LMA Insertion Research Articles

Comparison between the standard method and the 30° curved tongue depressor-aided technique for insertion of a laryngeal mask airway: a randomized controlled trial

BackgroundLaryngeal mask airway (LMA) has been increasingly used for airway management; however, LMA insertion can be difficult and cause adverse effects. Therefore, the rapid, safe, and effective insertion of LMA is necessary. This study aimed to compare the efficacy of the standard method with that of the 30° curved tongue depressor-aided technique for LMA insertion to determine the superior technique.MethodsThis study included 154 patients aged 18–70 years (American Society of Anesthesiologists class I or II) scheduled for general anesthesia. The patients were randomly assigned to the standard LMA insertion group (Group C, n = 77) or the 30° curved tongue depressor-aided LMA insertion group (Group T, n = 77). The primary outcome evaluated was the first-attempt success rate. The secondary outcomes were the second-attempt success rate, insertion time, fiberoptic position grade, oropharyngeal leak pressure (OPLP), and adverse events.ResultsThe first-attempt success rate was significantly higher in Group T than in Group C (97.40% vs. 88.31%, P = 0.029). The second-attempt success rate (P = 0.209), insertion time (P = 0.340), fiberoptic position grade (P = 0.872), and OPLP (P = 0.203) were slightly improved in Group T; however, there was no statistical significance. Bleeding events were reduced in Group T than in Group C (6.49% vs. 14.29%); however, there was no statistical significance. The incidence of sore throat symptoms was significantly reduced in Group T than in Group C (5.19% vs. 15.58%, P = 0.035).ConclusionsThe curved tongue depressor-aided technique significantly improved the first-attempt success rate of LMA insertion and reduced the incidence of sore throat symptoms.Trial registrationKCT0004964; Registered at https://cris.nih.go.kr on April 27, 2020.

Comparison of Index-Finger Guided, Two-Finger Guided, and 90° Rotation Techniques for Insertion of Flexible LMA in Pediatric Patients

Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients. Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted. In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA. Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B. Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial.

An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use. Simulation-based randomized trial, conducted from May to December 2021. Four pediatric simulation centers. Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales. A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand ( p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales ( p < 0.05). The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.

Effect of Intranasal Remifentanil versus Lidocaine on Facilitation of Laryngeal Mask Airway Insertion and Cardiovascular Response: A Double-blind Clinical Trial Study.

This study aimed to assess and compare the effects of intranasal administration of lidocaine and remifentanil on the condition of LMA insertion and cardiovascular response. From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg, the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its insertion were investigated. In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try (p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference was observed. In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the cardiovascular response to LMA insertion, but it did not outperform lidocaine.

A randomised controlled trial to compare blind intubation success through LMA Blockbuster® and I-Gel® LMA.

Laryngeal mask airway-blockbuster (LMA-BT) is a relatively new supraglottic airway device (SGAD). In this study, we compared LMA-BT with I-Gel LMA for efficacy of blind tracheal intubation. We conducted a single-blind prospective study after ethical approval. One hundred American Society of Anesthesiology (ASA) Grade I-III (age 18-60 years) patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were included and randomly divided into 2 groups. Blind tracheal intubation was performed through LMA-BT ( n = 50) and I-Gel ( n = 50) in groups 1 and 2, respectively. The primary aim was to evaluate the first pass success rate of blind tracheal intubation through the LMAs. The secondary objectives noted were attempts and ease of LMA insertion, total time taken for LMA insertion, airway seal pressure of LMA, ease of NGT insertion through LMA, fibre-optic grading of laryngeal view through LMA, overall success rate and time of intubation through LMA, time for LMA removal, and complications, if any. In the LMA-BT group, the first pass success rate ( P < 0.019) and the overall success rate of intubation ( P < 0.005) were significantly higher than in the I-Gel group. Using LMA-BT also resulted in statistically significant shorter intubation time ( P < 0.0001) with higher airway seal pressure as compared to I-Gel ( P < 0.001). The difference in the first attempt insertion, number of insertion attempts, ease and time of LMA insertion and removal after intubation, and postoperative complications were comparable among the groups. LMA-BT is a superior device as compared to I-Gel LMA as a conduit for blind tracheal intubation.

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.

Randomized Clinical Trial Comparing the Success Rate of Blockbuster Intubating Laryngeal Mask Airway Versus Fastrach Intubating Laryngeal Mask Airway During Blind Endotracheal Intubation.

Background A new piece of equipment, the Blockbuster (BB) Intubating Laryngeal Mask Airway (ILMA; Tuoren MedicalIndia, Gurugram, India), was created in 2012. Dr. Chandy created the Fastrach (F) ILMA in 1997, which is another supraglottic airway equipment. The primary purpose of this study was to compare the success rateof intubation with BB-ILMA and F-ILMA. Methods In the chosen age category of >20 to <70 years, undergoing general anesthesia for intubation with ILMAs, 55 patients were in the BB-ILMA(group B), and 55 patients were in the F-ILMA (group F). These ILMAs were put in after the induction and checked to see if adequate ventilation was accomplished with either of these devices. Once ventilation had been attained, weproceeded with fiberoptic scope to visualize the glottis, followed by blind intubation. The primary objective was to compare the first pass successful intubation of BB-ILMA and F-ILMA. The secondary objectives were ease of LMA insertion, time taken for intubation, hemodynamic changes, glottis fiberoptic view, and complications. Results The first pass successful intubation of the BB-ILMA and F-ILMA are 94.5% and87.3%, respectively, whereas thetime taken for intubation in BB-ILMA and F-ILMA are 25.02 seconds (s) and42.77 s with ap-value of 0.0001, indicating a statistically significant relationship. Conclusion When compared to the F-ILMA (group F), the BB-ILMA (group B) has a higher success rate for blind tracheal intubation, with lesser time taken for intubation and fewer complications.

Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children

BackgroundsTo preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children.MethodsOne hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation.ResultsThe first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04–1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03–1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia.ConclusionThe SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management.Trial registrationThis study was approved by the University’s Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn. Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Comparative study of intubating LMA and I-gel for ease of insertion and as a conduit for endotracheal intubation

Background: A recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel and LMA was evaluated. Methods: This is a prospective study was conducted in the Department of Anesthesia at Sapthagiri Institute of Medical Sciences &amp; Research Centre among 140 patients fulfilling the criteria. Fasting patients with ages 20-50 years undergoing elective procedures under general anesthesia with ASA physical status 1 and 2 and Mallampatti class I and II were included in the study. Whereas patients with ASA physical status 3 or 4, and having contraindications to insertion of LMA or i-gel™ such as; mouth opening less than 2 cm, increased risk of aspiration, anticipated difficult intubation and facemask ventilation, with Mallampatti class III to IV were excluded. Results: One of the groups was administered the I-gel (Group G) and the other group was given I-LMA (Group L). Two groups were statistically similar in terms of distribution of ASA physical status grading (p&lt;0.05). Two groups were statistically similar in terms of mallampati score distribution. Distribution of duration of surgery was not statistically significant in both the groups (p&gt;0.05). It was observed that insertion I-gel was easy in 50 out of 70 patients. Difficulin 56 out of 70 patients. Difficult to insertion took place in 14 patients. The comparison of ease of insertion between the two groups did not reveal any statistical significance (p&gt;0.05). Conclusion: We concluded I-gel aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

Comparison between propofol and desflurane anaesthetic agent for short elective surgery

Background: Desflurane is known to have a rapid onset and offset of action, thereby making it possible for the anesthetist to control the depth of anesthesia rapidly. Intravenous propofol with rapid induction and recovery is currently a popular induction agent for surgical anesthesia. Objective: To compare desflurane and propofol as single agent anesthesia in short elective surgeries. Materials and methods: It was a hospital based prospective comparative study, 80 patients scheduled for elective short surgery were taken. After routine pre-anesthetic work up, patients were induced with either Group D: O2:N2O (50:50) + Desflurane 3-4% or; Group P: O2:N20 (50:50) + Propofol 3-5 mg/kg. Baseline parameters, relevant intra-op details, ease of procedure, hemodynamic changes, recovery, and complication rate were compared between both groups. Statistical analysis was done using SPSS ver. 22. Results: Parameters like jaw opening, attempts for LMA and ease of insertion was comparable in both the groups (p&gt; 0.05). Time to loss of consciousness and time to LMA insertion was significantly shorter with Propofol (p&lt;0.05). Mean pulse rate and MAP was significantly higher in Desflurane group (p&lt; 0.05). Modified Aldrete score was significantly higher in Desflurane group while Complication rate was comparable.

A comparative study of awakening characteristics after propofol based total intravenous anaesthesia and sevoflurane based volatile induction and maintenance anaesthesia in short surgical procedure

To maintain hemodynamic parameters and rapid emergence is a challenge for anaesthesiologist in emerging era of early recovery. The aim of this study was to assess recovery characteristics of propofol and sevoflurane for induction as well as maintenance of anaesthesia in short surgical procedures. Sixty patients were assigned randomly into two groups. Group P patients were induced with 2mg/kg propofol intravenously followed by infusion of 12mg/kg/hr for 10mins, 10mg/kg/hr for 20 mins and 8mg/kg/hr till end of procedure. Group S patients were induced with 8% sevoflurane in 4L/min nitrous oxide and 2L/min oxygen mixture and maintained with 3.5% sevoflurane with spontaneous breathing. LMA was inserted in all patients. LMA insertion time and insertion attempt were observed. Time from end of procedure to first spontaneous movement, spontaneous eye opening, removal of LMA, followed verbal commands and became fully oriented to time and place, time to achieve Aldrete score ≥9 (phase I recovery) and time to achieve PADSS score ≥9(phase II recovery) were noted. Phase 1 recovery time was less in sevoflurane group as compared to propofol group. Phase 2 recovery time was less in propofol group as compared to sevoflurane group. They were statistically significant. Incidence of both nausea and vomiting was significantly higher in the sevoflurane group. We concluded that sevoflurane provides rapid induction with LMA insertion condition comparable with propofol. Sevoflurane provides early phase I recovery where as home readiness is early with propofol. Sevoflurane can be a suitable alternative to propofol for induction and maintenance.

Determination of the median effective dose of sufentanil for inhibiting the laryngeal mask insertion response in geriatric patients: a prospective, double-blinded, dose–response trial

BackgroundLaryngeal mask airway(LMA) have been widely used in clinical practice. Irritation to the patient during the insertion of a laryngeal mask can cause hemodynamic fluctuations, which is particularly unsafe for geriatric patients. We used probit regression analysis to determine the median effective dose of sufentanil to inhibit the response to LMA insertion in geriatric patients.MethodsA total of 90 patients were selected for the study using the following inclusion criteria: age ≥ 65 years old, ASA grade I–III, and scheduled to undergo intravenous general anesthesia with LMA insertion. Each patient received a dose of sufentanil for anesthesia induction in one of six levels: 0.05, 0.1, 0.15, 0.2, 0.25, or 0.3 μg kg−1. LMA insertion was scored with a 3-point, 6-category scale, with scores ≥ 16 indicating effective LMA insertion, and < 16 indicating ineffective LMA insertion. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index (BIS) were recorded 1 min before induction (T1), 1 min after induction (T2), 1 min after LMA insertion (T3), and 5 min after LMA insertion (T4) in each group. In addition, the plasma norepinephrine (NE) levels and adverse reactions were measured at T2 and T3 in each dosage group.ResultsProbit regression analysis showed that the ED50 of sufentanil inhibiting the response to LMA insertion in geriatric patients was 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1), and the ED95 was 0.31 μg kg−1 (95% CI: 0.27–0.38 μg kg−1), and the probit(p) = -2.34 + 12.90 × ln(Dose)(chi^{2} = 0.725, p = 0.948). Among all the patients, the number of effective LMA insertions was 57 (group A), and the number of ineffective LMA insertions was 33 (group B). The MAP, HR, and NE in group B were significantly higher than in group A at T3.ConclusionsSufentanil can effectively inhibit the patient’s response to LMA insertion, with stable hemodynamics and small stress response. The ED50 and ED95 were 0.18 μg kg−1 (95% CI: 0.16–0.21 μg kg−1) and 0.31 μg kg−1(95% CI: 0.27–0.38 μg kg−1), respectively.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100051827) on October 6, 2021.

Randomized double blind comparison of ketamine – propofol and fentanyl – propofol for the insertion of laryngeal mask airway in children

The ideal combination that provides smooth insertion conditions with minimal side effects has not been identified, particularly in children. In this study, 70 children of age 3-12 years are divided randomly into 2 groups: Group 1-Group-F-Fentanyl (n=35) received Fentanyl 2μg/kg and Group 2-Group –K- Ketamine (n=35) received Ketamine 0.5mg/kg before induction of anaesthesia. Baseline heart rate and arterial blood pressure were measured. Vital parameters (Heart rate and Arterial Blood Pressure) were measured before induction, before LMA insertion and thereafter at 1, 3 and 5 minutes after LMA insertion. Ideal LMA insertion conditions were evaluated with six variables by blinded observer: mouth opening, gagging, head and limb movements, laryngospasm and resistance to insertion. Also the apnoea time was noted. The incidence of head/limb movements was statistically significant and Group Propofol – Ketamine showed 22% compared to Fentanyl-Propofol group (2.8%) Coughing/gagging was seen in 2.86% of both the groups. Resistance to insertion was statistically significant with p value of 0.0268 showing more in Propofol + Ketamine. There was no statistical significance in the occurrence of restricted mouth opening, restriction to LMA insertion and occurrence of swallowing between the two groups.

Comparing the Effectiveness of Ambu® AuraGain™ Laryngeal Mask Airway with LMA® ProSeal™ in Patients Undergoing Laparoscopic Surgeries- A Randomised Clinical Trial

Introduction: Second generation Supraglottic Airway Devices (SADs) contain a gastric drain tube which separates the respiratory and the alimentary tract. This provides a better oropharyngeal seal and reduces the risk of pulmonary aspiration of refluxed gastric contents compared to the first generation SADs. Aim: To compare Ambu® AuraGain™ (AAU) laryngeal mask airway with LMA® ProSeal ™ (PLMA) in terms of Oropharyngeal Leak Pressure (OLP) in laparoscopic surgeries. Materials and methods: This randomised clinical study was conducted from December 2017 to September 2019, at Shri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, India in 80 patients, aged 18 to 65 years, of American Society of Anesthesiologists (ASA) physical status I and II undergoing laparoscopic surgeries. Patients were randomly assigned to one of the two groups: group PLMA and group AAU. After induction of anaesthesia, SADs were inserted by an experienced anaesthesiologist. OLP, pharyngeal mucosal pressure, peak airway pressure and secondary outcome parameters (the number of attempts, time required, ease, and hemodynamic response associated with insertion of LMA) were recorded at set time points. Data was analysed using Statistical Packages for Social Sciences (SPSS) version 22. Results: All patients in both the groups were comparable in terms of demographic data and baseline vital parameters. The Oropharyngeal Leak Pressure of group AAU was comparable to group PLMA at all measured time-points. The two groups were comparable in terms of pharyngeal mucosal pressure immediately after insertion of LMA, but group AAU had lesser pharyngeal mucosal pressure compared to group PLMA immediately after pneumoperitoneum, at 30 and 60 minutes. Mean peak airway pressures were lower in group AAU than group PLMA immediately after insertion of LMA (15.53±1.50 versus 17.06±2.56 cmH2 O, p=0.004) and immediately after creation of pneumoperitoneum (23.03±2.96 versus 23.03±2.96 cmH2 O, p= 0.04). Both the groups were comparable in terms of number of attempts, time taken, haemodynamic response associated with LMA insertion and with passage of gastric tube except that PLMA was easier to insert in the first attempt compared to AAU (26/40 versus 13/40, Grade 1 ease of insertion). Conclusion: Ambu® AuraGain™ could be a useful alternative to LMA® ProSeal ™ in patients undergoing laparoscopic surgeries.

A Comparison of Tracheal Intubation with Ambu® AuraGainTM, Fastrach® and BlockBuster® Laryngeal Mask Airway: A Randomised Clinical Trial

Introduction: Airway management has been a key to quality, efficacy and safety of anaesthesia. The Ambu® AuraGain™ is an anatomically curved Supraglottic Airway Device (SAD), which has gastric access port and is used for both ventilation and endotracheal intubation. Fastrach® Intubating Laryngeal Mask Airway (FT-LMA) serves as a conduit for intubation and ventilation for difficult airway situation. It has an epiglottic elevating bar designed to lift the epiglottis as endotracheal tube passes. BlockBuster® LMA is latest generation LMA used for ventilation and intubation. It has a short airway tube which has &gt; 95° angulation to match the oropharyngeal curve and thus makes the insertion easy and less traumatic. Aim: To compare first attempt success rate of tracheal intubation using Ambu® AuraGain™, Fastrach® and BlockBuster® LMA in adult patients. Materials and Methods: The present randomised clinical trial was conducted in the Department of Anaesthesiology, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan, India from February 2021 to February 2022. The study comprised of 135 ASA physical status I and II patients of both sex, aged 18-60 years who were admitted and scheduled for elective surgery requiring general anaesthesia and tracheal intubation. The patients were randomly assigned into three groups (45 in each) - group A (Ambu® AuraGain™ group), group F (Fastrach® group), and group B (BlockBuster® group). Tracheal intubation was performed using appropriate size endotracheal tube after LMA placement. The outcome measures were first attempt successful intubation, time taken for intubation, glottis visualisation, and incidence of complications (blood stained LMA, nausea/vomiting). Results: The mean age of the group A, group B and group F were 35.8±15.0, 32.71±12.59, and 38.7.0±14 respectively which was statistically not significant. Group B had a significantly greater success rate of first attempt intubation (93.3%) in comparison with group F (64.4%), and group A (22.2%). LMA insertion score of 1 was found in 53.3% patients in group B, 42.2% patients in group F and 15.5% patients in group A. A Brimacombe score of 4 was found in 46.6% patients in group B as compared to 13.3% patients in group F and (33.3%) patients in group A, (p-value=0.020). Blood stained LMA was found in 1 patient in group B, 9 in group F and 7 in group A (p-value=0.030). Conclusion: BlockBuster® LMA is a better conduit for tracheal intubation than Fastrach® LMA and Ambu® AuraGain™ in adult patients with no anticipated airway difficulties.

LMA\xae protector\u2122 in patients undergoing laparoscopic surgeries: a multicenter prospective observational study

BackgroundLaryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery.MethodsPatients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™.ResultsThree hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients.ConclusionsThe LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists.Trial registrationThe trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018300, date of registration: September 2018).

Comparison of Post-Operative Pain Between Nalbuphine and Tramadol in Total Intravenous Anesthesia for Dilation and Evacuation

Objective: Comparison of post-operative pain between nalbuphine and tramadol in total intravenous anesthesia for dilation and evacuation. Methodology: This randomized controlled trial was conducted at Fatima Memorial Medical and Dental College and Hospital, Lahore during June 2019 to September 2020. We randomly enrolled in Two Groups-A, who received intravenous injection tramadol 1.5 mg/kg after rapid sequence induction with propofol2mg/kg, succinylcholine 1-1.5mg/kg followed by LMA insertion and Group-B those receiving nalbuphine0.1mg/kg after rapid sequence induction with propofol2mg/kg, succinylcholine 1-1.5mg/kg followed by LMA insertion. Consultant anesthetist administered these drugs and evaluated pain score after 30 mins of surgery done with the help of VAS. Results: Comparison of mean pain score in both groups shows 2.28+1.13 pain on VAS in Group-A and 1.07+0.82 in Group-B, p value was 0.0001 showing a significant difference. (Table 1) Conclusion: Post-operative pain is significantly lower in nalbuphinewhen compared with tramadol in total intravenous anesthesia for dilation and evacuation. Keywords: Dilation and evacuation, postoperative pain, nalbuphine, tramadol

Effectiveness of selected alternative methods of airway management by the nursing staff

Abstract Aim. The aim of the study was to assess the effectiveness of selected methods of alternative airway management by nursing staff. Material and methods. A prospective, pilot observational study was conducted on a group of 51 nurses undergoing specialization training or with specialty. Each nurse managed the airway with a laryngeal mask (LMA-Laryngeal Mask) and a laryngeal tube (LT-D-Laryngeal Tube) on a BT-CSIE trainer, and then carried out one minute ventilation using a bag valve mask, according to possessed knowledge and skills. The obtained parameters (time, pressure on the incisors, head tilt, ventilation quality) were recorded using a dedicated tablet. Statistical analysis was performed using the IBMSPSS Statistics 20 package. Results. No statistically significant differences were observed between the trials to open the airway using LMA and LT-D. Higher efficiency of LMA airway opening was demonstrated in the first trial and the average tidal volume during ventilation in relation to LT-D (LMA 547.84ml vs. LT-D 522.63ml). In addition, there was a significant difference in pressure on the incisors (LMA 6.82N vs. LT-D 4.12N). Conclusions. The effectiveness of LMA and LT-D insertion was assessed at a high level, with no significant differences between them. Variables: age, seniority, education level and type of specialization did not significantly differentiate the results obtained.

EFFECTS OF SEVOFLURANE, PROPOFOL, AND COMBINATION OF SEVOFLURANE AND PROPOFOL FOR CLASSIC LARYNGEAL MASK AIRWAY INSERTION IN ADULTS- A CLINICAL COMPARATIVE STUDY

Background and Aims:Although LMA insertion is less invasive than endotracheal intubation,it also requires adequate mouth opening and blunting of minimal airway reflexes. Propofol is considered an appropriate IV agent for LMA insertion owing to its prompt induction and suppression of airway reflexes but induction doses required are often associated with hypotension,pain and apnea.Sevoflurane on the other hand,has minimal respiratory irritability,better hemodynamic stability and less apnea, but is associated with delayed jaw relaxation. Our hypothesis is that the combination of sevoflurane and propofol may be of better outcome whereby the insertion conditions of the LMA may be optimized adequately,at the same time the potential side-effects of individual drugs are effectively curtailed. Methods: 90 patients aged 20-60yrs of ASA I and II, 30 in each group were induced with Propofol (2mg/kg) in Group P, 8% Sevoflurane in N O: O (67%:33%) TVB technique in Group S and Group SP with additional propofol (1mg/kg) in 2 2 Group SP after loss of eyelash reflex. Induction characteristics, hemodynamic parameters and complications were observed. Results: 87% of the patients of Group SP had successful LMA insertion at first attempt, compared to 53% and 40% in Group P and Group S respectively, which was statistically significant. Less apnea was seen in Group SP(20%) as compared to Group P(60%),which was statistically significant. Conclusion: Our study showed that the combination group stood out to be the best with highest successful LMA insertion at first attempt and less incidence of apnea.