Laryngeal Mask Research Articles

Intubating Laryngeal Mask Airway for Airway Management and Blind Tracheal Intubation Through It From 360° Around a Supine Patient: A Randomized Controlled Clinical Study in a Simulated Prehospital Emergency Scenario.

Introduction In emergency situations, airway management is often given priority over other treatment methods. The preferred technique for airway management of unconscious patients is endotracheal intubation, which has become the standard of care. Intubation of the trachea not only enables controlled ventilation even for extended periods and in any position but also allows for the removal of tracheal secretions. Supraglottic airways have several advantages over endotracheal intubation, including faster insertion,less need for neuromuscular blockade, and less hemodynamic instability. They can also be used as a bridge to intubation or as a rescue device when intubation fails or is contraindicated. The aim of this randomized controlled clinical study is to simulate a prehospital emergency/disaster scenario to evaluate and study the feasibility and effectiveness of the use of intubating laryngeal mask airway (ILMA) for onsite airway management from 360 degrees around the patient's head as in such situations, there may be limited or no access behind the head of the victim. Such a scenario can be extrapolated to disaster conditions where the victims may be trapped under the rubble following a building collapse /earthquake or are trapped in a vehicular road traffic/ train accident. It may take substantial time for extrication and evacuation of such patients to a hospital and hence it may be life-saving to provide prompt and early onsite airway management from wherever access is possible around the victim. We believe that the provision of a steel handle integrated with the airway tube may provide an opportunity for successful insertion of the device from 360 degrees around the patient merely by suitably changing the way the handle is gripped, so as to allow a single-handed smooth arc-like movement of the device for insertion, irrespective of the position of the rescuer relative to the patient's head. Objectives Our objective is to study the ease and time of insertion of ILMA, the number of attempts for successful ILMA insertion, and oropharyngeal leak pressure attained from unconventional positions in a supine patient. Materials and methods This prospective, randomized, observer-blinded controlled trial included 90 patients undergoing elective surgery under general anesthesia. Patients were randomized using a chit and box system for group allocation. Groups were as follows: Group 1 (n=30) - Investigator standing on the back of the head of the patient (0°); Group 2 (n=30) - Investigator standing on the left side facing the patient (120°); Group 3 (n=30) - Investigator standing on the right side facing the patient (240°). Then ease and time of insertion of ILMA, number of attempts for successful ILMA insertion and oropharyngeal leak pressure were noted, and intergroup comparison was done. Conclusion ILMA has proved to be an effective ventilatory device and a suitable conduit for intubation in patients lying in the supine position from a conventional standard position standing behind the head of the patient, as well as non-conventional position, facing the patient at 120° or 240° from the standard position.

A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study

BackgroundThe video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. MethodsOne hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. ResultsThe first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. ConclusionsThe new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. Trial registrationChinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).

Perbedaan Tingkat Nyeri Tenggorokan Pasca Ekstubasi Endotracheal Tube (ETT) dan Laryngeal Mask Airway (LMA) di RSUD Dr. Soedirman Kebumen

General anesthesia is a condition in which the patient loses consciousness completely after taking certain medications. Sore throat is a common complication in postoperative patients with general anesthesia after extubation with laryngeal mask airway or endotracheal tube. The aim of this study was to compare the level of throat pain after extubation using an endotracheal tube versus a laryngeal mask airway. Methods: A quantitative cross-sectional approach was utilized, with accidental sampling as the technique. The study sample comprised 78 respondents who underwent surgery and were extubated with either an endotracheal tube or a laryngeal mask airway at Dr. Soedirman Hospital, Kebumen. Data analysis was conducted using the Mann-Whitney test. Results: Each group, consisting of endotracheal tube and laryngeal mask airway users, had 39 respondents. Throat pain was reported by 34 respondents (84.6%) in the endotracheal tube group and 27 respondents (69.2%) in the laryngeal mask airway group. The Mann-Whitney test yielded a p-value of 0.022, which is less than 0.05. Conclusion: There is a significant difference in the level of sore throat in postoperative patients with the laryngeal extubation technique with the laryngeal mask air way extubation technique and the endotracheal tube extubation technique at dr. Soedirman Kebumen Hospital.

Laryngeal mask airway versus endotracheal tube during percutaneous dilatational tracheostomy in critically ill adult patients

BackgroundOne of the most often used bedside surgical techniques in critical care units (ICUs) for critically ill individuals who need prolonged mechanical ventilation is percutaneous dilatational tracheostomy (PDT). Numerous difficulties may arise from puncturing the esophagus or making a false passage during surgery.ObjectivesTo compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) during PDT guided by ultrasonography (US) or bronchoscopy.MethodsOur study was a prospective cohort of 120 patients admitted to the Critical Care Department at Kasr Alainy Hospital and Damanhur Medical National Institute between March 2020 and November 2021. Hemodynamics, arterial blood gasses, complications, and outcomes of the patients were recorded.ResultsThe studied patients were divided into the ETT and LMA groups (60 patients in each group). Then, each group was subdivided into two subgroups (ETT-US, ETT-Bronch, LMA-US, and LMA-Bronch; 30 patients in each subgroup) according to the guiding procedure used for puncturing the trachea: US-guided or bronchoscopy-guided. Regarding HR, there was no statistically significant difference between the two groups or four subgroups before, during, and after the procedure. In addition, there was no statistically significant difference between the two studied groups regarding MAP before the procedure. However, during and after the procedure, MAP was significantly higher in the ETT group. There was no discernible change in oxygen saturation or PaO2 before, during, or after the procedure. However, there was no discernible difference in PaCO2 levels before and after the procedure; it was much greater in the ETT group and ETT-Bronch subgroup during the process. Furthermore, there was no statistically significant variation in the number of punctures between the two groups or the four subgroups. The length of the process varied significantly across the two major groups and the four evaluated subgroups. The LMA group had the shortest procedure duration (5.05 ± 1.28 min), the LMA-Bronch subgroup (4.79 ± 1.42 min), and the LMA-US subgroup (5.31 ± 1.10 min), while the ETT had the longest procedure duration group (5.86 ± 1.11 min), the ETT-Bronch subgroup (6.09 ± 1.23 min), and ETT-US (5.63 ± 0.94 min). Regarding complications, there was no considerable difference between the two groups or four subgroups except aerophagia. Aerophagia was considerably more common in the LMA group (7 candidates) and was not observed in the ETT group.ConclusionsOur study concluded that the laryngeal mask airway improves ventilation during percutaneous dilatation tracheostomy, especially when used with ultrasound, and thus can be used for candidates with traumatic brain injury and brain edema.

Application of combined anesthesia with spontaneous breathing in the surgery of intertrochanteric fracture of femur in elderly patients.

This study aims to investigate the feasibility and safety of combined anesthesia with spontaneous breathing in the operation of intertrochanteric fracture of femur in the elderly. Between January 2020 and January 2023, a total of 141 elderly patients (45 males, 96 females; mean age: 72.5±6.8 years; range, 65 to 87 years) who underwent proximal femoral nail anti-rotation (PFNA) surgery for intertrochanteric fracture of femur were included in this single-blind, prospective, randomized-controlled study. The patients were randomly divided into three groups. Group A (experimental group) was a general anesthesia with laryngeal mask airway (LMA) group preserving spontaneous breathing, Group B (control group 1) was a general anesthesia with LMA group for mechanical ventilation, and Group C (control group 2) was a tracheal intubation anesthesia group for mechanical ventilation. The differences of related indexes among the three groups were compared. The mean onset time of anesthesia (6.23±1.45 vs. 12.78±2.78 vs. 13.73±2.43 min), postoperative recovery time of consciousness (8.13±0.83 vs. 11.34±0.89 vs. 12.45±0.86 min), and postoperative complete awakening time (10.45±2.34 vs. 18.87±2.56 vs. 19.62±2.93 min) were significantly shorter in Group A than in Groups B and C (p<0.05). The duration of analgesic effect was longer in Group A than in Groups B and C (p<0.05). After anesthesia, the Ramsay Sedation Scale and Visual Analog Scale (VAS) scores were significantly lower in Group A than the other groups (p<0.05). The mean Mini-Mental State Examination (MMS) scores were significantly higher in Group A than in Groups B and C (p<0.05). Hemodynamic parameters showed that blood pressure, heart rate, cardiac output, and cardiac index (CI) levels were significantly higher in Group A than the other groups (p<0.05). Our study results indicate that combined anesthesia preserving spontaneous breathing is safe and feasible in the operation of intertrochanteric fracture of femur in the elderly, with faster anesthesia recovery than the mechanical ventilation group.

Comparison of Incidence of Laryngospasm between Laryngeal Mask Airway and Endotracheal Tube during the Recovery Phase following Urological Procedure in Paediatric Patients

Airway-related issues pose significant perioperative complications in paediatric anaesthesia, with laryngospasm being particularly noteworthy. The choice of airway device has been identified as a contributing factor to this concern. This research was conducted from January to December of 2023; it specifically investigated and compared the incidence of laryngospasm following removal of a laryngeal mask airway (LMA) versus an endotracheal tube (ET) in paediatric patients undergoing elective urological procedure. Sixty ASA – I/II patients, aged 2 to 5 years and of both genders, were randomly allocated into two groups: Group I received ETT, while Group II received LMA. Various parameters including hemodynamic measures and the occurrence of laryngospasm, cough, and other complications were assessed. Results demonstrated a higher incidence of laryngospasm and cough in the ET group compared to the LMA group (p&lt;0.05). However, no significant differences were observed between the groups regarding other complications such as bradycardia, apnoea, desaturation, shivering, and abdominal distension. Adoption of a laryngeal mask airway (LMA) instead of an endotracheal tube (ET) during elective urological procedures in paediatric patients may lead to a lower occurrence of laryngospasm. CBMJ 2024 July: vol. 13 no. 02 P: 183-191

Effect of simulation-based emergency airway management education on the knowledge, skills and perceived confidence of medical interns.

An effective airway management education program is a crucial part of the undergraduate medical education curriculum. Theoretical instructions and practical demonstrations are the major modalities of medical education in Nepal. Simulation-based education (SBE) programs have not yet been implemented effectively. The authors aimed to determine the effects of an SBE program on the knowledge, skills, and perceived confidence of medical interns regarding emergency airway management. This mixed methods study comprised both quantitative and qualitative components. The study participants were 47 medical interns who had participated in the SBE program. The mean age of the 47 participants was 24.74 years. There were 33 (70.21%) male and 14 (29.79%) female participants. The knowledge, skills, and perceived confidence scores of the participants for airway management preparation, basic airway management, endotracheal intubation, and laryngeal mask airway (LMA) insertion improved significantly following the SBE program (P<0.001). Analysis of the participants' feedback indicated that they largely approved of the SBE program. The majority of students and faculty expressed a willingness to include similar programs in the undergraduate medical education curriculum. This study demonstrated through quantitative and qualitative metrics that SBE can enhance the knowledge, skills, and perceived confidence in performing emergency airway management among medical interns. The authors recommend measures to include and effectively implement SBE in the undergraduate medical education curriculum of Nepal.

Thoracoscopic wedge resection of the upper lobe of the left lung achieved by a new approach of laryngeal mask general anesthesia with preservation of spontaneous breathing: A case report.

General laryngeal mask anesthesia with the preservation of spontaneous breathing has accelerated the advancement of the enhanced recovery after surgery concept in thoracoscopic surgery. However, the need for increased doses of anesthetic drugs to reduce laryngeal mask airway (LMA) stimulation poses challenges due to the increased risk of hypotension, respiratory depression, susceptibility to hypoxemia, and carbon dioxide retention, particularly in the lateral position. During the perioperative period, reducing the dose of anesthetic drugs while simultaneously improving LMA tolerance and preventing circulatory and respiratory depression poses a challenge. The patient was diagnosed with a nodule in the upper lobe of the left lung. In this case, we chose remimazolam sedation, which mildly inhibits circulatory respiration, and used mucosal surface anesthesia in the pharynx. This approach improved the patient's tolerance to LMA, reduced the dose of anesthetic drugs, and facilitated the successful thoracoscopic wedge resection of the upper lobe of the left lung with preservation of spontaneous respiration. During 2 weeks follow-up, the patient recovered satisfactorily and did not report any discomfort. We used pharyngeal mucosal surface anesthesia and thoracic paravertebral nerve block in combination with remimazolam sedation to provide precise analgesia, moderate sedation, and successful LMA general anesthesia with preservation of spontaneous respiration in patients undergoing thoracoscopic pulmonary wedge resection.

Video laryngoscopy improves ProSeal™ laryngeal mask airway position by anesthesia residents: A randomized controlled, double-blind study

BackgroundThe insertion of ProSeal laryngeal mask airway (LMA) using a blind digital technique is difficult for inexperienced performers and malpositioning of the device can impair ventilation and may lead to complications. AimThis study aimed to compare the proper ProSeal LMA position inserted by anesthesia residents between video laryngoscopy-assisted and blind digital insertion techniques. MethodsA total of 138 patients aged 18–80 years, ASA I and II undergoing elective surgery, were randomly allocated to the digital or video laryngoscopy-assisted group. Anesthesia residents performed ProSeal LMA insertion. The primary outcome was the proportion of a proper LMA position evaluated by a blinded assessor using the fiber-optic scores. Secondary outcomes included first attempt success rate, duration of insertion, incidence of desaturation during insertion, peak airway and oropharyngeal leak pressure, gastric tube placement difficulty, hemodynamic disturbance, and airway complications at 1 and 24 h after surgery. ResultsPatients in the video laryngoscopy group demonstrated a significantly higher proportion of proper LMA position than those in the digital group (53/68 [78 %] vs. 24/67 [36 %]; RR 2.18 [95%CI 1.54–3.07]; P < 0.001). Using the video laryngoscopy-guided insertion improved the fiber-optic scores by 7.11 folds (95%CI 3.53–14.32; P < 0.001) compared with the digital technique. Patients in the video laryngoscopy group showed higher sealing pressure, easier gastric tube placement, but longer insertion time. There was no significant difference in the peak airway pressure, first-attempt success rate, hemodynamic changes, and airway complications between groups. No desaturation occurred during the study. ConclusionUsing a Macintosh-shaped blade video laryngoscope facilitates novice anesthesiologists in achieving improved ProSeal LMA positioning without compromising airway or hemodynamic complications. The optimal ProSeal LMA position also provides a higher oropharyngeal sealing pressure and easier gastric tube placement.

Laryngeal Mask Airway vs. Orotracheal Intubation: A Review of Safety and Efficacy in Elective Procedures

Laryngeal Mask Airway vs. Orotracheal Intubation: A Review of Safety and Efficacy in Elective Procedures

Non-intubated tracheal resection and reconstruction for a tracheal tumor in an 8-year-old child

IntroductionIt has been reported that non-intubated anesthesia can be used successfully in adult trachea reconstruction. Herein, our center reported a case of a child undergoing non-intubated trachea reconstruction for benign tracheal tumors.Case descriptionIn January 2023, it was decided to attempt tracheal resection and reconstruction (TRR) in an 8-year-old child with an inflammatory myofibroblastic tumor under non-intubated spontaneous breathing. After anesthesia induction, the laryngeal mask airway (LMA) was inserted. Thereafter, a bilateral superficial cervical plexus block was performed with 15 mL of 0.25% ropivacaine injected into each side. The patient was induced to resume spontaneous breathing by artificially assisted ventilation with an oxygen flow of 2 to 5 L/min and FiO2=1. After tracheotomy, the oxygen flow was increased to 15 L/min to improve the local oxygen flow to maintain the pulse oxygen saturation (SpO2) above 90% under spontaneous breathing. The patient had stable spontaneous breathing after tracheal anastomosis. The anastomosis was perfect without leakage. The LMA was removed and oxygen was given by the nasal catheter under light sedation at post anesthesia care unit (PACU).ConclusionTracheal reconstruction under spontaneous breathing may be an alternative anesthesia method for upper tracheal surgery in children.

Impact of Sugammadex Introduction on Using Neuromuscular Blockade and Endotracheal Intubation in a Pediatric Hospital: A Retrospective, Observational Cross-Sectional Study.

Sugammadex is a neuromuscular blockade (NMB) reversal agent introduced in the United States in 2016, which allows the reversal of deep NMB, not possible with neostigmine. Few data describe associated practice changes, if any, in NMB medication use that may have resulted from its availability. We hypothesized that after institutional introduction, use of NMB agents increased. Furthermore, as NMB medication is typically used when the airway has been secured with an endotracheal tube (ETT), we speculated that ETT use may have also increased over the same time period as a result of sugammadex availability. This was a single-center cross-sectional study of patients ages 2 to 17 years undergoing general anesthesia for surgical cases where anesthesia providers often have discretion over NMB medication use or whether to use an ETT versus a laryngeal mask airway (LMA), comparing the time periods 2014 to 2016 (presugammadex) to 2017 to 2019 (early sugammadex) and 2020 to 2022 (established sugammadex). Outcomes included use of (1) any nondepolarizing NMB medication during the case and (2) an ETT versus LMA. We used generalized linear mixed models to examine changes in practice patterns over time. We also examined whether patient age group and in-room provider (resident versus certified registered nurse anesthetist [CRNA]) were associated with increased NMB medication or ETT use. There were 25,638 eligible anesthetics. Patient and surgical characteristics were similar across time periods. In adjusted analyses, the odds of NMB medication use increased from 2017 to 2019 (odds ratio [OR], 1.55, 95% confidence interval [CI], 1.38-1.75) and 2020 to 2022 (OR, 5.62, 95% CI, 4.96-6.37) relative to 2014 to 2016, and were higher in older children (age 6-11 years vs 2-5 years OR, 1.81, 95% CI, 1.63-2.01; age 12-17 years vs 2-5 years OR, 7.01, 95% CI, 6.19-7.92) and when the primary in-room provider was a resident rather than a CRNA (OR, 1.24, 95% CI, 1.12-1.37). The odds of ETT use declined 2017 to 2019 (OR, 0.69, 95% CI, 0.63-0.75) and 2020 to 2022 (OR, 0.71, 95% CI, 0.65-0.78), more so in older children (age 6-11 years vs 2-5 years OR, 0.45, 95% CI, 0.42-0.49; age 12-17 years vs 2-5 years OR, 0.28, 95% CI, 0.25-0.31). Resident presence at induction was associated with increased odds of ETT use (OR, 1.50, 95% CI, 1.38-1.62). The decision to use NMB medication as part of an anesthetic plan increased substantially after sugammadex became available, particularly in older children and cases staffed by residents. ETT use declined over the study period.

Comparison of Endotracheal Tube (ETT) and Laryngeal Mask Airway (LMA) in Pediatric Anesthesia: A Systematic Review

The present systematic review compares the effects ofthe laryngeal mask airway (LMA) and the endotrachealtube (ETT) on hemodynamic response and airwaydifficulties in pediatric anesthesia patients. The terms"children," "postoperative," "pediatrics," "laryngealmask airway," "endotracheal tube," and "subglottic"were utilized. The scope of the literature review waslimited to randomized controlled trials (RCTs), andPubMed, Google Scholar, and the Cochrane Library wereamong the databases searched. Two reviewers used theCochrane Risk of Bias Tool to assess quality. Eight RCTsin total were included. When compared to the ETT,results showed that the number of attempts forendotracheal intubation was fewer than for theplacement of the LMA. Additionally, there was anincrease in blood pressure, heart rate, and mean arterialpressure with the use of the ETT. The incidence ofpostoperative respiratory complications, includinglaryngospasm, bronchospasm, and sore throat, washigher with the use of the ETT. We conclude that the useof the LMA can be a safe alternative to the ETT inpediatric patients, producing fewer hemodynamicchanges and postoperative complications.

Study of effect of head elevation in PROSEAL laryngeal mask airway insertion at a tertiary hospital

Background &amp; Aims: Proseal Laryngeal Mask Airway (PLMA) is a supra-glottic airway device that prevents gastric insufflation and pulmonary aspiration. In the present study, we intend to determine the effect of head elevation in PLMA insertion. Methodology: The present study was a single-center, comparative, interventional study, conducted in patients of 18-60 years of age, either gender, American Society of Anaesthesiologists (ASA) grade I-II, patients posted for elective surgical procedures under general anaesthesia. 123 adult patients were randomized into three groups using a random number table. Group C: No head elevation (No pillow), Group LP: 4 cm head elevation (4 cm pillow), and Group HP: 8 cm head elevation (8 cm pillow). Results: PLMA insertion at first attempt was successful in 30 patients (73.17%) in Group C, 40 patients (97.56%) in Group LP &amp; 22 patients (53.66 %) in Group HP, the difference was statistically significant (P &lt;0.001). The mean insertion time of LMA in Group C, Group LP, and Group HP was found to be 21.90 ± 4.48s, 16.12 ± 5.35s, and 25.14 ± 8.79s respectively which was significantly less in Group LP when compared with Group C and Group HP (P&lt; 0.001). The ncidence of blood staining on PLMA was significant in Group HP (20 patients) as compared to Group C (3 patients) &amp; Group LP (2 patients), the difference was statistically significant (P &lt;0.001). Conclusion: A head elevation by a pillow of height of 4 cm was effective for PLMA insertion in adult patients when compared with an 8 cm pillow.

Comparison of Anesthetics for Laryngeal Mask Airway Insertion: A Network Meta-Analysis.

This study aimed to establish which anesthetic agents are associated with minimized adverse outcomes during laryngeal mask airway (LMA) insertion. Databases were searched for randomized controlled trials (RCTs) with American Society of Anesthesiologists I or II adult patients (≥15 years of age) receiving general anesthesia (GA) with an LMA. Propofol only was the comparator to other anesthetics used during LMA insertion. The primary outcome was prolonged apnea, and secondary outcomes were adverse airway events, LMA insertion failure, inadequate depth of anesthesia, and hemodynamic events. A network meta-analysis was conducted to estimate the treatment effects (odds ratios, 95% credible intervals, and surface under the cumulative ranking curve [SUCRA]). A total of 28 anesthetic combinations used on 4695 patients for GA induction and LMA insertion were examined across 53 RCTs. Overall, there was an apnea incidence rate of 33.3% (849 of 2548) with a mean time of 3.74 ± 3.56 minutes (n = 3091). Propofol + dexmedetomidine had the highest overall summed score of SUCRA ranks in reducing adverse outcomes (apnea incidence: SUCRA = 37%, apnea time: SUCRA = 66%, airway adverse event: SUCRA = 67%, insertion failure: SUCRA = 73%, inadequate depth of anesthesia: SUCRA = 84%). In comparison among all propofol combinations, propofol alone ranked lowest for overall summed score of SUCRA in reducing adverse outcomes (apnea incidence: SUCRA = 47%, apnea time: SUCRA = 71%, airway adverse event: SUCRA = 9%, insertion failure: SUCRA = 20%, inadequate depth of anesthesia: SUCRA = 9%). All anesthetic combinations, other than those with thiopental, reduced adverse outcomes as compared with propofol alone. The combination of propofol and dexmedetomidine infused over 10 minutes ranked as the most effective for reducing adverse outcomes during LMA insertion.

Beyond laryngoscopy: Trends in advanced technique endotracheal intubation in pediatric intensive care units across the United States

ObjectivesEndotracheal intubation (ETI) is a lifesaving procedure in critically ill children. Direct laryngoscopy (DL) is the most utilized method for ETI, however advanced techniques beyond DL are indicated in some patients. The purpose of this study is to describe trends of advanced ETI techniques in the critical care setting. Materials and methodsUsing the National Emergency Airway Registry for Children (NEAR4KIDS), advanced technique ETI quality improvement data were prospectively collected for ETIs in PICUs from April 2018 to September 2021. Those who underwent ETI with only DL or who underwent exchange of an existing endotracheal tube were excluded. ResultsA total of 79 patients underwent advanced technique ETI with a median age of 8 (IQR 1–17) years. Advanced technique ETI was successful on the first attempt in 46.8 % of cases, with an overall success rate of 91.1 %. 1.3 % of patients received emergent surgical airway management. The most utilized advanced ETI technique was video laryngoscopy, followed by flexible bronchoscopy, and intubation through a laryngeal mask airway (LMA). The provider discipline ultimately successful in performing advanced technique ETI was most often pediatric critical care medicine (n = 26, 32.9 %), followed by anesthesia (n = 20, 25.3 %), and otolaryngology (n = 16, 20.3 %). ConclusionWhile often indicated in challenging clinical scenarios, advanced ETI techniques are ultimately successful in the vast majority of cases. Advanced technique ETI is a highly multidisciplinary process.

Airway management may influence postoperative ventilation need in preterm infantsafter laser eye treatment.

Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV. Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]). The use of LMA is associated with a reduced need for postoperative MV. Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.

Comparison of incidence of sore throat with laryngeal mask airway Protector and laryngeal mask airway ProSeal: A randomised clinical trial.

Postoperative sore throat (POST) can be as high as 42% in supraglottic devices. LMA® Protector™ is a novel second-generation laryngeal mask airway (LMA) with Cuff Pilot™ technology that allows continuous cuff pressure monitoring. Elevated cuff pressure is a risk factor for POST in supraglottic devices, so we conducted this study to determine whether continuous cuff pressure monitoring can alleviate POST. This randomised double-blinded clinical trial compared the incidence of sore throat between LMA® Protector™ and LMA® ProSeal™ and was conducted in 118 patients scheduled for elective short surgical procedures. They were randomised to either LMA® Protector™ (Group PT) or LMA® ProSeal™ (Group P). The airway was secured with either of the two devices. The primary outcome was the incidence of sore throat at 1, 6, and 24 hours postoperatively and compared using the Chi-square test along with other parameters like first attempt success rate and blood staining of the device. The time taken for insertion and oropharyngeal seal pressure were compared using an independent t-test. The incidence of POST was low with Group PT (12%) compared to Group P (28.8%) (P = 0.005). The mean oropharyngeal seal pressure was significantly higher in Group PT than in Group P [33.72 (3.07) versus 27.72 (3.88) cm of H2O], P < 0.005. The first attempt success rate was 81.2% and 100% in LMA® Protector™ versus LMA® ProSeal™. LMA® Protector™ had a reduced incidence of POST compared to LMA ProSeal. However, a longer insertion time and difficult placement may be a concern.

Laryngeal Mask Airway in Neonatal Resuscitation: A Survey of the Union of European Neonatal and Perinatal Societies

Introduction: Laryngeal mask airway (LMA) use in neonatal resuscitation is limited despite existing evidence and recommendations. This survey investigated the knowledge and experience of healthcare providers on the use of the LMA and explored barriers and solutions for implementation. Methods: This online, cross-sectional survey on LMA in neonatal resuscitation involved healthcare professionals of the Union of European Neonatal and Perinatal Societies (UENPS). Results: A total of 858 healthcare professionals from 42 countries participated in the survey. Only 6% took part in an LMA-specific course. Some delivery rooms were not equipped with LMA (26.1%). LMA was mainly considered after the failure of a face mask (FM) or endotracheal tube (ET), while the first choice was limited to neonates with upper airway malformations. LMA and FM were considered easier to position but less effective than ET, while LMA was considered less invasive than ET but more invasive than FM. Participants felt less competent and experienced with LMA than FM and ET. The lack of confidence in LMA was perceived as the main barrier to its implementation in neonatal resuscitation. More training, supervision, and device availability in delivery wards were suggested as possible actions to overcome those barriers. Conclusion: Our survey confirms previous findings on limited knowledge, experience, and confidence with LMA, which is usually considered an option after the failure of FM/ET. Our findings highlight the need for increasing the availability of LMA in delivery wards. Moreover, increasing LMA training and having an LMA expert supervisor during clinical practice may improve the implementation of LMA use in neonatal clinical practice.

The Role of Magnesium Sulfate to Facilitate Classical LMA Insertion, in Spontaneous Breathing Anesthesia

Background: Laryngeal Mask Airway (LMA) is a noninvasive supraglottic device that requires Smooth insertion and correct positioning of an LMA requires adequate through mouth opening and sufficient depth of anesthesia to prevent complications such as gagging, coughing, swallowing, head and limb movements and laryngospasm. Propofol is consider the induction agent of choice for LMA insertion but when used alone it provides less than satisfactory LMA insertion conditions. Aim of the study: Is to find The role Of Magnesium Sulfate to facilitate classical LMA insertion ,in spontaneous breathing anesthesia. Patients and method: A prospective randomizes clinical trial study was carried out in General Surgery theatres of Baghdad Teaching Hospital. A 40 patients where included and they were undergoing minor elective surgery, divided into two groups equally, magnesium group (M group, n=16) and control group (C group, n=18), 6 cases were dropped from the study(2 from C group and 4 from M group). All patients were premeditated with Ranitidine 50mg, Metoclopramide 10mg and Dexamethasone 8mg. Then patient would receive either a 100ml of (0.09% N/S) for the C group, or 30mg/Kg of Magnesium Sulfate in 100ml of (0.09% N/S) for the M group. Results: that there were no significant differences between M group (n=16) and C group (n=18) in the age, weight and duration of surgery where p value was (0.571, 0.791 and 0.351 respectively). Also there was no improvement in LMA insertion condition in M group in compares to C group regarding number of insertion attempt where p value was non-significant(0.498),nor did it influence the easiness of LMA grading were P value was found to be(1,0.112 and 0.471 for grades I,II and III respectively),but an accidental finding that M group had a shorter time duration from skin closure until LMA removal which was significant (p=0.021). Conclusion: We concluded that giving magnesium sulfate infusion at 30 mg/Kg prior to induction, does not improve LMA insertion condition in spontaneous breathing anesthesia.