Laryngeal Mask Airway Group Research Articles

Optimized strategy of anesthesia for modified radical mastectomy: transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia

Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups (n=20 each) using a random number table method: thoracic nerve block-general anesthesia group (group P+ G), transverse thoracic muscle plane-thoracic nerve block-general anesthesia group (group T+ P+ G) and general anesthesia group (group G). Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium.Thoracic nerve block typeⅠ and Ⅱ was performed after implanting laryngeal mask airway in group P+ G.Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠ and Ⅱ in group T+ P+ G.Flurbiprofen 50 mg was intravenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3.The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recorded.Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway.The requirement for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+ G and T+ P+ G groups (P 0.05). Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy. Key words: Thoracic nerves; Nerve block; Anesthesia, general; Breast neoplasms; Transversus thoracic muscle

Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery.

This study will determine the safety of laryngeal mask airway (LMA) compared with endotracheal tube (ETT) in patients undergoing general anesthesia for dacryocystorhinostomy (DCR) surgery. In this retrospective cohort study, intraoperative and postoperative outcomes of patients who underwent DCR at UAB Callahan Eye Hospital using either LMA or ETT were compared. Over a period of 52 months, 429 patients underwent external DCR surgery. An ETT was used in 37 patients and LMA in 392 patients. Baseline patient characteristics and anesthetic management were similar. No documented cases of blood or gastric aspiration occurred in the total cohort. Our study confirmed the findings of others that there is less cardiovascular lability on LMA placement than with ETT intubation. A 30% increase in heart rate from baseline after intubation (ETT 10.8%, LMA 1.8%; p = 0.010) and after incision (ETT 8.1%, LMA 1.8%; p = 0.047) occurred more frequently in the ETT group. Airway management with an LMA was also less difficult compared with an ETT (ETT 5.7%, LMA 0.5%; p = 0.035). The use of an LMA for airway control is safe and effective in patients undergoing general anesthesia for DCR surgery. No events of aspiration occurred with LMA use. Heart rate increase was significantly less in the LMA group. In our opinion, use of an LMA for airway control during DCR surgery is superior to use of an ETT. Airway protection, improved hemodynamics, and less difficulty in placement of the laryngeal airway device are all validated by this study.

A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure.

This study evaluates and compares the feasibility and safety of application of laryngeal mask airway (LMA) and endotracheal intubation (ETT) for anaesthesia in adult patients undergoing thoracoscopic surgery. Sixty adult patients with pectus excavatum (PE) undergoing video-assisted thoracoscopic surgery for the NUSS procedure (VATS-NUSS) between September 2016 and March 2017 were selected and randomly separated into two groups with different methods of airway management. In one group, LMA was applied for general anaesthesia, and in the other group, ETT was used. The clinical parameters before, during and after the surgery in patients from both groups were collected from multiple data resources in a hospital. SPSS software was used for the analysis. Of all the selected patients, the physiological parameters showed similarity between the LMA and ETT groups, indicating consistency in the clinical characteristics of the study sample. Additionally, no significant differences were discovered between the two groups in terms of the anaesthesia and surgical time, peak PetCO2 during operation, anaesthetic satisfaction score, and amount of blood loss as well as inpatient time for recovery. However, with a similar level of anaesthesia effects and suitable parameters for mechanical ventilation, patients in the LMA group showed much more stability in the physiological indicators for inflammation and haemodynamics, including white blood cell count (ΔWBC) and percentage of neutrophil granulocytes (ΔNEU%) in the blood as well as heart rate (ΔHR) and mean arterial pressure (ΔMAP). Moreover, the LMA patients had a significantly shorter time for recovery of consciousness and food/water intake. Finally, compared to the ETT group, patients in the LMA group also had a significantly lower incidence of side effects induced by the anaesthesia procedure after surgery, such as gastrointestinal reactions, throat discomfort and hoarseness. Compared with ETT, the application of LMA for general anaesthesia may demonstrate promising advantages in airway management for the VATS-NUSS procedure.

The use of laryngeal mask airway for adenoidectomy

ObjectivesAirway management during adenoidectomy is traditionally performed through endotracheal intubation (ETT). Laryngeal mask airway (LMA) may be less stimulating to the airway and allow for shorter overall operating room time. Previous studies report LMA use during adenotonsillectomy. There has been no prior evaluation of LMA use during adenoidectomy alone. In this study, we attempt to identify the rate and contributing factors of LMA failure during adenoidectomy. MethodsAll pediatric patients undergoing adenoidectomy between January 1, 2016 and June 30, 2017 were reviewed. Demographic and clinical data were collected and analyzed to determine the need for conversion to ETT and the occurrence of any complications. ResultsOur study revealed 139 pediatric patients who underwent adenoidectomy during the study period. 110 patients had adenoidectomy performed with LMA and 27 patients had ETT. Two patients (1.8%) required conversion to ETT because of difficulty with ventilation when the mouth gag was in place. There were no complications. Mean operating room time was 20 min less in the LMA group (P < 0.05). ConclusionsThe use of an LMA in adenoidectomy may be a safe and effective alternative to ETT. More study is required to determine overall complication rates.

Nasopharyngeal Airway Versus Laryngeal Mask Airway During Diagnostic Flexible Fiber-Optic Bronchoscope in Children

Background: Pediatric fibreoptic diagnostic bronchoscope under general anesthesia using Supraglottic devices as Laryngeal Mask Airway (LMA) and nasopharyngeal airway (NPA) are one of the variable techniques used for patient’s ventilation during this procedure. Objective: We studied the effect of both devices on hypoxemia, the duration of the procedure, recovery time and the overall propofol consumption. Methods: Ninety patients of both sexes, aged 5-10 years, American society of Anesthesiology class I &amp; II scheduled for diagnostic fibreoptic bronchoscope under general anesthesia were divided randomly into two equal groups; LMA group &amp; NPA group, during the procedure: heart rate, non invasive blood pressure, peripheral arterial oxygen saturation (SpO2), arterial partial pressure of carbon dioxide(PaCO2), time of procedure, recovery time and total dose of propofol were measured and compared for each patient in both groups. Results: Hypoxemia &amp; desaturation incidence was more in LMA group than NPA group with high significant difference (p-value 0.005). Also the duration of procedure, recovery time in PACU, and total dose of propofol consumed were significantly less in the NPA group (p&lt; 0.001). With no difference in hemodynamic status and PaCO2. Conclusion: The use of NPA as supraglottic ventilating device for children undergoing diagnostic flexible fibreoptic bronchoscopy is considered a good alternative for shortening the bronchoscopy time with less incidence of hypoxemia and better recovery time compared to LMA.

Use of the Classic Laryngeal Mask Airway Versus an Endotracheal Tube in Children Undergoing Elective Surgery in the Prone Position: A Prospective Randomized Feasibility Study

Background: A laryngeal mask airway (LMA) has been used successfully during surgical procedures in the prone position for adults and children in some cases. In this study, we compared the use of a classic LMA versus an endotracheal tube (ETT) in children undergoing minor surgical procedures in the prone position. Patients and methods: Forty children aged 4-8 years with an American Society of Anesthesiologists' classification of I who were undergoing elective surgery in the prone position were assigned to an airway secured by an uncuffed ETT (n=20) and or an airway secured by an LMA (n=20). SpO2, end-tidal CO2, heart rate, and mean arterial blood pressure were recorded before and after insertion of the LMA or ETT. The numbers of insertion attempts using the ETT or LMA were documented, along with any complications. Results: The time taken to insert the ETT was longer than that taken to insert the LMA (15.35 ± 2.907 vs. 14.35 ± 1.843 s). No intraoperative laryngospasm was reported in either group. Bronchospasm occurred intraoperatively in 2 patients in the ETT group and in one patient in the LMA group. No device displacement was reported. Conclusions: The classic LMA and ETT were both used successfully in spontaneously breathing children undergoing surgical procedures in the prone position. However, LMA was associated with fewer intraoperative and postoperative complications.

Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial

To determine if preterm infants with moderate respiratory distress syndrome on continuous positive airway pressure (CPAP) who received surfactant via a laryngeal mask airway (LMA) would have a decreased rate of intubation and mechanical ventilation compared with those on CPAP who did not receive surfactant. In this prospective, multicenter, randomized controlled trial, 103 premature infants 280/7-356/7 weeks gestation, ≥1250 g and ≤36 hours old on CPAP requiring fraction of inspired oxygen 0.30-0.40 were assigned to receive surfactant administered through an LMA then placed back on CPAP (LMA group) or maintained on CPAP with no surfactant administered (control group). The primary outcome was treatment failure necessitating intubation and mechanical ventilation in the first 7 days of life. Surfactant administration through an LMA (n = 50) significantly decreased the rate of intubation and mechanical ventilation compared with controls (n = 53): 38% vs 64%, respectively, OR 0.30 (95% CI 0.13, 0.70), P = .006, number needed to treat: 4). There were no serious adverse events associated with placement of the LMA or surfactant administration. In premature neonates with moderate respiratory distress syndrome, surfactant administered through an LMA decreased the rate of intubation and mechanical ventilation. This intervention may have significant impact on clinical care in both high and low resource settings. ClinicalTrials.gov: NCT01116921.

Can Transesophageal Echocardiography Be Performed Safely Using a Laryngeal Mask Airway During Atrial Fibrillation Ablation?

To investigate the feasibility and safety of using a laryngeal mask airway (LMA) compared with a cuffed oral endotracheal tube (COETT) for atrial fibrillation (AF) ablation with transesophageal echocardiography (TEE). Prospective, cohort study. A single-center inner-city hospital. The study comprised adult patients undergoing elective AF ablation with periprocedural TEE over a 3-year period. Patients were treated with either an LMA or a COETT before undergoing a standardized protocol for TEE and AF ablation. The primary outcome was the need for conversion from an LMA to a COETT. Between January 2014 and January 2017, 346 patients underwent AF ablation. Of those, 126 procedures were performed with a COETT (36.4%) and 220 (63.6%) with an LMA. There were no differences between groups in terms of baseline characteristics, including age, sex, body mass index, and American Society of Anesthesiologists grade. An adequate airway seal was unable to be maintained in 3 patients in the LMA group (1.4%), and those patients were converted to a COETT. No episodes of airway complications occurred in either group. No difference was found in mean propofol (2%) dose between COETT and LMA (385 mg/h v 374 mg/h; p = 0.127). However, the mean remifentanil dose (100 µg/mL) was reduced significantly in the LMA group compared with the COETT group at 355 µg/h and 939 µg/h, respectively (p < 0.001). LMA use is safe and feasible in the vast majority of patients undergoing AF ablation with TEE and is an acceptable alternative to COETT. A significantly reduced rate of remifentanil was required to maintain anesthesia in the LMA group.

Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study.

Background:The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA).Methods:We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups.Results:During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups.Conclusions:Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

The Safety of Laryngeal Mask Airway-Assisted Bronchoscopy versus Standard Nasal Bronchoscopy

Background: The use of laryngeal mask airway (LMA) for fiberoptic bronchoscopy was first described in 1982. The LMA was found to be beneficial in operator view, flexibility, and also in maintaining stable oxygen saturation. Despite its advantages, the use of LMA has not become widespread. Objective: The aim of this paper was to evaluate the safety of LMA-assisted bronchoscopy compared to standard nasal bronchoscopy. Methods: We conducted a prospective randomized trial. The study group included 105 patients prospectively randomized to undergo either LMA-assisted (53 patients) or standard nasal bronchoscopy (52 patients). The data collected included continuous monitoring of respiratory and hemodynamic parameters and medication doses. Results: The LMA group had a significantly lower percentage of desaturation (pulse oximetry saturation [Sp<smlcap>O</smlcap>₂] <88%) events compared to the non-LMA (NLMA) group (37 vs. 63.4%; p = 0.008). The median percentage of time with Sp<smlcap>O</smlcap>₂ >88%, from the total procedure time, was 100% (IQR 98-100) in the LMA group and 98% (IQR 96-98) in the NLMA group (p = 0.003). Sedation in the LMA group required significantly higher doses of propofol (p < 0.001). The mean systolic blood pressure values were significantly lower in the LMA group, but this difference did not result in a higher percentage of clinically significant hypotension. Conclusion: The use of LMA allows for better airway support, stable oxygen saturation, and a more convenient port of entry during flexible fiberoptic bronchoscopy. These results, together with the known advantages of the laryngeal mask, should lead to more widespread use in the evolving field of interventional pulmonology, in particular in high-risk patients and complicated procedures.

Comparative Study between the Laryngeal Mask Airway and Endotracheal Tube on Haemodynamic Changes for Laparoscopic Cholecystectomy Under General Anaesthesia

Background: Evidence based data in the very recent years suggest that in spite of tremendous advances in contemporary anaesthetic practice and advances, airway management continue to be of paramount importance to anaesthesiologists and data regarding the outcomes of use of LMA (laryngeal mask airway) in contrast to ETT (endotracheal tube) are scanty in our clinical setup. Aims &amp; Objectives: In this RCT (Randomized Control Clinical Trial), the ultimate aim was to depict the anaesthetic safety and haemodynamic changes of use of LMA in contrast to ETT for the patients of routine laparoscopic cholecystectomy (ASA II &amp; III). Methods and Materials: This randomized control clinical trial (RCT) was conducted in BIRDEM General Hospital, Dhaka, Bangladesh with a total number of 60 patients (30 patients with endotracheal tube &amp; 30 patients with LMA) were selected on the basis of systemic random sampling. The haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal complication (LPM) were noted. Results: The ultimate result of this study suggest that in Group A (ETT group), mean±SD of age was 48±1.9 and in Group B (LMA group), it was 52±1.7. Demographic status suggests that the average BMI in both group were 28.9 and 30.6 respectively. In ETT group, majority of patients (69%) had ASA grade II, in contrast, in LMA group, it was 52%. Average anaesthetic duration in both group were 45 &amp; 50 minutes respectively. There found significant difference in haemodynamic parameter during Intubation and LMA insertion. There were no statistically significant differences in oxygen saturation (SpO2) between the two groups before or during peritoneal insufflation. Laryngeal complications, like coughing and vomiting following removal of tube were found in 6.7% and 3.3% patients respectively with the use of LMA. No case of tube leak, gastric insufflation, regurgitation, aspiration, trauma to lip, teeth, tongue, dysphagia, dysphonia and dysarthia was recorded. P-values suggests statistically insignificant result here (&gt;0.05). Conclusion: The effectiveness and safety of LMA in terms of intra and postoperative haemodynamic status, SaO2 and laryngeal complications are clinically comparable to those of endotracheal tube. And LMA insertion causes less changes of haemodynamic parameters when compared with that of ET intubation. Our finding suggests that LMA can be safe and beneficial alternative to ETT. JBSA 2017; 30(1): 34-40

Endotracheal intubation in patients with difficult airway: using laryngeal mask airway with bougie versus video laryngoscopy.

Airway management is essential for safe anesthesia and endotracheal intubation is the most important procedure by which critically ill patients can be better managed, especially if done quickly and successfully. This study aimed to compare the techniques of intubation through laryngeal mask airway (LMA) using a bougie versus video laryngoscopy (VL) regarding to intubation success and the quality of intubation indices in patients with difficult airways. This randomized clinical trial was performed on 96 patients aged 16–76 years with Mallampati class 3 or 4 who underwent elective surgery. Once the demographics were recorded, patients were randomly divided into two groups and the first group intubated with VL, and the second group intubated through laryngeal mask using a bougie. Then vital signs, arterial oxygen saturation, the time required for successful intubation, and ease of intubation were recorded. Here t-tests, chi-square, Fisher exact tests, and analysis of variance for repeated measurement were used to analyze the data in SPSS software. The overall success rates of intubation in VL and LMA groups were 46 (96%) and 44 (92%), respectively. The mean duration of intubation for the LMA and VL groups was 18.70 ± 6.73 and 14.21 ± 4.14 seconds, respectively (P < 0.001). Moreover, visual analogue scale score for pain in throat was significantly lower in VL group than LMA (1.65 ± 0.76 vs. 1.33 ± 0.52). Moreover, easy intubation in bougie group was 50%, while the easy intubation in VL was 73% (P = 0.023). In addition, incidence of cough was 31% in the LMA with bougie group and 9% in VL group (P = 0.005). The VL technique is an easier method and has a shorter intubation time than LMA using bougie, and causes a lower incidence of coughing, laryngospasm in patients that need intubation. Moreover, cough and discomfort in the throat tend to be less in VL, and the LMA could be used as replacement of VL in hard situations.

Effectiveness and Superiority of Ventilation with Laryngeal Mask Airway in Partial Laryngectomy

Background: Laryngeal carcinoma occupies the space of glottis. It may lead to difficult airway, and is prone to bleed if intubated with endotracheal tube (ETI). Intubation can also result in the possibility of tumor cultivation in the lung. Use of laryngeal mask airway (LMA) could avoid the disadvantages of endotracheal intubation, which would benefit patients undergoing partial laryngectomy. Methods: This was a randomized controlled clinical trial. Thirty adult patients scheduled to receive partial laryngectomy were enrolled. All study subjects received an ASA rating of grade III. Subjects were randomly assigned to the LMA group or the ETI group. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO2), tidal volume and end tidal CO2 were recorded at 6 to 8 time points throughout the procedure. Arterial blood gas was analyzed at the time of tracheotomy and the same time interval after tracheotomy. Comparison analysis was performed using the Student’s t-test for continuous variables. Results: ETI and LMA both provided satisfactory ventilation, and there was no significant difference in time to tracheotomy time between the two groups. Arterial blood gas analysis showed no significant differences in pH, PCO2, PO2, SaO2, BE, or HCO3- between the two groups. Significant differences were observed regarding hemodynamics, however; immediately after intubation, HR, SBP and HBP were significantly lower in the LMA group than in the ETI group (74.47 ± 11.77 vs. 84.67 ± 14.23, 99.67 ± 9.21 vs. 137.53 ± 35.50, 61.20 ± 8.10 vs. 82.53 ± 22.48, respectively). Five minutes after intubation SBP was still significantly lower in the LMA group (94.00 ± 11.28 vs. 110.53 ± 24.61). Conclusions: Ventilation with LMA in partial laryngectomy was as effective as ETI, and hemodynamics were more stable in the LMA group compared with the ETI group.

Evaluation of Hemodynamic Response between Laryngeal Mask Airway and Endotracheal Tube Extubation with General Anaesthesia

Introduction: Airway management is an essential, but challenging skill in the field of anaesthesiology. Since many years, endotracheal tube has been in vogue for surgeries involving general anaesthesia. However, endotracheal extubation causes serious hemodynamic changes, which could result in several cardiovascular complications. Among several advanced techniques, Laryngeal Mask Airway (LMA) is a less invasive procedure, with similar therapeutic outcomes. This study was carried out to compare the hemodynamic responses between LMA and endotracheal tube extubation.Methodology: This study was done as a single blind randomized controlled trial among 60 normotensive individuals who underwent elective surgeries under general anaesthesia, with 30 participants in each group. Values of heart rate and blood pressure were recorded, while rate pressure product was calculated. The hemodynamic parameters were recorded at baseline, pre-extubation 1, 2, 3, 5 and 10 min after extubation/removal. Independent samples t test was carried out to check for statistical significance at 95% level.Results: The mean age of the participants in LMA group was 39.3 ± 8 years while that of endotracheal tube group was 40.1 ± 9.4 years. There was a steady increase in the hemodynamic responses with both the groups. Overall the mean increase in the values of heart rate, blood pressure and rate pressure product were lower for the LMA group compared to the endotracheal tube group beginning from one min (p<0.05).Conclusion: This study elucidates the advantages of LMA over endotracheal tube extubation, in terms of minimizing the cardiovascular complications among normotensive individuals.

Comparing the efficacy and safety of laryngeal mask airway, streamlined liner of the pharyngeal airway and I-gel following tracheal extubation.

Adverse events following surgical operations are common complications due to removal of tracheal tube in contrast to the tracheal intubation. Awareness about the new methods and strategies for tracheal tube extubation is necessary for a safe and successful extubation. Therefore, we aimed to assess the safety and efficacy of laryngeal mask airway (LMA), streamlined liner of the pharyngeal airway (SLIPA) and I-gel in extubation time of tracheal tube. A one-single randomized clinical trial was conducted in 105 eligible patients in three groups including LMA, SLIPA and I-gel. The patients were under surgery after general anesthesia with propofol (2–3 mg/kg) and fentanyl (1–2 μg/kg). Hemodynamic responses and extubation consequences including coughing rate, laryngospasm, airway obstruction, apnea, breath holding and straining of patients, vomiting, and need for re-intubation were recorded every 5 minutes since inserting of supraglottic airway devices (SADs) until patients restore consciousness. Analysis of data was conducted in SPSS software by analysis of variance (ANOVA) and ANOVA for repeated measurements tests. The overall successful insertion was 100% for LMA and I-Gel and this rate was 97.1% for SLIPA method. A significant decrease was observed in trend of hemodynamic responses in all three groups. Nevertheless, the MBP was lower in LMA group and lower HR was observed in I-Gel and higher HR occurred in SLIPA (P < 0.05). Three groups was same statistically regarding sore throat, vomiting, coughing, breath holding, apnea, laryngospasm, and re-intubation need (P > 0.05). However, the incidence rate of apnea, and laryngospasm, as well as re-intubation need in SLIPA group was 2.9%, respectively. LMA, I-GEL and SLIPA could be considered as useful and safe devices for ventilation control after tracheal tube removal at the end of operation. Three devices were same regarding to sore throat, vomiting, coughing, and breath holding. However, LMA showed lower side effects while SLIPA was related to more occurrences of apnea, laryngospasm, and re-intubation need.

A clinical trial evaluating the laryngeal mask airway-Supreme in obese children during general anesthesia.

IntroductionThe laryngeal mask airway (LMA)-Supreme is a disposable double-lumen laryngeal mask airway that is widely used in clinical practice. However, its use in obese children has not been evaluated. The aim of this study was to determine whether the LMA-Supreme could perform equally as well as endotracheal intubation in obese children having a minor surgical procedure.Material and methodsAfter ethical board approval, 100 obese male children receiving non-emergent appendectomy for chronic appendicitis or surgery to correct concealed penis were randomly divided into an endotracheal intubation group and an LMA-Supreme group. Endotracheal intubation was performed under direct vision laryngoscopy. In the LMA group, a size-3 LMA-Supreme was placed and a stomach tube inserted via the drainage tube of the mask. Cardiovascular and respiratory parameters, time taken for placement, placement attempts, time to removal of the endotracheal tube/LMA, length of stay in the post-anesthesia care unit (PACU), and complications were recorded.ResultsInsertion time was significantly longer (p < 0.001) in the LMA-Supreme group than in the endotracheal intubation group. Peak airway pressure was significantly higher, and pulmonary compliance and PACU stay time lower in the LMA-Supreme group. No significant differences between endotracheal intubation and the LMA-Supreme were seen in other parameters, except for a higher incidence of coughing in the endotracheal intubation group.ConclusionsThe LMA-Supreme can be easily inserted and effectively used for airway management in obese children undergoing minor surgery.

Supraglottic jet oxygenation and ventilation-assisted fibre-optic bronchoscope intubation in patients with difficult airways

A difficult airway may lead to hypoxia and brain damage. The WEI Nasal Jet Tube (WNJ) is a new nasal pharyngeal tube that applies supraglottic jet oxygenation and ventilation (SJOV) for patients during tracheal intubation without the need for mask ventilation. We evaluated the effectiveness and safety of SJOV-assisted fibre-optic bronchoscopy (FOB) using the WNJ in the management of difficult tracheal intubations. A total of 50 adult patients with Cormack-Lehane grade ≥3 and general anesthesia with tracheal intubation were randomly assigned to either the laryngeal mask airway (LMA) or WNJ groups. The primary outcome was the percentage of patients with SpO2 values lower than 94% during intubation. The proportion of successful intubations, total time of intubation, and associated complications were also recorded. The percentage of patients with SpO2 values lower than 94% during intubation was significantly higher in the LMA group (25% in the LMA vs. 0% in the WNJ, P=0.01). Although there were no statistically significant differences in the total success rates of intubation, the first-attempt success rate was significantly higher in the WNJ group (100 vs. 79.2%, P=0.02). The total time required for intubation with the WNJ was shorter than that of the LMA (73.4 vs. 99.5s, P<0.001), although the duration of fibre-optic intubation was similar. The incidence of complications was similar between the two groups. SJOV-assisted FOB using the WNJ improved oxygenation and successful tracheal intubation in the management of difficult airways. This technique can be used as an alternative approach to improve success and minimize hypoxia during difficult airway management.

Abstract PR555

Background & Objectives: Postoperative sore throat, cough, nausea, apnea and laryngospasm are common complications of intubation by endotracheal tube (ETT) in pediatrics. Laryngeal mask airway (LMA) is a supraglottic device used as alternative equipment for ETT in order to decrease the complications. Objective: to compare the incidence of postoperative sore throat after LMA with ETT in pediatrics. Materials & Methods: Seventy six patients between 2-12 years old with ASA class I-II who underwent cochlear implant surgery were enrolled and randomly divided in to two groups including ETT or LMA for airway management. The incidence of complications including sore throat, apnea, vomiting, laryngospasm, post operative cough, intra and post operative arrhythmia and the influence of these equipments on O2 saturation,End tidal co2, airway pressure, hemodynamic changes during operation were compared. Wong-Baker facial grimace scale was used to evaluate the severity of pain. Results: The rate of post operative sore throat and laryngospasm in ETT group was significantly higher than LMA group (p=0. 002, 0.011; respectively). Apnea and vomiting were not significantly different. Rate of post operative cough, incidence of intra and post operative arrhythmia were not significantly different between two groups. Mean arterial pressure, peak airway pressure, end tidal CO2, and Oxygen saturation during operation which measured continuously had not significantly different between two groups. Conclusion: LMA significantly decreases the rate of post operative sore throat and laryngospasm in pediatric. However, the rates of apnea, Oxygen saturation, and nausea were similar in both groups. Application of LMA for airway management is appropriate alternative to ETT in pediatric. Disclosure of Interest: None declared

A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO&lt;sub&gt;2&lt;/sub&gt; and SPO&lt;sub&gt;2&lt;/sub&gt;, perioperative hemodynamic parameters and intra operative and postoperative complication.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In “sniffing air” position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO&lt;sub&gt;2&lt;/sub&gt; &amp;gt;95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO&lt;sub&gt;2&lt;/sub&gt; and ETCO&lt;sub&gt;2&lt;/sub&gt;. Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO&lt;sub&gt;2&lt;/sub&gt; and ETCO&lt;sub&gt;2 &lt;/sub&gt;were maintained in both the groups. &lt;/p&gt;

The feasibility of vasopressin administration via laryngeal mask airway using a porcine model

Background. In pre-hospital situations, delay in resuscitation might carry extra risks for patients, so resuscitative measures should be rapid, easy-to use, and effective. A laryngeal mask airway (LMA) is a quickly placed supraglottic airway that may be used as a route for drug administration. Vasopressin is a vasopressor and might be absorbed well via the mucosa of the airways and alveoli. We conducted this animal study to verify the feasibility of administering vasopressin via a LMA.Methods. Twenty-four Yorkshire pigs were anesthetized and randomly divided into four groups. The pigs in Groups Placebo and tracheal tube (TT) were intubated with a cuffed tracheal tube, and those in Groups LMA and laryngeal mask airway and a catheter (LMAC) underwent a size 4 LMA insertion. In the LMAC group, an aerosolized catheter was placed into the trachea through a LMA to deliver the drug. All pigs were able to breathe spontaneously without the assistance of a ventilator. The placebo group received 5 ml of distilled water via a tracheal tube. The other groups received 1 U/kg vasopressin, which was diluted to a total volume of 5 ml with distilled water via the varied routes. The heart rates and arterial pressures were recorded before and after drug administration.Results. The mean arterial pressure (MAP) and diastolic arterial pressure (DAP) increased significantly and maintained a plateau from 3 to 7 min in Group TT and 2 to 29 min in Group LMAC. Group LMA and Group Placebo demonstrated only one occasional elevation in MAP and no changes in DAP. Furthermore, the heart rate decreased significantly from 2 to 29 min in Group LMAC.Conclusions. In this porcine model, vasopressin administered via an aerosolized catheter and ventilated with a LMA demonstrated a positive and prolonged pressor effect. The results suggest that an aerosolized catheter placed through a LMA, may be a practical alternative route for vasopressin administration, and that the effective duration of vasopressin is long enough to cover the period of pre-hospital management.