Laryngeal Mask Research Articles

Comparative evaluation of Bailey manoeuvre of deep extubation with conventional awake extubation technique - A randomized clinical study

Background: Extubation is a critical procedure in anesthesia and critical care, often accompanied by complications, such as bucking, coughing, and hemodynamic instability, particularly after major surgeries. The Bailey manoeuvre, involving deep extubation with the i-gel laryngeal mask airway (LMA), may mitigate these issues. The study was planned to compare the hemodynamic effects and side effect profiles of conventional awake endotracheal extubation and exchange extubation with the i-gel LMA. Aims and Objectives: The study was designed to compare hemodynamic stress response and respiratory complication between the conventional extubation group and the following exchange extubation group. Materials and Methods: In a prospective, randomized, single-blinded controlled study, 60 patients undergoing surgery under general anesthesia were divided into two groups: Group T (awake extubation) and Group L (exchange extubation with the i-gel LMA). Hemodynamic parameters and side effects were recorded and analyzed. Results: Group L exhibited significantly lower heart rates, systolic and diastolic blood pressures, and mean arterial pressures at various time points post-extubation compared to Group T. The incidence of hypertension was significantly higher in Group T (90%) versus Group L (50%). Bucking and coughing less in the i-gel LMA exchange group compared to the standard endotracheal tube extubation group. Conclusion: Exchange extubation with the i-gel LMA offers better hemodynamic stability and a lower incidence of hypertension compared to conventional awake extubation. This technique may be particularly beneficial for high-risk patients and those undergoing complex surgeries.

Anesthesia in Obese Patients and Complications

Background: Almost all ages and socioeconomic categories are affected by the complex illness known as obesity, which has major social and psychological ramifications. Global obesity rates have reached epidemic proportions and obesity plays a significant role in the burden of chronic illnesses and disabilities worldwide. The aim of the study was to assess the Anesthesia in obese patient and its Complications in a tertiary care hospital. Materials and mathods: This cross-sectional observational study was carried out in the Department of Anesthesiology, Bangabandhu Memorial Hospital (BBMH) from July 2020 to June 2022.Total sample size was 200. Adult in-patients who had undergone non-cardiac surgery and were older than 18 with a BMI greater than 30 kg/m2 met the inclusion criteria. Pregnancy, ambulatory surgery and missing or insufficient data on the desired outcomes were the exclusion criteria. Results: Mean age ±SD was 32 ± 0.9 years. About 55% of the patients were female and 45% were male. Regarding ASA classification 53.5% had 2, 45.5% had 3 and 1.0% had 4 score. Regarding coexisting disease 42.5% had hypertension, 14% had dyslipidemia, 18% had DM type-2 and 7.5% had obstructive sleep apnea. Here, type of anesthesia was 55% general anesthesia, 6% normal mask ventilation, 25% regional anesthesia, 4% total intravenous anesthesia and 10% LMA (Laryngeal Mask Airway). Regarding complication 4.5% was Reintubation, 5.5 %Pneumonia, 7.5% Upper airway obstruction, 0.5% Delay emergence respectively. 2.5% Urinary retention, 5% Oliguria, 2% Wound infection. 0.5% myocardial infarction and 0.5% Cardiac arrest occurred and no death occur inpatient respectively. Conclusion: Obesity has long been seen from a surgical standpoint as a risk factor for unfavorable post-surgical outcomes. Patients who are morbidly obese may experience respiratory adverse effects following surgery as a result of physiological disruption. The undesirable effects range depending on the surgical population. IAHS Medical Journal Vol 7(1), June 2024; 97-101

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

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

Failed airway in the emergency department; what’s next?

A failed airway is defined as an unsuccessful intubation. It is a rare occurrence in the emergency department (ED) and always poses a challenge to emergency physicians. The ‘can’t intubate, can ventilate’ situation is one of the two ways a failed airway can occur in ED. Here, we present a case of failed emergency endotracheal intubation due to unanticipated subglottic stenosis. An elderly presented to a district hospital (without specialist) with acute bronchospasm, in which he was treated as severe exacerbation of chronic obstructive pulmonary disease (COPD). Despite maximal medical therapy, symptoms worsen, requiring intubation for airway protection. Standard rapid sequence intubation (RSI) was performed, with a good view of glottic opening; however endotracheal tube (ETT) size 7.5 could not be passed beyond the larynx. Several attempts using smaller-size ETTs still failed. A laryngeal mask airway (LMA) was inserted as a rescue device for ventilation. The patient was then sent to our centre for further evaluation and treatment. Initial examination in our ED revealed an elderly that was sedated and ventilated through LMA. Ventilation and oxygenation via the LMA were adequate. Diagnostic endoscopy was performed through LMA using flexible intubating scope which showed subglottic stenosis around 2cm below the vocal cord. The patient was referred to the Ear, Nose and Throat (ENT) team, where emergency tracheostomy was then performed in operating theatre. He was discharged well after 14 days of admission and given follow-up for his COPD and tracheostomy care.

Delivery Efficiency of Albuterol Pressurized Metered Dose Inhaler Through Small Size Laryngeal Mask Airways in an Infant and Child Model.

Intraoperative bronchospasm in pediatric patients supported through laryngeal mask airways (LMAs) is commonly treated with pressurized metered-dose inhaler (pMDI) albuterol. The aim of the study was to evaluate delivery of pMDI albuterol through LMAs under different conditions in a model of infant/child supported with a ventilator. We compared drug delivery efficiency of 4 actuations of albuterol pMDI (captured on a filter placed between the LMA and a test lung), drug deposition in the circuit (elbow) and in the LMA under different experimental conditions. Outcomes were expressed of percentage of nominal dose. We compared devices (valved holding chamber [VHC] and adapter), timing of administration (inspiration and expiration), tidal volumes (50 mL and 100 mL), mode of actuation (single and multiple), and LMA sizes (1, 1.5, and 2). Multiple regression analysis was used to evaluate the contribution of each to these components to the outcomes. P < .05 was considered statistically significant. Results are expressed as median (interquartile range) of pooled data. Drug delivery efficiency was 0% (0-1.1) and 6.3% (3.2-14.7) for adapter and VHC, respectively. Elbow deposition was 25.8% (19.2-63.3) and 2.9% (1.4-6.4) for adapter and VHC, respectively. LMA deposition was 2.6% (1.3-4.6) and 4.6% (2.9-6.1) for adapter and VHC, respectively. Multiple regression analysis showed that device, timing of actuation, and LMA size explained 33%, 17%, and 8% of the observed variation in delivery efficiency (R2 0.63), respectively. Multiple regression analysis showed that device and timing of actuation explained 52% and 16% of the observed variation, respectively (R2 0.70). Multiple regression analysis poorly explained factors associated with LMA deposition (R2 0.22). Using a VHC, actuating the pMDI during exhalation, and using a small LMA size increased drug delivery efficiency. The adapter was an inefficient add-on device for aerosol delivery with a pMDI through an LMA that caused significant circuit deposition.

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p&lt;0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p&lt; 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

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

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

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

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

Challenges, Innovations, and Training in Airway Management During Cardiopulmonary Resuscitation: A Narrative Review.

Emergency airway management is a crucial procedure performed to secure the airway and ensure effective ventilation during respiratory distress or airway obstruction. In the context of cardiopulmonary resuscitation (CPR), this process is complicated by factors such as anatomical challenges, environmental conditions, and the urgency of the situation. Recent advancements in airway management devices, including videolaryngoscopes and supraglottic devices (SGDs), have proven beneficial in managing these challenges. SGDs, such as the laryngeal mask airway (LMA) and i-gel®, provide an effective alternative when tracheal intubation is difficult or when continuous chest compressions are required. Furthermore, simulation-based education plays a critical role in training healthcare providers to handle complex airway scenarios during CPR. This review discusses the challenges of tracheal intubation during CPR, the usefulness of various devices including videolaryngoscopes and gum-elastic bougies (GEB), and the role of simulation training in improving outcomes. Ensuring proficiency in airway management techniques through hands-on practice and advanced simulation is essential for improving both survival rates and neurological outcomes in emergency settings.

Anesthesia practices during magnetic resonance imaging in pediatric patients

Aims: The use of magnetic resonance imaging (MRI) is becoming increasingly common for diagnostic and therapeutic purposes in pediatric cases. Among children who are too young to cooperate with the procedure or in those with anxiety, anesthesia may be required to minimize excessive motion and optimize image quality. The aim of this study was to determine the efficacy and associated complications of different anesthesia techniques used during MRI in pediatric patients at our hospital. Methods: Anesthesia follow-up forms and computer records of pediatric patients who had undergone MRI under anesthesia between January 2021 and January 2023 in a training and research hospital in Ankara were retrospectively reviewed. The included patients were categorized into four groups according to their anesthesia maintenance protocols to compare their efficacy and associated complications. Results: Of the 358 included patients, only 2% underwent MRI under general anesthesia with a laryngeal mask airway (LMA), whereas the rest underwent MRI under sedation. In our hospital, the most commonly used technique for MRI under anesthesia in pediatric patients involved sevoflurane inhalation with a simple facemask and airway (54.5%), and the lowest complication rate (0.8%) was observed in those who underwent only anesthesia induction without the administration of an agent for the maintenance of anesthesia. Conclusion: Daily anesthesia is generally considered the most effective and comfortable method for sedation during MRI. The results of this study suggest that anesthesia involving sevoflurane inhalation with a simple face mask applied to preserve spontaneous breathing is an effective and safe method for pediatric patients undergoing MRI.

Application of placing the anterior end of endotracheal tube at the glottis in laryngeal mask airway positive ventilation during general anesthesia: A prospective, randomized, controlled trial.

Glottic contraction and closure causes ventilation obstruction and laryngeal mask airway (LMA) leakage during positive pressure ventilation using LMA. This study aimed to assess the effect of placing the anterior end of the endotracheal tube (ET) at the glottis through the LMA ventilation conduit on treating LMA leakage following glottic contraction and closure. In this prospective, randomized, controlled trial, patients with non-minor surgery using LMA ventilation were randomly allocated to the i-gel group (group L) and the i-gel combined with ET group (group LE). The tip of ET was placed 2 cm under glottis guided by fiberoptic bronchoscope through i-gel ventilation conduit in group LE. The perioperative incidence of i-gel leakage, the changes of systolic blood pressure (SBP) and heart rate (HR) following artificial airway insertion, and adverse events were recorded. Perioperative i-gel leakage was observed in 7 of 48 patients (14.6%) in group L and 1 of 49 patients (2.0%) in group LE. There was significant difference in the incidence of leakage between the 2 groups (P = .031). SBP and HR after ET insertion in group LE increased significantly compared to those in group L (P < .05/5). The values of both SBP and HR after ET insertion did not exceed the basic values in group LE (P > .05/4). There were no significant differences in the incidence and severity of postoperative sore pain and hoarseness, cough during i-gel and ET removal between the 2 groups (P > .05). Placing the anterior end of ET at the glottis reduced LMA air leakage related to glottic contraction and closure in non-minor surgery. The ET placing had low stress response and did not significantly increase postoperative complications.

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

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

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

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

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

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

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

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

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

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

Complications and Risks of Laryngeal Mask versus Endotracheal Tube for Patients Undergoing General Anesthesia

Complications and Risks of Laryngeal Mask versus Endotracheal Tube for Patients Undergoing General Anesthesia

Anaesthetic challenges of carinal resection and reconstruction: A case report.

Carinal resection of tumour involving trachea and carina remains as a challenge for thoracic surgeons and anaesthesiologists. Resection is technically demanding and can be associated with significant morbidity and mortality. In this case report, we describe the successful management of carinal tumour with carinal resection in a 45-year-old female. The tumour was involving lowermost trachea, carina and bilateral primary bronchi causing 60% narrowing of the lower trachea just before carina, more than 90% narrowing of right main bronchus and 50% luminal narrowing of left main bronchus. Carinal resection and reconstruction were successfully performed under general anaesthesia. Patient was managed with conventional orotracheal intubation with Micro laryngeal endotracheal tube and positioned in left principal bronchus railroaded over a paediatric bronchoscope for lung isolation. After thoracotomy, the left main bronchus was intubated directly across the operative field with a sterile flexometallic endotracheal tube. With intermittent ventilation, anastomosis was completed. During anastomosis Micro laryngeal endotracheal tube cuff was damaged twice and we had to reintubate the patient twice in lateral position itself. At the end of anastomoses, flexometallic tube was removed and wound repaired. After confirming no leakage at anastomotic site, Micro laryngeal endotracheal tube was removed and Laryngeal Mask Airway was inserted and bronchial toileting done with adult bronchoscope. Meticulous planning and communication between the anaesthesia and surgical teams are mandatory for the safe and successful anaesthetic management of carinal resection surgeries.

Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol.

(1) To demonstrate feasibility and safety of surfactant administration via laryngeal mask airway (LMA) as a first-line therapy. (2) To measure treatment success, defined as avoidance of intubation/invasive mechanical ventilation, and determine if specific clinical variables could predict success/failure. Observational cohort with eligible infants given surfactant using one type of LMA via standardized protocol. Data was captured prospectively followed by retrospective chart review. 120 infants ≥1250 g and 28.3-41.1 weeks gestation were included. First-line LMA surfactant therapy was successful in 70% of the infants and those infants weaned to room air significantly quicker than infants requiring subsequent intubation/mechanical ventilation (p = 0.002 by 72 h, p = 0.001 by 96 h). Clinical variables assessed could not predict treatment success/failure. Complications were infrequent and did not differ between groups. First-line LMA surfactant is feasible and safe for certain infants. Prediction of treatment success was not possible in our cohort.

Application of Laryngeal Mask Airway in Airway Management of Patients with A Tracheal Stenosis – A Case Report

Tracheal stenosis is a severe condition that significantly affects patients’ quality of life, with airway reconstruction surgery being the primary treatment. Airway management is critical during general anesthesia, especially when the airway is the surgical site. This report presents clinical concepts and cases of the successful use of laryngeal masks as a supraglottic airway for intraoperative tracheal management in patients with tracheal stenosis. As a transitional device for airway management, a laryngeal mask can provide adequate ventilation and oxygenation and should be incorporated into airway control protocols for individuals with tracheal stenosis.