LMA Group Research Articles

Comparative Case Series on LMA-Assisted Flexible Fiberoptic Bronchoscopy

ABSTRACT Fiberoptic bronchoscopy in children requires sedation, while routinely employed techniques for oxygenation under sedation don’t provide airway protection.LMA during FOB can provide safer ventilation with good operative views.Although the use of laryngeal mask airway for FOB was described in 1982, its application has not been established in pediatric patients. The aim of our study was to compare the safety and efficacy of LMA-assisted bronchoscopy compared to nasal airway with oxygenation-assisted bronchoscopy. The study was conducted on 12 patients, 6 in each group. Data collected includes monitoring of oxygen saturation, hemodynamics, ETCO2, and complications. LMA group children had lower episodes of desaturation as compared to nasal airway group. ETCO2 values were maintained and rate of complications were less in LMA group. Hemodynamic stability in both groups were comparable. Hence the use of LMA allows better airway conduit, with stable O2 saturation and ETCO2 values than nasal airway-assisted bronchoscopy.

Comparing the Efficiency of Laryngeal Mask Airway and Endotracheal Tube Insertion in Airway Management in Patients Planning for Elective Orthopedic Surgery under General Anesthesia: A Randomized Clinical Trial.

The present study compared respiratory parameters between the two methods of airway establishment, ETT and LMA, for patients scheduled for orthopedic surgery with general anesthesia. This randomized double-blinded clinical trial was conducted on patients scheduled for elective orthopedic surgery under general anesthesia, in Bandar Abbas, Iran, from January 2021 to December 2021. Using a random allocation table, the study participants were randomly divided into two groups, to employ either ETT (n=48) or LMA insertion (n=48). The study's ultimate goal was to assess the respiratory parameters in 1, 3, 5, 10, and 15 minutes following intubation. At all-time points, the average of peak airway pressure (P peak) and P plateau parameters in the ETT group was much higher than the EMA group (p<0.001 in all comparisons). The value of dynamic lung compliance in the LMA group was significantly higher than the ETT group in all considered time periods (p<0.001 in all comparisons). The upward trend in the value of this index was significant only in the LMA group (p=0.030). There were no significant differences in arterial oxygen saturation and end-tidal carbon dioxide levels between the two groups (p>0.05). In terms of arterial oxygen saturation stability and at the same time providing respiratory dynamic compliance, the LMA device outperformed the ETT.

COMPARATIVE STUDY OF HEMODYNAMIC RESPONSE USING LARYNGEAL MASK AIRWAY (LMA) VERSUS ENDOTRACHEAL TUBE (ETT) IN CONTROLLED HYPERTENSION PATIENTS

In the practical conduct of Anaesthesia, Airway management is crucial to the outcome &amp; best patient care. A total of n=114 patients,30-50 yrs with mean age 38.736± 4.36 years; 57 each group of Laryngoscopy and ETT; and LMA group undergoing elective surgery of 30 minutes to 01-hour duration in controlled hypertensives were included in the study. The hemodynamic response was noted, recording pulse rate, Systolic BP, Diastolic BP, and MAP immediately after 1,3,5 minute of laryngoscopy &amp; intubation or LMA insertion. The study results showed a hemodynamic response of 59.6% in patients of the Laryngoscopy &amp; ETT group compared to 40.4% in the LMA group. The study revealed attenuated hemodynamic response to LMA insertion with improved hemodynamic; stability compared to laryngoscopy &amp; intubation. The results advocate using supraglottic airway devices, especially LMA merits, in selected patients &amp; circumstances.

Laryngeal mask general anaesthesia versus spinal anaesthesia for promoting early recovery of cervical conisation: A randomised, controlled clinical study

BackgroundAlthough both spinal and general anaesthesia provides good anaesthesia for cervical conization, spinal anaesthesia delays the return of lower limb movements and urinary function, whereas general anaesthesia requires the patient to be unconscious. It is unclear which anaesthetic technique is more conducive to early postoperative recovery in patients undergoing cervical conization. Patients and methods140 patients undergoing cervical conization underwent either laryngeal mask general anaesthesia (LMA, n = 70) or spinal anaesthesia (SA, n = 70). In the LMA group, an i-gel mask was used for airway management. In the SA group, spinal anaesthesia was received with 0.75% ropivacaine (15 mg) in the L3-4 interval. The quality of recovery score (QoR-15) was the primary endpoint of the study. Secondary endpoints included incidence of adverse 24-h analgesia (NRS>3); return of lower limb activity; first bed activity and feeding; and the number of catheters removed at 6, 12 and 24 h postoperatively. ResultThe LMA group significantly improved QoR-15 scores (136.62 ± 11.02 vs 119.97 ± 12.75; P < 0.001); and reduced the incidence of poor analgesia (NRS >3) within 24 h postoperatively (20% vs 42.8%, P = 0.006); reduced time in bed (15.62 ± 3.83 h vs 18.27 ± 5.57 vs, P = 0.001); improved patient satisfaction (86% vs 27%; P < 0.001); and catheters removal within 24 h (70/70 vs 42/70, P < 0.001). ConclusionLMA general anaesthesia can facilitate early postoperative recovery in patients undergoing cervical conization compared with conventional spinal anaesthesia. Trial registrationChinese Clinical Trial Registry (ID: ChiCTR1800019384), http://www.chictr.org.cn/listbycreater.aspx (08/11/2018).

COMPARISON OF TWO SUPRAGLOTTIC AIRWAY DEVICES IN MAINTAINING AIRWAY FOR SHORT SURGERIES

Objective: To find the better supraglottic airway device in terms of advantages, and complications, in short surgeries following anesthesia and paralysis.&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration of Study: Combined Military Hospital Okara and Armed Forces Institute of Urology, Rawalpindi Pakistan, from July 2018 to July 2020.&#x0D; Methodology: Prospectively, 130 American Society of Anesthesiologist (ASA) 1, 2, and 3 patients, aged 15-60 years, scheduled for short urology or gynecological procedure were randomly divided into Group LMA (Group L, n=65) or i-gel group (Group G, n=65). Laryngeal mask airway and i-gel were inserted in respective groups after anesthesia induction and muscle paralysis. The parameters compared were: simplicity of insertion, time taken for insertion, insertion attempts, device exchanged, and complications rate of each device. The data thus obtained was analyzed with SPSS-16.&#x0D; Results: LMA group was similar to i-gel group for gender distribution 68 (52%) vs. 62(47%) and surgery type 60 (urology 46.2%) vs. gynecology 70 (53.8%). The successful insertion rate at first attempt (38.4% vs. 40.7%) was similar in both devices. The device was changed in 3.07% of i-gel patient’s vs. 6.92% LMA group patients, and complication rate was not substantially different in either group (i-gel 5.3% vs. LMA 6%). The insertion time was less in i-gel group (17.62 sec ± 6.41 vs.22.06 sec ±7.92) which was statistically significant p≤0.05.&#x0D; Conclusion: LMA and i-gel are the two supraglottic devices for maintaining airways with different indications from emergency lifesaving to routine surgical procedures but their use in situations like difficult.......

Abstract No. : ABS1275: Efficacy of novel dual channel LMAGastro™ with colour coded pressure gauge in day care GI endoscopy procedures

Background &Aims:The aims and objectives were to evaluate the utility ofGastro™Laryngealmaskairway(LMA) for gastrointestinal(GI)endoscopic procedures for improvement of airway control, to prevent hypoxia andto avoid intubation.Methods:A prospective randomised observational study was conducted in 50 patients, 25 in each group for elective GI endoscopy procedures.Group G : LMA Gastro Group N : Nasal Cannula .All were observed for intraoperative hypoxia/any adverse events/endotracheal intubation. Inclusion criteriawere 18 -60 years, AmericanSocietyofAnesthesiologists(ASA) gradel,ll,lll,ModifiedMallampatiscorEclassIandII,supine/lateral position, Day care,,fasting. Exclusion criteriawere emergency procedure,notnil by mouth,prone position, pregnant and lactating females.Results:50 patients of ASAI,IIand III undergoing GI endoscopic procedure were divided into two groups. Gastro LMA and nasal prong groups;each having 25 patients. In Gastro™ LMA group, 1 patient (4%) required endotracheal intubation and in nasal prong group, 2 patients (8%) required endotracheal intubation. No postoperative complication was noted in any of the two groups.Conclusion:LMA Gastro™ airway is auser friendly device for the gastro physician and anaesthesiologists. It isa useful airway management tool for clinical use in day care GIendoscopic procedures.

An Exploration and Technical Notes for Advanced Airway Management on the Ski Slope: A Simulation Experiment.

Background Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports. During skiing rescue, the harsh natural environments will increase the difficulty of artificial airway establishment. There has been no research focusing on the establishment of the artificial airway during skiing rescue site. This study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope. Methods The simulated human was placed on the cold slope with the head under the feet. Artificial airway was established by the same anesthesiologist using endotracheal intubation (endotracheal intubation group), LMA Supreme laryngeal mask (LMA group), and I-gel laryngeal mask (I-gel group). Each method was repeated 5 times, and the operation time and whether it was successful by one attempt were recorded and compared between groups. Results Three groups of artificial airway were successful by one attempt.. The bite block dropped and drifted away for one time in the endotracheal intubation group. Operation time is 209.2 ± 32.7 seconds in the endotracheal intubation group, 72.2 ± 3.1 seconds in the LMA group, and 52.6 ± 4.2 seconds in the I-gel group. ANOVA showed that there was a significant difference in the operation time among the three groups (p < 0.001). Tukey's post hoc test showed that there were statistically significant differences between the endotracheal intubation group and the other two groups in operation time, p < 0.001, while there was no significant difference between the LMA group and I-gel group (p=0.275). Conclusion The artificial airway can be completed by endotracheal intubation and LMA and I-gel laryngeal mask insertion on the cold slope. Artificial airway with the I-gel laryngeal mask takes the shortest time in this study. Extra caution should be paid to slippery and drifting.

A comparative study on the perfomance between I-gel® and Classic laryngeal mask airway in anaesthetized spontaneously breathing patients

The classic Laryngeal Mask Airway (c-LMA) is a first generation supraglottic airway device with an inflatable cuff forming a low pressure seal around the laryngeal inlet and permitting ventilation. I-gel is a supraglottic airway device made of thermoplastic elastomer which is soft gel-like and transparent. Unlike the classic LMA(c-LMA), I-gel does not have an inflatable cuff. In view of this, the present study was undertaken to compare the performance of the two supraglottic airway devices in spontaneously breathing adult patients posted for elective surgeries under general anesthesia.To compare the ease of insertion, number of insertion attempts, time for insertion, airway leak pressure, hemodynamic changes as well as perioperative complications such as cough sore throat between patients using the two devices.Sixty patients admitted in SRM medical college and research center scheduled for various elective surgical procedures under general anesthesia belonging to ASA class I and II were included in the study. They were randomly divided into two groups of 30 each using a random number generator. In group I, I-gel supraglottic airway device was used and in Group 2 classic laryngeal mask airway was used. Data was collected using a questionair containing socio-demographic details, details regarding performance of the device as well as hemodynamic changes and perioperative complications.The insertion was easy in 25 patients (83.3%) in group I, while in group II 15 patients (50%) had easy insertion. P=0.0 1781. The mean time of insertion for I-gel was (20. 17± 3 .91 seconds) which was significantly shorter compared to c-LMA (26.80 ±7.24 seconds) (P&amp;#60;0.001).There was no statistically significant difference between the devices with respect to number of attempts of insertion. Even though the airway leak pressure is not statically significant, the mean oropharyngeal leak pressure for I-gel was 20.40±5.68 (mm Hg), which was higher than c-LMA 18.73±5.06 (mm Hg), which is well within the normal limits to prevent aspiration. There were no statistically significant differences in hemodynamic changes. No Blood staining was seen after removal of device in I-gel group where it was observed in 2 (7%) patients in c- LMA group. Post removal cough was more in c -LMA (13 .3%) than l-gel (P= 0.04 SS*). Pharyngo-Laryngeal morbidity was more with classic LMA. Sore throat was more with the classic LMA (13 .3%) when compared to I-gel group (3%).We conclude that I-gel is a better airway when compared to c-LMA with respect to ease of insertion, shorter duration for insertion, adequate oropharyngeal seal with lesser pharyngo-laryngeal morbidity and less incidence of airway trauma.

The effectiveness of the Ambu® AuraGain™ laryngeal mask on hemodynamic and respiratory parameters in patients undergoing septoplasty: A randomized prospective clinical study

Background/Aim: The use of laryngeal masks is increasing with the introduction of 3rd generation airway vehicles. However, endotracheal intubation is preferred by most anesthesiologists in septoplasty operations due to airway safety concerns. In this study, we aimed to compare the 3rd generation airway device, Ambu® Auragain ™ LMA, with tracheal intubation in terms of hemodynamic and respiratory parameters. Methods: This study included 69 patients aged 18–60 years with an ASA score of 1–2 who were scheduled for septoplasty in Adıyaman University Research and Educational Hospital between 2016.01.01 and 2017.06.31. Study groups were randomly defined as Group 1 - Ambu® AuraGain™ laryngeal mask (LMA, n = 37) and Group 2 - endotracheal intubation (ETT, n = 32), and the hemodynamic and respiratory parameters were measured and recorded. Results: The demographic data and partial oxygen saturation of the patients were similar (P>0.05 for all values). The patients in the ETT group had a higher heart rate at induction, intubation and at the first minute compared to the LMA group (P<0.05 for all values). The mean arterial pressure was significantly lower at induction, intubation, at minutes 1, 2, 3, and 4 of intubation, and at extubation in the LMA group (P<0.05 for all values). Conclusion: The Ambu® AuraGain™ laryngeal mask was similar to or better than tracheal intubation in terms of hemodynamic and respiratory parameters. The Ambu® AuraGain™ LMA can be used as an equivalent to tracheal intubation in terms of hemodynamic and respiratory parameters.

The Association of Oral Stimulant Medication Adherence with Work Productivity among Adults with ADHD

Objective: Examine associations between oral psychostimulant pharmacotherapy adherence, work productivity, and related indirect costs among US adults with ADHD. Methods: Medication adherence (Medication Adherence Reasons Scale [MAR-Scale]), work productivity and activity impairment (Work Productivity and Activity Impairment–General Health questionnaire), and ADHD symptom level (Adult ADHD Self-Report Scale version 1.1 Symptom Checklist) were assessed in this noninterventional online survey of adults who self-reported having an ADHD diagnosis and were currently receiving oral psychostimulant treatment for ≥3 months. Results: Of 602 respondents, 395 had low/medium adherence (LMA: MAR-Scale total score ≥1) and 207 had high adherence (HA: MAR-Scale total score 0). After adjusting for covariates, the LMA group had significantly greater levels of absenteeism, absenteeism-related indirect costs, and total indirect costs (all p < .01) than the HA group. Conclusion: In adults with ADHD using oral psychostimulants, lower medication adherence was associated with greater absenteeism and indirect costs.

Assessment of the efficacy and safety of a Judo exercise program in improving the quality of life among elderly patients.

Objectives: Several reports have shown that Tai Chi Chuan can be an effective way to prevent falls among the elderly. However, an exercise program that can prevent injury during falls has not been reported previously. The judo technique called ukemi is used to prevent injuries. To evaluate whether a judo-based exercise program could prevent falls in the elderly, we had the participants practice ukemi as part of a therapeutic routine. The purpose of this study was to examine the clinical significance of the program and to predict its safety.Methods: From July 2016 to March 2017, we examined 53 individuals who participated in the exercise program. The individuals were divided into high (n=39) and low (n=14) movement ability groups (HMA and LMA groups, respectively), and their physical and psychological functions were evaluated using scores from the Short-Form Health Survey 36. We also collected and analyzed data from questionnaires obtained from 384 patients who participated in the program from July 2016 to July 2019.Results: The HMA group showed a significant increase in the mental component summary scores before and after the exercise program. In the LMA group, physical functioning, social functioning, and physical component summary scores were significantly improved. Of the participants surveyed, 94.8% had a high level of satisfaction, and 93.2% began accepting the exercise as a daily habit. No adverse events were observed during these exercises.Conclusion: This novel exercise program was performed safely, and positive effects were observed, especially in individuals with a low quality of life.

Different anesthesia management in preterm infants undergoing surgeries for retinopathy of prematurity: A retrospective study

Objective To evaluate the effect of different anesthesia management on clinical outcomes in former prematurely born infants undergoing surgeries for retinopathy of prematurity (ROP). Methods In this retrospective study, electronic medical record database was searched for all former prematurely born infants (gestational age Results Sixty eight preterm infants in the LMA group and 100 preterm infants in the ETT group were included. The incidence of adverse events during surgery (including airway management change and desaturation) was similar in LMA group and ETT group (4.4% vs. 1.0%, P =0.364). During the early recovery period after surgery, the incidence of difficult extubation (extubation time >30 min) was significantly lower in LMA group compared with ETT group (4.4% vs.15.0%, RR=0.262, 95%CI:0.073－0.942, P=0.029). The incidence of respiratory events was similar between the two groups (20.6% vs. 27.0%, P =0.342). However, the incidence of apnea was significantly lower in the LMA group than in the ETT group (5.9% vs.19.0%, RR=0.266, 95%CI: 0.086－0.822, P =0.015). No significant difference was observed between the LMA group and ETT group in incidences of cardiovascular events (0% vs. 1.0%, P =1.000) and unplanned admission to neonatal intensive care unit (5.9% vs. 7.0%, P=0.774). No airway spasm, re-intubation, aspiration or regurgitation was observed during early recovery. During late recovery after returning to ward, the incidence of adverse events was also similar between the two groups (0% vs. 2.0%, P =0.241). The median (IQR) extubation time was 6 (5, 10) min in LMA group and 10 (6, 19) min in ETT group (P Conclusion Compared with endotracheal intubation with intravenous muscle relaxant injection, laryngeal mask airway insertion without muscle relaxant could achieve an early extubation, and reduce the incidence of apnea during early recovery period in former prematurely born infants undergoing ROP surgery.

Effect of Laryngeal Mask Air Way Insertion versus Endotracheal Intubation over Hemodynamic Responses in Pediatrics Patient Who Underwent Ophthalmic Surgery at Menelik II Hospital, Addis Ababa: A Prospective Observational Study Design.

Background The airway of an anesthetized child is usually maintained with an endotracheal tube or laryngeal mask airway. However, both are related with some level of pressor response which may be risky in several groups of patient. Methods An institutional-based prospective observational study design was employed. A systematic random sampling technique was used to select study participants. Data were entered into Epi info version 7 and transported to SPSS version 20 for analysis. Normality of the data was checked using Shapiro–Wilk tests. An independent t test was used to determine the mean differences between the two groups while the paired sample t test was used to determine the mean differences within the groups. A p value of less than 0.05 was used as a cut-off point for the presence of association. Results The changes in systolic and diastolic blood pressure were returned to baseline values at five and three minutes in both groups, respectively. However, the changes in the heart rate and mean arterial pressure returned to baseline values in five minutes in the ETT group and three minutes in the LMA group. At baseline, the difference in systolic blood pressure between the two groups was not statistically significant (p=0.328). Conclusions A significant hemodynamic pressor response was observed after the insertion of both LMA and ETT groups. However, the LMA group has less hemodynamic change as compared to the ETT group. Therefore, the practice of LMA insertion was strongly recommended.

Comparison of laryngeal mask airway &amp; endotracheal intubation in pediatric age group: A cross sectional study

The laryngeal mask airway, it is a supraglottic airway instrument developed by British Anesthesiologist Dr. Archie Brain. Initially it was designed only for the use in the operating room for the purpose of elective ventilation; it is a proved alternative to bag-valve-mask ventilation, freeing the hands of the provider with the benefit of less gastric distention. Initially used primarily in the operating room setting, the laryngeal mask airway has more recently come into use in the emergency situation as a very important device for the treatment of the difficult airway. The objective of the study was To compare the various parameters that occur during laryngeal mask airway insertion and endotracheal intubation for surgical procedures under general anesthesia. In the present study, 18 children’s belongs to age group of 2 to 6 years and 32 children’s belongs to age group of 7 to 10 years. Totally 29 children’s were male and 21 children’s were female. In LMA group, LMA insertion was graded easy in 97% of patient and difficult in 3% cases. In none of the case was LMA insertion impossible (0%). In the ETT group, endotracheal intubation was easy in 85% of patients and difficult in 15% of patients. In none of the patients was endotracheal intubation impossible. In the LMA group, LMA was placed correctly in the first attempt in 94% patients and was placed correctly in the 2nd attempt in 6%. The ETT was placed in the first attempt in 80% patients and was placed correctly in the 2nd attempt in 20%. According to the results of our study, laryngeal mask airway it is device of choice for elective outpatient surgeries in pediatric patients due to its lesser hemodynamic changes and complications, ease of insertion in cases where endotracheal tube insertion gets difficult and also faster insertion.

Evaluation of Flexible Laryngeal Mask Airway® in Tongue Trauma Repair: A Randomized Trial

BackgroundFlexible laryngeal mask airway may be used instead of the endotracheal tube in children presented for elective repair of tongue trauma, as it may shorten the time for extubation and recovery with the amelioration of stress response to airway management.ObjectivesThis study aimed to evaluate the extubation time and hemodynamic response to the endotracheal tube or flexible laryngeal mask airway in children presented for tongue trauma repair.MethodsThe study recruited 90 children presented for elective repair of tongue trauma that were randomly assigned into the following groups: the ETT group for which the airway was controlled by a cuffed endotracheal tube and the LMA group for which the airway was controlled by a flexible laryngeal mask. The intubation time, surgical time, total anesthesia time, extubation time, recovery time, changes in the hemodynamic parameters, and the incidence of complications were measured.ResultsThe use of flexible laryngeal mask airway instead of endotracheal tube significantly decreased the extubation time to 7.47 ± 2.74 min (P < 0.0001) and the recovery time to 52.67 ± 11.16 min (P = 0.001) while no significant differences were observed in the intubation time (P = 0.874), surgical time (P = 0.411), and total anesthesia time (P = 0.725). In addition, the changes in the hemodynamic parameters were significantly lower with flexible laryngeal mask airway both during airway securing and at the start of the surgery (P < 0.05). Moreover, it significantly decreased the incidence of postoperative cough, stridor, and sore throat (P = 0.039, 0.006, and 0.027, respectively).ConclusionsThe flexible laryngeal mask airway can be used instead of the endotracheal tube in children undergoing the repair of tongue trauma, as it decreases the extubation time, recovery time, and hemodynamic changes to the airway control.

Efficacy of Laryngeal Mask Airway in Neonatal Resuscitation

Aim: This study aimed at evaluating the use of LMA for resuscitation in the delivery room among newborn infants whom positive pressure ventilation (PPV) by bag and mask had failed. Materials and methods: This is a single center, prospective, unblinded, randomized clinical trial of LMA ventilation versus ETT on neonates during resuscitation upon delivery at Ain Shams Maternity Hospital during the period between January 2012 and January 2015. The Study included 80 newborns delivered in the Maternity hospital, Ain Shams University with gestational age of 34 weeks or more who needed neonatal resuscitation in the delivery room which was performed according to the current guidelines for neonatal resuscitation by the American Academy of Pediatrics. Results: In Our Study, there was significant correlation between the LMA and the ETT as both of them succeeded to achieve adequate ventilation of the resuscitated infants. Both groups showed statistical significant improvement between their Oxygen saturation at 1 minute & at 5 minutes. The ETT showed more improvement as the mean difference between 1 & 5 minutes was -27.4±3.07 compared to -26.5±3.4 among the LMA, but with insignificant difference between both groups. Comparison between Apgar score at 1 & 5 minutes in both groups is apparent, which showed statistical significant improvement in the 2 groups. However, the ETT group showed more improvement (although non-significant) as the mean difference between 1 & 5 minutes was -5.02±0.9 compared to -4.6±0.7 among the LMA group. Conclusion: The Laryngeal Mask Airway can be used as an efficient and successful alternative to endotracheal intubation in newborns > 2000 Gms who require neonatal resuscitation.

A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates

ObjectiveTo compare the short‐term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. MethodsPreterm infants (28–35 weeks of gestational age), weighing 1kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2)≥0.40 to maintain oxygen saturation 91–95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2≤0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24h, MV requirement, and presence of surfactant in gastric content. ResultsForty‐eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p=0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. ConclusionsSurfactant administration by LMA showed short‐term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.

Postoperative sore throat in patients undergone head and neck surgeries under endotracheal intubation and laryngeal mask anaesthesia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Postoperative sore throat (POST) is a frequent complaint among the subjects undergoing head and neck surgeries. Orotracheal intubation with the endotracheal tube (ETT) and laryngeal mask (LM) was used for anaesthesia. This study was aimed to analyze the effect of variation in cuff pressure and size of ETT and LM mask anaesthesia on post-surgical pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patients (ages of 10-79) who underwent head and neck surgeries by ETT intubation and LM anaesthesia were included in the study. The pain was measured as pain score during different cuff pressure and size of tube or mask and data was statistically analyzed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 100 subjects of each group and both genders were included in the prospective study. No statistically significant difference could be observed among the number of cases in both groups. Among the patients, females were dominant (p = 0.405). The intensity of pain was gradually decreased during the 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; post surgical days in both groups. The frequency of patients with pain in the LMA group was less than that of ETT group on the 1&lt;sup&gt;st&lt;/sup&gt; day. No correlation between the pain score and cuff pressure or size of ETT and LMA could be evidenced.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The postoperative sore throat can be effectively reduced by LMA. The pain score and frequency of patients with pain in the LMA group was less than that of ETT group. No correlation of pain score with different cuff pressure and size of tube or mask could be evidenced. &lt;/p&gt;

A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates

ObjectiveTo compare the short-term efficacy of surfactant administration by laryngeal mask airway versus endotracheal tube. MethodsPreterm infants (28–35 weeks of gestational age), weighing 1kg or more, with respiratory distress syndrome, requiring nasal continuous positive airway pressure, with increased respiratory effort and/or fraction of inspired oxygen (FiO2)≥0.40 to maintain oxygen saturation 91–95%, were randomized to receive surfactant by LMA following nCPAP or by ETT following mechanical ventilation (MV). The primary outcome was a clinical response defined as FiO2≤0.30 three hours after surfactant. Secondary outcomes for LMA group were: need of surfactant retreatment during the first 24h, MV requirement, and presence of surfactant in gastric content. ResultsForty-eight patients were randomized; 26 in the LMA group and 22 in the ETT group. Six of 26 patients (23%) in the LMA group and five of 22 patients (22.7%) in the ETT group did not meet the primary outcome (p=0.977). Fourteen (53.8%) of the LMA patients were not intubated nor ventilated; 12 (46.1%) were ventilated: for surfactant failure (23%), for nCPAP failure (11.5%), and for late complications (11.5%). Groups were similar regarding prenatal status, birth conditions, and adverse events. No significant gastric content was found in 61.5% of the LMA patients. Oxygen and second dose surfactant requirements, arterial/alveolar ratio, and morbidities were similar among groups. ConclusionsSurfactant administration by LMA showed short-term efficacy, with similar supplementary oxygen need compared to surfactant by ETT, and lower MV requirement. Further studies with larger sample size are necessary to confirm these results.

LOW FLOW ANESTHESIA

Objectives: The aim of our study is to determine the incidence of complicationswhen using Laryngeal mask airway and compare it with endotracheal tube intubation, duringadministration of low flow anesthesia. Study Design: A randomized control trial. Period: 3months from February 2015 to April 2015. Setting: Tertiary Care Hospital in Karachi Pakistan.Materials and Methods: The study population consisted of n= 100 patients who underwentelective operative procedures of the eye. Patients who belonged to the ASA classification typeI and II were allocated into two groups using a random number generator. Group A consistedof all the patients on whom endotracheal tube was used as airway and group B included all thepatients on whom Laryngeal mask airway was used. The complications were noted on a predesignedproforma. Data was analyzed using SPSS version 23. Results: The study populationconsisted of n= 100 patients out of which n= 43 were males and n= 57 were females, 42%of the patients belonged to ASA classification I and 58% belonged to the ASA classificationII. Leakage of air was observed in 7% of the patients, postoperative shivering was observedin 20%, sore throat was observed in n= 22 patients, of which n= 18 patients belonged to theETT group and n= 4 patients belonged to the LMA group. Endotracheal carbon dioxide levelsdid not show any significant difference. Conclusion: According to the results of our study,Laryngeal mask airway has a lower incidence of post-operative complications, provided that itspositioning and cuff pressure are noted and maintained regularly, and it can be used as a safealternative to endotracheal intubation when using low flow controlled anesthesia respectively.