasibility and safety of non-intubated general anesthesia with spontaneous breathing combined with paravertebral nerve blocks (PVNB) in young children undergoing video-assisted thoracic surgery (VATS) and to determine its significance for rapid recovery after pediatric thoracic surgery. The data of 46 children aged 6-36 months with an American Society of Anesthesiologists status of I-II who underwent elective VATS under general anesthesia were retrospectively analyzed. Of these patients, 25 underwent non-intubated general anesthesia with spontaneous breathing combined with PVNB (non-intubation group), and 21 received conventional intubated general anesthesia combined with local infiltration anesthesia (intubation group). The following perioperative parameters were compared between the two groups: heart rate (HR), mean arterial pressure, saturation of pulse oximetry (SpO2), partial pressure end-tidal carbon dioxide, time from the completion of the operation to extubation or removing laryngeal masks, time to first feeding after the operation, length of postoperative in-hospital stay, incidence of postoperative complications, and hospitalization expenses. The operations were completed successfully in both groups. When the non-intubation group was compared with the intubation group, the minimal SpO2 level during the surgery was higher (93% vs. 88%, P < 0.001), which might indicate better oxygenation. There was no significant difference of the duration of surgery and intraoperative blood loss between two groups. Compared to the intubation group, the duration of anesthesia (P = 0.027), time from the completion of the operation to extubation (P < 0.001), time to the first feeding after surgery (P < 0.001), and length of postoperative in-hospital stay (P < 0.001) were significantly reduced in the non-intubation group. The incidence of postoperative complications was not significantly different. Non-intubated general anesthesia with spontaneous breathing combined with PVNB is safe and feasible in young children undergoing VATS and can promote rapid recovery in young children undergoing thoracoscopic surgery.

The effect of the laryngeal mask airway on the outcomes of the endoscopic tympanoplasty

Aim: Chronic otitis media is a common disease characterized by a tympanic membrane perforation and conductive hearing loss. Tympanoplasty is performed to provide a healthy middle ear and to create an intact eardrum. In recent years, endoscopic tympanoplasty has become more popular for the repair of the tympanic membrane. This method saves time for the surgeon and provides a comfortable opportunity for the patient.Endotracheal intubation (ET) and laryngeal mask airway (LMA) are two different airway systems used in general anesthesia. It is known that LMA provides shorter operating times for surgeries requiring general anesthesia.The aim of this study was to evaluate the outcomes of endoscopic tympanoplasty in patients who underwent endoscopic tympanoplasty with LMA or ET anesthesia, and to compare this method that regards to graft success rates. We also investigated the duration of surgery and operation time, and pain scores in both groups.Materials and Methods: In this retrospective study, we included the patients who were performed endoscopic type 1 tympanoplasty with tragal cartilage graft. Visual evaluation of eardrums and audiologic datas of the patients were performed. The cases with cholesteatoma and/or ossicular chain problem were not included to study. Patients were evaluated in two different groups as LMA and endotracheal tube (ET) group. Preoperatively perforation types and audiological data; intraoperatively operation and surgical times; postoperatively 3th month surgical success, pain scores and audiological results were recorded in each group. And these results were evaluated statistically to compare the differences between LMA and ET group.Results: Ninety-three patients were included in the study and 36 of them underwent endoscopic tympanoplasty with LMA and 57 patients with ET. The surgery time was similar in both groups (p> 0.05), but the operation time was statistically significantly shorter in the LMA group (p 0.05). Graft success rates and hearing gain were higher in the LMA group but not statistically significant.Conclusions: We observed that endoscopic tympanoplasty with LMA or ET had similar surgery time, graft success rate, and pain scores, but total operation time was significantly shorter in the LMA group. As a result, LMA can be considered as a suitable method for endoscopic tympanoplasty.

Noninferior of desflurane to sevoflurane in the occurrence of adverse respiratory events during laryngeal mask airway anesthesia in pediatrics.

Noninferior of desflurane to sevoflurane in the occurrence of adverse respiratory events during laryngeal mask airway anesthesia in pediatrics.

Desflurane is not inferior to sevoflurane in the occurrence of adverse respiratory events during laryngeal mask airway anesthesia: a non-inferiority randomized double-blinded controlled study.

Compared to sevoflurane, desflurane is less favorable to most anesthesiologists for laryngeal mask airway (LMA) anesthesia because desflurane has a pungent odor. This non-inferiority study aimed to determine whether desflurane is not worse than sevoflurane in triggering airway irritations during general anesthesia using LMA. Patients scheduled for elective surgery under LMA anesthesia were randomly allocated to receive either desflurane or sevoflurane for maintenance of anesthesia. After intravenous fentanyl, lidocaine and propofol administration followed by LMA insertion, 0.5-1.0 MAC of the volatile anesthetic in 50% N2O was maintained throughout the surgery. The primary outcome was the occurrence of perioperative adverse respiratory events. Other outcomes included recovery profiles, hemodynamic changes and postoperative complications. One-hundred and ten patients per group completed the study without any serious complications, lost to follow-up, or protocol deviation. During awake LMA removal, patients in the desflurane group experienced lesser episodes of laryngospasm (risk difference, -7.3%; 95% CI, -12.7% to -1.9%; P=0.009) than those in the sevoflurane group. The emergence time and time to LMA removal were significantly shorter in the desflurane group. The quality of recovery indicated by an ability to self-transfer from bed to bed was significantly better after desflurane anesthesia. No difference between groups was found in a return of orientation and a readiness for post-anesthesia care unit discharge. Desflurane is non-inferior to sevoflurane in the occurrence of laryngospasm at emergence after LMA anesthesia. The superiority of desflurane compared to sevoflurane with regards to respiratory complications requires further investigation.

Nonoperating Room Anesthesia for Interventional Neuroangiographic Procedures: Outcomes of 105 Patients

Background and Aim: Accurate anesthesia management is of great importance for the success of interventional neuroangiographic procedures (INPs). General anesthesia with endotracheal intubation is the most commonly preferred anesthetic method for these procedures. However, whether laryngeal mask airway (LMA) anesthesia is a suitable and safe option for such cases is unclear. The aims of this study were to report the outcomes of anesthetic management in patients who underwent INP, and to compare endotracheal intubation with LMA anesthesia in terms of anesthesia-related outcomes. Methods: Data of patients who underwent INP under general anesthesia at interventional neuroangiography unit were retrospectively evaluated. Results: A total of 105 patients with a mean age of 52.9 years were included in the study. All procedures were performed under general anesthesia with using endotracheal tube (n = 79, 75.2%) or laryngeal mask (n = 26, 24.8%). Anesthesia-related complications, including respiratory (laryngospasm,bronchospasm, and desaturation) and circulatory (disrhythmia, hypotension, hypertension), were observed in 20 (19.1%) patients. The 2 airway instruments were similar in age, gender, diagnosis, American Society of Anesthesiologist score, mallampati score, duration of procedure, and duration of anesthesia (P > .05). Anesthesia-related complications were more common in LMA group compared with patients who were intubated using endotracheal tube (P = .003). Conclusions: Anesthesia management in INPs carries many challenges for anesthesiologists, due to the need of exact immobility during the procedure and potential procedure-related risks such as vasculary perforation and bleeding. General anesthesia using endotracheal intubation seems to be more secure, in comparison to LMA anesthesia.

Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery: a randomized trial.

BackgroundPostoperative agitation after general anesthesia is a common complication in children; however, pain or uncomfortable feeling is the main reason of emergence agitation. Here, we have investigated the effects of fascia iliaca compartment block (FICB) combined with general laryngeal mask airway (LMA) anesthesia in children undergoing femoral surgery.MethodsEighty children undergoing femoral surgery were randomly divided into two groups: FICB + LMA group and control group (n=40). The FICB + LMA group received FICB combined with general LMA anesthesia, and the control group received tracheal intubation general anesthesia alone. Anesthesia was maintained with nitrous oxide and sevoflurane. Hemodynamic parameters were monitored, and pain was assessed by verbal numeric score within 24 hours postoperatively. Time to extubation, time to discharge from the postanesthesia care unit and postoperative complications were recorded.ResultsHemodynamic parameters were more stable in the FICB + LMA group than in the control group during anesthesia induction (P<0.05). Verbal numeric score values were lower in the FICB + LMA group than in the control group at 2–8 hours postoperatively (P>0.05). Compared with the control group, the time to extubation and time to discharge from postanesthesia care unit were shorter in the FICB + LMA group (P<0.05). Additionally, postoperative complications were less in the FICB + LMA group.ConclusionThe FICB combined with general LMA anesthesia may provide intra- and postoperative analgesia, shorten emergence time and reduce postoperative agitation in children undergoing femoral surgery.Trial registrationThis study is registered at http://www.chictr.org.cn (registration number: ChiCTR-IOR-17012725).

Effect of positive end-expiratory pressure on the cross-sectional area of the internal jugular vein and anatomic relationship between the internal jugular vein and the carotid artery in general anaesthesia of laryngeal mask airway

Objective: To investigate the effect of positive end-expiratory pressure(PEEP) on the cross-sectional area (CSA) of the internal jugular vein (IJV) and anatomic relationship between the IJV and the common carotid artery (CCA) in general anaesthesia of laryngeal mask airway(LMA). Methods: Sixty American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ grade patients undergoing elective operation received general anaesthesia using LMA from May to November 2017, aged 20-65, were included in this study and randomly divided into 4 groups: group P0 (PEEP: 0 cmH(2)O), group P5 (PEEP: 5 cmH(2)O), group P10 (PEEP: 10 cmH(2)O), group P15 (PEEP: 15 cmH(2)O). Following the induction of anesthesia, LMA was inserted, and mechanical ventilation was started while the right cervical vessels was imaged by ultrasonography after applying 4 different PEEPs in random order. Measurements were made after 1 min in each PEEP. The CSA, transverse diameter (TD), anteroposterior diameters (AD) of the IJV and the diameter, overlap distance and overlap index of CCA was measured. The arterial blood pressure, heart rate, and vasoactive drugs used were also recorded. Results: The CSA of group P0, P10 and P15 was (1.36±0.55), (1.80±0.54), (2.02±0.58) cm(2). The TD was (1.31±0.33), (1.61±0.49), (1.74±0.53) cm. The AD was (1.12±0.20), (1.33±0.30), (1.46±0.32) cm. Compared to group P0, the CSA, TD and AD of IJV in group P10 and P15 were significantly increased (P0/P10: t=7.81, 3.81, 4.30, all P<0.01; P0/P15: t=11.68, 5.40, 6.96, all P<0.01). There was no significant difference in the AD and TD of IJV between group P10 and P15 (all P>0.05), while the CSA of group P15 was bigger than that of group P10 (t=2.17, P<0.05). The overlap distance of group P0, P10 and P15 was (0.51±0.12), (0.62±0.16), (0.66±0.15) cm. The overlap index was (76.80±20.03)%, (91.10±26.13)%, (96.21±25.36)%. Compared to group P0, the overlap distance and overlap index in group P10 and P15 were significantly increased (P0/P10: t=4.49, 3.41, both P<0.01; P0/P15: t=5.91, 4.63, both P<0.01). There was no significant changes in the overlap distance and overlap index between group P10 and P15 (all P>0.05). The MAP of group P15 was lower than that of group P10 [(73.35±9.73 )vs (67.58±12.58) mmHg, t=2.745, P<0.05]. No patients were given atropine or norepinephrine. Conclusions: The application of PEEP effectively increases the CSA of IJV in general anaesthesia of LMA. At the same time, it also lead to higher overlap index between the IJV and CCA.Ten cmH(2)O PEEP provides the best balance between the increase of CSA and the stability of haemodynamics.

General laryngeal mask airway anesthesia with lumbar plexus and sciatic block provides better outcomes than general anesthesia and endotracheal intubation in elderly patients undergoing hip surgery

ObjectiveTo compare the perioperative outcomes and hemodynamic effects at induction of general laryngeal mask airway (LMA) anesthesia with lumbar plexus-sciatic nerve block (LPSB) and general anesthesia with endotracheal intubation (ET) in elderly patients undergoing hip surgery. MethodsA total of 63 patients having open reduction internal fixation of an intertrochanteric fracture were randomly assigned to receive LMA anesthesia with LPSB or general anesthesia with ET. Perioperative and postoperative outcomes were compared between the 2 groups. ResultsCompared with the LMA/block group, there were significant reductions in systolic blood pressure, diastolic blood pressure, and mean arterial pressure at induction in the general endotracheal group (all, P < 0.001). In the general ET group, 84% of the patients experienced at least one episode of significant hypotension, whereas no patient in the LMA/block group had significant hypotension (P < 0.001). There were no changes in cardiac output, cardiac index, stroke volume, and stroke volume index of the LMA/block group, whereas significant changes were noted in the general anesthesia ET group. Significantly fewer complications were noted in the LMA/block group, and LMA block was associated with shorter weaning time, fewer returns to the intensive care unit, and less postoperative pain. ConclusionsGeneral LMA anesthesia with LPSB provides better outcomes that general ET anesthesia in elderly patients undergoing hip surgery.

Safety and efficacy of laryngeal mask airway ventilation in obese patients with airway stenosis.

To assess the efficacy of laryngeal mask airway (LMA) ventilation in obese patients with airway stenosis. A retrospective chart review was conducted in an academic practice in a tertiary care center. We retrospectively reviewed our experience using LMA ventilation in obese patients with airway stenosis. Lowest intraoperative O2 saturation and maximum-end tidal carbon dioxide (CO2 ) levels were recorded. Complications including intubation, unplanned admission, re-admission, postoperative pain, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy were recorded. Fourteen bronchoscopies with laser incisions and dilation were performed in patients with airway stenosis exclusively using LMA ventilation. Thirteen of 14 procedures were performed on patients who had body mass index (BMI) > 30 kg/m2 . Mean BMI was noted to be 38 kg/m2 (range 25-54). All patients underwent successful laser incisions and dilation via LMA anesthesia without major or minor adverse events. The mean lowest O2 saturation level was noted to be 92%; the mean highest CO2 level was noted to be 56 mm Hg; and no patients required endotracheal intubation. In this small series of obese patients with airway stenosis, LMA anesthesia was effectively used without major or minor complications. 4. Laryngoscope, 127:2582-2584, 2017.

Effects of opioids on recovery quality in elderly patients undergoing transurethral laser lithotripsy

Objective The current study aimed to evaluate the effects of opioids on recovery quality in elderly patients undergoing transurethral laser lithotripsy. Methods We enrolled 134 patients aged 65-79 y with ASA Ⅰor Ⅱ who underwent laryngeal mask airway anesthesia for elective transurethral laser lithotripsy. The patients were randomly assigned to remifentanil group (group R, n=46), remifentanil and fentanyl combination group(group RF, n=44), fentanyl group(group F, n=44). In group R, propofol and remifentanil was administered by target-controlled infusion(TCI) for anesthesia induction and anesthesia maintenance. In group RF, propofol TCI and fentanyl single-dose 2 μg/kg was administered for anesthesia induction, propofol and remifentanil TCI was administered for anesthesia maintenance. In group F, propofol TCI and fentanyl single-dose 4 μg/kg was administered for anesthesia induction, propofol TCI for anesthesia maintenance. MAP and HR were recorded when patients were sent to the PACU(T1), 2 min before removal of the laryngeal mask airway(T2), the moment of removal of the laryngeal mask airway(T3) and 5 min after removal of the laryngeal mask airway(T4). VAS was evaluated after removal of the laryngeal mask airway and requirement for fentanyl analgesia was evaluated in PACU. Time to eye opening, time to removal of the laryngeal mask airway and length of stay in PACU were recorded and compared. Results MAP [(110±18), (122±13), (121±14) mmHg(1 mmHg=0.133 kPa)] and HR [(79±15), (97±17), (99±18) bpm] were significantly higher in group R than that in group RF(P<0.05). VAS(1.8±1.4) was higher in group R than that in group RF (0.9±0.9) and group F(0.9±0.9). The proportion of patients who needed fentanyl in group R was significantly higher(P<0.05). Time to eye opening, time to removal of the laryngeal mask airway and length of stay in PACU were significantly longer in group F than that in the other two groups(P<0.05). Conclusions Our results showed that the combined use of propofol with fentanyl and remifentanil in elderly patients undergoing transurethral laser lithotripsy who received total intravenous anesthesia provided hemodynamic stability during anesthetic recovery, provided early recovery and adequate postoperative analgesia compared to the administration of propofol in combination with remifentanil or fentanyl alone. Key words: Analgesic, opioid; Aged; Transurethral laser lithotripsy; Target-controlled infusion

Laryngeal Mask Airway Anaesthesia in Hypotonic Cases with Expected Difficult Intubation.

Laryngeal Mask Airway Anaesthesia in Hypotonic Cases with Expected Difficult Intubation.

Application of laryngeal mask airway anesthesia combined with sacral canal block in pediatric surgery

Objective To observe differences between the application of laryngeal mask anesthesia combined with sacral canal block and single intratracheal anesthesia in African pediatric surgery and provide references for child anaesthesia. Methods Sixty 4-6 year-old children for lower abdominal or lower limb surgerywere randomly divided into two groups(n=30): laryngeal mask airway anaesthesia combined with sacral canal block group(group A) and single intratracheal anaesthesia group(group B). MAP, HR and SpO2 were recorded before induction of anaesthesia(T0), before and after intubation of laryngeal mask airway or tracheal tube (T1, T2) and after removal of laryngeal mask airway or tracheal tube(T3). The waking-up time, VAS pain scores and adverse reaction were recorded after surgery. Results There were no significant differences in MAP, HR and SpO2 between the two groups at T0 and T1 (P>0.05). The MAP and HR [(68±10) mmHg(1 mmHg=0.133 kPa), (108±17) bpm] values in group A were significantly lower than the MAP and HR [(91±8) mmHg, (139±18) bpm] values in group B at T2(P<0.05). The MAP and HR [(67±9) mmHg, (121±16) bpm] values in the group A were also significantly lower than the MAP and HR [(85 ± 9) mmHg, (141 ± 17) bpm] values in the group B at T3(P<0.05). The postoperative VAS values (1.5±0.5) in groups A were significantly lower than values (6.5±1.5) in the group B (P<0.05). The waking-up time [(5.8±2.4) min] in group A was significantly shorter than the time [(12.2±2.8) min] in group B (P<0.05). There are only 4 cases of postoperative agitation in group A which was significantly lower than that in group B (P<0.05). The frequencies of postoperative cry and cough in group A were significantly lower than that in group B. Conclusions The general anesthesia via laryngeal mask airway combined with sacral canal block in children during the induction and the waking-up time guaranteed more stable hemodynamics and significantly reduce postoperative pain, the waking-up time significantly shorten, significantly reduce the incidence of postoperative mania ,so it is an more ideal anesthesia methed in lower abdominal or lower limb surgery. Key words: Laryngeal mask airway; Anesthesia, general; Sacral canal block; African child

When may systematic reviews and meta-analyses be considered reliable?

When may systematic reviews and meta-analyses be considered reliable?

Laryngeal Mask Airway versus Endotracheal Tube Intubation for Repairing of Nasal bone Fracture: A 7 Year Single Institution Case-Control Study

Introduction: Closed reduction nasal fracture is a common and well established procedure in the otolaryngology literature. The Laryngeal mask airway (LMA) is being used more frequently for otolaryngologic procedures in recent years because it has been proven safe for select procedures especially in the pediatric population. The frequency of closed reduction nasal fracture repair and the increased propensity to use LMA anesthesia for otolaryngologic cases warrants investigation. Objective: We sought to investigate the benefits, risks and safety of using LMA anesthesia for pediatric patients during closed reduction nasal fracture compared to case controlled equivalents that underwent ETT intubation. Methods: We performed a retrospective case-control study in which all cases of closed reduction nasal fracture at a single pediatric institution by a single surgeon were studied. This included patients from 2007 to 2013 at Ann & Robert H Lurie Children’s Hospital of Chicago. The primary outcomes assessed were postoperative VAS and FACES pain scores, blood loss, cough, stridor and aspiration. Secondary outcomes assessed included timing data to determine if one technique led to greater optimization of operating room (OR) time and/or total hospital stay. The timing data included overall OR duration, prep to cut time, cut to close time, non-operative OR time and the total hospital stay in minutes. Results: Fifty patients met the inclusion criteria. Of the 50 patients included an endotracheal tube was used in 16 patients and a LMA was used for 34 patients. Two of the LMA group 2/34 (6%) had aspiration documented compared to zero of the ETT group. The average total length of hospital stay was 268.5 m when both groups were included. The average total hospital stay was 252.6 minutes for the LMA group and 312.4 for ETT group. The average postoperative VAS pain score, as documented 0-10 by the RN, was 0.47 for the LMA group as opposed to 0.56 for the ETT group. A total of 24 patients had cough noted, 15/34 (44%) of the LMA group and 9/16 (56%) of the ETT group. Ten patients had stridor noted, 5/34 (15%) of the LMA group and 5/16 (31%) of ETT group. Conclusion: These results support the hypothesis that using an LMA versus an ETT for short procedures does save time when assessing overall hospital stay. Additional benefits of the LMA are reduced cough, pain, stridor and ease of placement. The data also supports our second hypothesis that using an LMA for close reduction nasal fracture can lead to more frequent post operative airway obstruction when compared to the ETT. Our data and review suggest that it is the combination of deep extubation (lack of airway protection) and the use of an LMA (allows for blood accumulation) that result in the increase risks of airway obstruction postoperatively. For operations in the pediatric population with a significant risk of bleeding into the pharynx we recommend using an ETT due to the risks of aspiration. If an LMA is used we recommend to only removing the LMA after the patient has been deemed in the state of anesthesia which is awake. For short cases with a low risk of immediate post operative bleeding into the pharynx, we are proponents of the LMA due to its’ time saving effect.

眼科全麻手术患者应用喉罩在术后恢复期常见问题与护理

The paper presented nursing care and common problems, such as choking cough , elevated intraocular pressure ,laryngospasm, reflux aspiration, laryngeal mask out carelessly or ventilation disorder,etc, during postoperative recovery period in patients undergoing ophthalmic general surgery with laryngeal mask airway anesthesia by studying 120 cases. Psychological care, preoperative preparation and targeted nursing can prevent and relieve the symptoms, ensure the operation effect, and improve the safety of patients.

The effect of preoperative intravenous dexketoprofen trometamol on postoperative pain in minor outpatient urologic surgery.

The aim of this prospective double-blind randomized study was to compare the effectiveness of preoperative dexketoprofen trometamol for acute postoperative pain in patients undergoing minor outpatient urologic surgery. Sixty male patients (ASA I and II) undergoing varicocelectomy and testicular sperm extraction (TESE) with standard laryngeal mask airway (LMA) anesthesia were randomly divided into two groups. Patients in Group I (n=30) received 50 mg of dexketoprofen trometamol iv before induction, whereas patients in Group II (n=30) received saline. All patients received standard LMA anesthesia (propofol, sevoflurane and N2O/O2). Analgesic efficacy was evaluated by self-assessment of pain intensity (VAS) at regular intervals. Vital signs, side effects and time to reach a postanesthesia discharge score (PADS) of ≥9 were also recorded. Paracetamol 1 gr iv and tramadol 100 mg iv were used for rescue analgesia. Demographic data and duration of surgery were similar in both groups. There was no significant difference between groups with respect to postoperative pain scores and side effects. Although more patients in Group II (60%) required rescue analgesia compared to Group I (33.3%), the difference did not reach statistical significance. Preoperative IV use of dexketoprofen trometamol iv did not decrease the need for rescue analgesia in patients undergoing minor outpatient urological surgery.

Carotid endarterectomy with local anesthesia and laryngeal mask airway/general anesthesia

Abstract There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring, and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our report was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective, and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.