Gastric Tube Placement Research Articles

Comparison of the Laryngeal Mask Airways: Laryngeal Mask Airway-classic and Laryngeal Mask Airway-proseal in Children.

Introduction:In the past 25 years with the development of various supraglottic airway devices, the armamentarium for airway management has increased. In our study, the laryngeal mask airway (LMA)-ProSeal is compared with the LMA-Classic with respect to as follows: (a) Ease of insertion and number of insertion attempts, (b) Device positional stability and possible oropharyngeal leak, (c) Airway trauma, and (d) Hemodynamic changes; in children aged 3–15 years undergoing elective surgery under general anesthesia, hypothesizing that these would be different.Materials and Methods:Sixty consecutive American Society of Anesthesiologists Physical Status Classes I and II children aged 3–15 years and weighing 5–45 kg undergoing elective surgery in the supine position were randomized for airway management with the LMA-Classic or LMA-ProSeal.Results:Size of the LMA used in both LMA-Classic and LMA-ProSeal was 1.5, 2, and 2.5 and was statistically nonsignificant. There was no difference between LMA-Classic and LMA-ProSeal with regard to ease of insertion, number of attempts for insertion, device positional stability, airway trauma and hemodynamic changes.Conclusions:The complications of usage of the LMA are minimal and similar in both the devices. The LMA-ProSeal has advantages over LMA-classic such as the placement of gastric tube, adequate ventilation, and oxygenation without any gastric distension.

Dysphagia Caused by Cervical Plate Erosion through the Hypopharynx

CASE REPORT A 53-year-old woman with a history of neurofibromatosis, Hodgkin's lymphoma, and C3-T2 fusion 4 years prior for swan-neck cervical deformity was admitted for evaluation of left frontal skull mass and progressively worsening dysphagia of solid foods and thick liquids over 6 weeks. Computed tomography (CT) of the abdomen, pelvis, and lumbothoracic spine showed multiple hypodense liver lesions and diffuse sclerotic bone lesions within the thoracic and lumbar spine, ribs, sacrum, and ischium suspicious for metastatic malignancy. Fine-needle aspiration of the liver lesions yielded immunochemistry positive for focal CA 19-9 staining suggestive of adenocarcinoma of upper gastrointestinal (GI) origin. Serum CEA and CA 19-9 were within normal limits. Esophagogastroduodenoscopy did not reveal an upper GI tumor; however, a metal object was seen in the hypopharynx just above the upper esophageal sphincter (Figure 1). It appeared to be fixed and could not be moved with grasping forceps. The adult gastroscope could not be advanced beyond the object; however, the ultraslim could. A sagittal CT view of the neck with contrast showed the offset of the anterior cervical internal fusion plate with direct communication to the hypopharyngeal airway and suggesting erosion through the posterior hypopharyngeal soft tissue (Figure 2). Given the patient's multiple comorbidities and presumably metastatic cholangiocarcinoma, neurosurgery service recommended medical management rather than surgical management. A 6-week course of intravenous ertapenem was initiated due to the high risk of abscess formation. The patient underwent gastric tube placement for feeding and was eventually discharged under hospice care.Figure 1.: Esophagogastroduodenoscopy showing a foreign metal object in the hypopharynx above the upper esophageal sphincter.Figure 2.: Sagittal view of the neck with contrast-enhanced computed tomography showing direct communication between the anterior cervical internal fusion plate and the hypopharyngeal airway.Dysphagia is an underrecognized but significant complication of cervical fusion surgeries.1 The incidence of esophageal perforation after anterior cervical spine surgery is estimated to be between 0.02% and 1.49% with a mortality rate of 6%.2 Most esophageal erosions occur in the intraoperative or immediate postoperative setting, although there has been an increase in cases with delayed presentation, which often lead to dramatic clinical deterioration with a higher mortality risk of 20-50%.3 Most esophageal injuries are due to iatrogenic injury intraoperatively from inappropriate placement or dislodgement of retractors or hardware migration. Delayed injuries are typically due to chronic compression, abscess formation, repetitive friction of the plating system, or hardware dislodgement and chronic migration.4 Diagnosis can be made with cervical radiographs; however negative imaging does not rule out esophageal injury. Operative intervention is recommended, but conservative medical treatment is appropriate depending on the patient and the clinical circumstances.5 Although cervical endplate erosion of the esophagus has been well documented in the literature, hypopharyngeal erosion has only been reported once previously.6 It is imperative that health care providers are vigilant and complete a thorough workup in patients with persistent or worsening dysphagia who have undergone a previous anterior cervical surgery. DISCLOSURES Author contributions: S. Kothari and T. Almouradi wrote the manuscript. T. Almouradi is the article guarantor.

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of Clinical Performance of Supraglottic Airway Devices I– gel vs LMA-Proseal in Paediatric Elective Surgeries

Dysphagia Caused by Cervical Plate Erosion through the Hypopharynx

CASE REPORT A 53-year-old woman with a history of neurofibromatosis, Hodgkin's lymphoma, and C3-T2 fusion 4 years prior for swan-neck cervical deformity was admitted for evaluation of left frontal skull mass and progressively worsening dysphagia of solid foods and thick liquids over 6 weeks. Computed tomography (CT) of the abdomen, pelvis, and lumbothoracic spine showed multiple hypodense liver lesions and diffuse sclerotic bone lesions within the thoracic and lumbar spine, ribs, sacrum, and ischium suspicious for metastatic malignancy. Fine-needle aspiration of the liver lesions yielded immunochemistry positive for focal CA 19-9 staining suggestive of adenocarcinoma of upper gastrointestinal (GI) origin. Serum CEA and CA 19-9 were within normal limits. Esophagogastroduodenoscopy did not reveal an upper GI tumor; however, a metal object was seen in the hypopharynx just above the upper esophageal sphincter (Figure 1). It appeared to be fixed and could not be moved with grasping forceps. The adult gastroscope could not be advanced beyond the object; however, the ultraslim could. A sagittal CT view of the neck with contrast showed the offset of the anterior cervical internal fusion plate with direct communication to the hypopharyngeal airway and suggesting erosion through the posterior hypopharyngeal soft tissue (Figure 2). Given the patient's multiple comorbidities and presumably metastatic cholangiocarcinoma, neurosurgery service recommended medical management rather than surgical management. A 6-week course of intravenous ertapenem was initiated due to the high risk of abscess formation. The patient underwent gastric tube placement for feeding and was eventually discharged under hospice care.Figure 1.: Esophagogastroduodenoscopy showing a foreign metal object in the hypopharynx above the upper esophageal sphincter.Figure 2.: Sagittal view of the neck with contrast-enhanced computed tomography showing direct communication between the anterior cervical internal fusion plate and the hypopharyngeal airway.Dysphagia is an underrecognized but significant complication of cervical fusion surgeries.1 The incidence of esophageal perforation after anterior cervical spine surgery is estimated to be between 0.02% and 1.49% with a mortality rate of 6%.2 Most esophageal erosions occur in the intraoperative or immediate postoperative setting, although there has been an increase in cases with delayed presentation, which often lead to dramatic clinical deterioration with a higher mortality risk of 20-50%.3 Most esophageal injuries are due to iatrogenic injury intraoperatively from inappropriate placement or dislodgement of retractors or hardware migration. Delayed injuries are typically due to chronic compression, abscess formation, repetitive friction of the plating system, or hardware dislodgement and chronic migration.4 Diagnosis can be made with cervical radiographs; however negative imaging does not rule out esophageal injury. Operative intervention is recommended, but conservative medical treatment is appropriate depending on the patient and the clinical circumstances.5 Although cervical endplate erosion of the esophagus has been well documented in the literature, hypopharyngeal erosion has only been reported once previously.6 It is imperative that health care providers are vigilant and complete a thorough workup in patients with persistent or worsening dysphagia who have undergone a previous anterior cervical surgery. DISCLOSURES Author contributions: S. Kothari and T. Almouradi wrote the manuscript. T. Almouradi is the article guarantor.

The status and influencing factors of the methods used by nurses verifying the blinded inserted nasogastric tube placement

Objective To investigate the status and influencing factors of the methods used by nurses verifying the nasogastric tube placement blinded inserted in adult, and to explore the best practice of nursing staff to verify the nasogastric tube placement. Methods We designed the questionnaire and conducted survey to the clinical nursing staff in accordance with the American Association of Critical-Care Nurses practice alert. Results Air bolus auscultation (70.53%, 675/957) and aspirate appearance(68.97%, 660/957) were the most used method during insertion procedure. There was insufficient in the cognition of X-ray as the gold standard and the use in clinical.The department, work years, specialist nursesand hospitallevel impact X-ray use (all P <0.05) .Age, education,title,hospital level, specialist nurses and department impact the cognition of X-ray as the gold standard (all P <0.05) . Conclusions Nurses still use the traditional methods to verify the nasogastric tube placement. There is a certain gap between clinical practice and AACN practice alert in themethods used to verify nasogastric tube placement.As the gold standard to verify gastric tube placement, the use and cognition of X-ray are impacted by many factors, including the department, specialist nurses, hospital level, et al. Therefore, hospital should establish a knowledge sharing platform, which will help to spread the advantages and disadvantages of various methods used in verifying the nasogastric tube placement, and then to strengthen the cognition with different people. Furthermore, based on potential influencing factors, it is necessary to further explore new bedside effective method of verifying the nasogastric tube placement and seek the best practice to validate the method of blind intubation of nasogastric tube. Key words: Nurses; Nasogastric tube; Intubation

Comparative study of indwelling gastric tube at different times in patients with invasive mechanical ventilation

Objective Comparative study of gastric tube implantation at different times in patients with invasive mechanical ventilation. Methods Random sampling was used to divide 160 patients who were incubated with mechanical ventilation at the hospital into two groups, There were 80 patients in each group. Two groups of patients were routinely placed gastric tube by a stationary nurse.The observation group was treated with ordinary silica gel stomach tube at early stage (immediately) after trachea cannula, the control group still used the ordinary silica gel stomach tube after the trachea cannula late (24 hours later).The one-time successful rate, the total successful rate, the operation time and the result of the two methods were observed in the two groups. Results The observation group Placing stomach tube one-time successful rate and the total successful rate was 75% (60/80), 97.5% (78/80), significantly higher than the control group 27.5% (22/80), 72.5% (58/80), the difference was statistically significant (χ2=36.12, 19.61, P<0.01).The operation time of gastric tube in observation group was (1.49 ± 0.45) min, which was significantly lower than that of control group (3.07 ± 0.32) min, the difference was statistically significant (t=25.48, P<0.01). The observation group only heard gurgling not pumped to the gastric juice of 10 cases (12.50%), only smoke into the gastric juice does not hear the gurgling in 0 cases, both in 70 cases (87.50%), both in 0 cases, the control group were 37 cases (46.25%), 0 cases, 40 cases (50.00%), 3 cases (3.75%). There were significant differences between the 2 groups in determining the success of gastric tube placement, and the difference was statistically significant (χ2=39.36, P<0.01). Conclusions After the trachea cannula, the ordinary silica gel gastric tube was placed in the early stage (immediately), which improved the successful rate of gastric tube placement in the mechanical ventilation patients, Shortened the operation time, improved the work efficiency and alleviated the patient′s pain. Key words: Trachea cannula; Mechanical ventilation; Silicagel stomach tube; Success rate

Role of Gastric Tube Placement in ALS Questioned

Gastric tubes (G-tubes) are commonly offered to amyotrophic lateral sclerosis (ALS) patients with dysphagia, although studies regarding efficacy are

Poster 344: Diverticular Associated Colitis After Gastric Tube Placement in a Hemorrhagic Stroke Patient with Severe Dysphagia: A Case Report

Poster 344: Diverticular Associated Colitis After Gastric Tube Placement in a Hemorrhagic Stroke Patient with Severe Dysphagia: A Case Report

Disparities in supportive therapy for head and neck cancer and impact on missed radiation days and weight loss.

6077 Background: National guidelines emphasize the importance of speech and swallowing (SS) and nutrition services (NS) for head and neck cancer patients (pts). This study evaluates influences of demographic and treatment factors on receipt of SS and NS at a safety-net hospital (SH) and an adjacent private hospital (PH). It also examines associations between lack of these services and negative outcomes. Methods: This retrospective analysis included non-metastatic laryngeal or oropharyngeal cancer pts treated with radiotherapy (RT) at a PH or SH. Univariate (UVA) and multivariable (MVA) analyses utilized linear regression, logistic regression, and zero-inflated Poisson regression. Covariates included race, ethnicity, preferred language, insurance status, immigration status, gender, age, treating hospital, comorbidity score, primary treatment modalities, time to treatment initiation (TTI), and stage. Potential negative outcomes of not receiving SS and/or NS were analyzed only among pts treated with chemoradiation (CRT). Results: Of 239 pts (PH = 138 pts; SH = 56 pts), 28.6% of SH pts received SS pre-RT vs 54.1% at the PH (p &lt; 0.001). Receipt of pre-RT NS did not differ significantly between SH (14.3%) and PH (19.7%) but was low at both. On MVA, SH care (OR 0.29; p = 0.029) and longer TTI (OR 0.99; p = 0.033) were associated with decreased pre-RT SS. In contrast, surgery before RT (OR 10.1; p = 0.002) and surgery before CRT (OR 10.7; p = 0.001) vs RT alone were associated with increased pre-RT SS. No covariates were significantly associated with receipt of NS on MVA. For pts receiving CRT, pre-RT SS was associated with less weight loss during RT (mean difference = 2%; p = 0.036). Receiving both pre-RT SS and NS was associated with fewer missed RT days (RR 0.49; p = 0.004). Receipt of SS and/or NS were not associated with gastric tube placement, emergency room visits, or non-chemotherapy admission days during or within 90 days of CRT. Conclusions: SS was received less often at a SH vs a PH. NS were delivered at a low level at both centers. Lack of supportive services was associated with increased missed RT days and increased weight loss during CRT. Quality metrics to establish supportive care benchmarks may help reduce disparities.

Ultrasonography for confirmation of gastric tube placement.

Gastric tubes are commonly used for the administration of drugs and tube feeding for people who are unable to swallow. Feeding via a tube misplaced in the trachea can result in severe pneumonia. Therefore, the confirmation of tube placement in the stomach after tube insertion is important. Recent studies have reported that ultrasonography provides good diagnostic accuracy estimates in the confirmation of appropriate tube placement. Hence, ultrasound could provide a promising alternative to X-rays in the confirmation of tube placement, especially in settings where X-ray facilities are unavailable or difficult to access. To assess the diagnostic accuracy of ultrasound for gastric tube placement confirmation. We searched the Cochrane Library (2016, Issue 3), MEDLINE (to March 2016), Embase (to March 2016), National Institute for Health Research (NIHR) PROSPERO Register (to May 2016), Aggressive Research Intelligence Facility Databases (to May 2016), ClinicalTrials.gov (to May 2016), ISRCTN registry (May 2016), World Health Organization International Clinical Trials Registry Platform (to May 2016) and reference lists of articles, and contacted study authors. We included studies that evaluated the diagnostic accuracy of naso- and orogastric tube placement confirmed by ultrasound visualization using X-ray visualization as the reference standard. We included cross-sectional studies, and case-control studies. We excluded case series or case reports. Studies were excluded if X-ray visualization was not the reference standard or if the tube being placed was a gastrostomy or enteric tube. Two review authors independently assessed the risk of bias and extracted data from each of the included studies. We contacted authors of the included studies to obtain missing data. We identified 10 studies (545 participants and 560 tube insertions) which met our inclusion criteria.No study was assigned low risk of bias or low concern in every QUADAS-2 domain. We judged only three (30%) studies to have low risk of bias in the participant selection domain because they performed ultrasound after they confirmed correct position by other methods.Few data (43 participants) were available for misplacement detection (specificity) due to the low incidence of misplacement. We did not perform a meta-analysis because of considerable heterogeneity of the index test such as the difference of echo window, the combination of ultrasound with other confirmation methods (e.g. saline flush visualization by ultrasound) and ultrasound during the insertion of the tube. For all settings, sensitivity estimates for individual studies ranged from 0.50 to 1.00 and specificity estimates from 0.17 to 1.00. For settings where X-ray was not readily available and participants underwent gastric tube insertion for drainage (four studies, 305 participants), sensitivity estimates of ultrasound in combination with other confirmatory tests ranged from 0.86 to 0.98 and specificity estimates of 1.00 with wide confidence intervals.For the studies using ultrasound alone (four studies, 314 participants), sensitivity estimates ranged from 0.91 to 0.98 and specificity estimates from 0.67 to 1.00. Of 10 studies that assessed the diagnostic accuracy of gastric tube placement, few studies had a low risk of bias. Based on limited evidence, ultrasound does not have sufficient accuracy as a single test to confirm gastric tube placement. However, in settings where X-ray is not readily available, ultrasound may be useful to detect misplaced gastric tubes. Larger studies are needed to determine the possibility of adverse events when ultrasound is used to confirm tube placement.

Nutrition in the critically ill patient.

To summarize recent relevant studies regarding nutrition during critical illness and provide recommendations for clinical practice. Recently acquired knowledge regarding nutritional status and risk assessment, body composition, gastric residual volume, prokinetics, tube positioning, enteral vs parenteral nutrition, nutritional dose and timing of initiation, pharmaconutrition, dysbiosis and probiotics are discussed. Body composition especially lean body mass is associated with clinical outcomes. The modified NUTrition Risk in the Critically ill score was validated for nutritional risk assessment and identifies patients that benefit from higher nutritional intake; however, caloric restriction decreases mortality in refeeding syndrome. Gastric residual volume monitoring is debated, as abandoning its application doesn't worsen outcome. There is no consensus regarding benefits of gastric vs postpyloric tube placement. Current prokinetics temporarily reduce feeding intolerance, new prokinetics are developed. Enteral remains preferable over parenteral nutrition, although no inferiority of parenteral nutrition is reported in recent studies. Studies imply no harm of hypocaloric feeding when protein requirements are met. Optimal protein provision may be more important than caloric adequacy. Pharmaconutrition confers no superior outcomes and may even confer harm. Dysbiosis is frequently encountered and associated with worse outcomes. Probiotics reduce infectious complications, but not mortality, and may contribute to earlier recovery of gut function.

Comparision of clinical performance of i-gel with laryngeal mask airway pro-seal in elective surgery in adults

Aim : The present study was performed to compare the clinical performance of i-gel and PLMA in terms of the efficacy and safety management in anaesthetized adult patients undergoing elective surgery. Materials and Methods: 80 patients of either sex were randomized in two groups. Group I (n=40) for i-gel and Group P (n=40) for Proseal. After induction i-gel or Proseal was inserted. The cuff of PLMA inflated and pressure maintained at 60cmH 2 O. Insertion time, ease and number of attempts at insertion, airway sealing pressure, airway sealing quality score (ASQS), fiberoptic assessment, ease and number of attempts at gastric tube placement and complications during insertion, maintenance and removal were noted. Statistical analysis was done using Statistical Package for Social Science (SPSS) 20, the sample size was calculated with 99% power (β error = 1%), 95% confidence(α error = 5%), p Results : Demographic data were comparable. Mean insertion time for i-gel (12.30± 1.018sec) was significantly lower than PLMA (13.82 ± 1.083sec):(p 2 O) was significantly lower in group-I (23.925±0.729 vs 29 ±0.751, p = 0.000). ASQS were comparable (p Conclusion: i -gel is an effective and safe alternative supraglottic airway device.

The evaluation of efficacy of three different ultrasonography methods for verification of gastric tube placement in intensive care unit patients

Gastric tube (GT) placement is a routine procedure in critically ill patients. Improper placement of GT could lead to severe complications. Radiography remains as the gold standard test to confirm tube position. The study aim is to estimate diagnostic accuracy of three different ultrasonography (USG) methods to verify GT placement in intensive care units (ICU). Twenty-five mechanically ventilated patients were included in this prospective and observational study. All real time US examinations were performed by an intensivist in three steps: sonography ofneck for visualizing esophagus and upper abdominal quadrant for visualizing stomach,and visualisation of dynamic fogging during water and air insufflations in gastric area. Finally, gastric placement of GT was confirmed with abdominal radiography. USG visualized GT in esophagus in 24 (96 %) patients. GT was directly visualized in stomach in 16 (64%) patients and dynamic fogging occurred in 20 (80 %) in the first attempt and in 23 (92 %) patients after tube removal. Because gastric tube was not seen in stomach in nine cases, dynamic fogging allowed to confirm intragastric position in seven cases. In two cases, no dynamic fogging was observed, and radiography confirmedtube malposition in esophagus. Entire sonographic procedure took 7.24±2.58 minutes. Visualization of the esophagus and dynamic fogging improves the diagnostic accuracy of USG in verifying GT position. Confirming correct GT placement by USG has the potential to reduce X-ray usage and save time. However, X-ray remains the gold standard in cases in which USG cannot verify placement of the GT.

Procedures for measuring and verifying gastric tube placement in newborns: an integrative review.

ABSTRACTObjective:to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. Method:an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors “Intubation, gastrointestinal” and “newborns” in original articles. Results:seventeen publications were included and categorized as “measuring method” or “technique for verifying placement”. Regarding measuring methods, the measurements of two morphological distances and the application of two formulas, one based on weight and another based on height, were found. Regarding the techniques for assessing placement, the following were found: electromagnetic tracing, diaphragm electrical activity, CO2 detection, indigo carmine solution, epigastrium auscultation, gastric secretion aspiration, color inspection, and evaluation of pH, enzymes and bilirubin. Conclusion:the measuring method using nose to earlobe to a point midway between the xiphoid process and the umbilicus measurement presents the best evidence. Equations based on weight and height need to be experimentally tested. The return of secretion into the tube aspiration, color assessment and secretion pH are reliable indicators to identify gastric tube placement, and are the currently indicated techniques.

A Case of Pyogenic Spondylitis Due to Pharyngeal Mucosa Perforation after Prolonged Gastric Tube Placement

A Case of Pyogenic Spondylitis Due to Pharyngeal Mucosa Perforation after Prolonged Gastric Tube Placement

Application of gastric tube interposition by touching laryngeal prominence in postoperative oral cancer patients

This study explores the application of gastric tube interposition by touching laryngeal prominence in postoperative oral cancer patients. This trial includes 66 patients treated in the West China Hospital of Stomatology from August 2014 to December 2014. These patients were randomly divided into two groups: the test group included 33 patients who underwent gastric tube interposition by touching laryngeal prominence; the 33 other patients, who served as control group, underwent regular gastric tube interposition. The two groups were compared in terms of the occurrence rate of bucking, success rate of one-time gastric tube placement, and interposition time. Compared with those in the control group, the occurrence rate of bucking and the interposition time in the test group decreased while the success rate of one-time gastric tube placement increased (P<0.05). Gastric tube interposition by touching laryngeal prominence can improve the success rate of one-time gastric tube interposition; moreover, it can reduce the average interposition time and the pain experienced by patients.

Evaluation of pH on removed tracheal tubes after general anesthesia: a prospective observational study

Study objectiveAspiration pneumonia is a complication of tracheal intubation and mechanical ventilation. We hypothesized that tracheal tubes removed after anesthesia that have an acidic pH may reflect latent regurgitation of gastric fluid. DesignA prospective observational study. SettingOperating room. PatientsTracheal tubes removed from 200 patients (age range, 20-85 years) who had undergone general anesthesia with tracheal intubation and gastric tube placement were examined. MeasurementsTo detect regurgitated gastric fluid on the tubes, we measured pH at 5 different points along the tubes and in the water in which the removed tracheal tubes were immersed. Main resultsOf the 200 removed tracheal tubes, 5 had an acidic pH. The tubes were used in patients who were in the prone (1 patients) or head-down (4 patients) position while under anesthesia. The incidence of acidic pH was significantly higher in patients who were in the prone (1/32) or head-down (4/56) position, compared with those in the supine (0/92) or lateral (0/20) position (P<.05). ConclusionAcidic pH was found on about 2.5% of removed tracheal tubes. These tubes were used in patients who were in the prone or head-down position during general anesthesia, although they did not exhibit significant aspiration symptom. Anesthesiologists should be aware of the inherent risk of gastric fluid regurgitation when their patients undergo general anesthesia in these positions.

Comparison of i-gel with LMA ProSeal for ease of insertion in adultanaesthetised paralysed patients: a prospective randomized trial

Background: i-gel,a recently developed non-inflatable supraglottic airway device, a suitable better alternative to cuffed inflatable suprglottic airway device like LMA ProSeal.Aim and objectives: This study aimed to compare the ease of insertion to achieve early successful airway between LMA ProSeal and i-gel. The secondary objectives were to compare hemodynamic parameters and any airway complications.Materials and methods: This prospective randomized study done in fifty (n=25, each group) ASA I and II adult patients, aged between 20 and 65 years of either sex scheduled for elective surgeries. Patients airway was secured with appropriate size eitherLMA ProSeal or i-gel. The time taken for successful insertion, number of attempts and ease ofgastric tube placement were recorded. Hemodynamic parameters at basal (pre operative), 1, 3 & 5 minutes after insertion were recorded. Blood stain of device and any postoperative airway complications were noted.Results: Time taken for successful insertion was significantly less in i-gel group [Group 1(LMA ProSeal) 20.56±2.00, Group 2 (i-gel) 12.08±1.53, p=0.001*]. Time taken for gastric tube placement was significantly less in i-gel group [Group 1(LMA ProSeal) 31.96±4.58, Group 2 (i-gel) 21.48±2.55, p=0.001*]. Among hemodynamic parameters, heart rate immediately after insertion of device was stable in i-gel group. The numbers of insertion attempts were also less with i-gel group.Conclusion: In our study, ease ofinsertion with less number of attempts was observed with i-gel group.So i-gel found to be the better alternative to LMA ProSeal.

Accuracy of a Weight-Based Formula for Neonatal Gastric Tube Insertion Length.

Gastric tubes are used in nurseries on a daily basis. Various methods of estimating gastric tube length for insertion using anatomical landmarks are used to assist correct placement. Sometimes, however, they can be up to 55% inaccurate. In 2012, we published a weight-based formula to estimate gastric tube length for insertion. This study reviews the rates of correct gastric tube placement, as confirmed by radiography, after the incorporation of this weight-based formula into bedside practice. A 6-month prospective study was performed in a tertiary neonatal intensive care unit. The formula estimating gastric tube length for insertion had been derived in an earlier study. This was incorporated into the hospital's policies and procedures guideline for the insertion of gastric tubes. Neonates with gastric tubes who required radiography for clinical reasons were included. The infant's weight and the type (orogastric or nasogastric) and length of tube were documented. A single radiologist assessed the tube position to be high, borderline, correct, or long. A total of 195 chest radiographs were obtained. Correct tube position was found in 84% of instances. This was a statistically and clinically significant improvement. Implementation of a simple weight-based estimate for gastric tube length improves correct position rates. Further studies comparing accuracy of length/height and weight-based estimations for gastric tube insertion lengths in very preterm and extremely preterm infants are needed.

Comparison of clinical performance of I-Gel with LMA-Proseal in elective surgeries under general anesthesia

Aim: To compare insertion characteristics of two different supraglottic devices [I-gel and LMA-Proseal] and to observe any associated complications. Materials and Methods: This prospective, randomized study was conducted in 60 patients [Group A- LMAProseal (n = 30) and Group B - I-Gel (n =30)] of ASA grades I/II, of either sex in the age group 18-60 years. Both groups were compared with respect to haemodynamic response to device insertion, success rate of insertion, time taken for insertion, ease of gastric tube placement, airway trauma by post operative blood staining of the device, tongue, lip and dental trauma and 24 hours after surgery we watched for sore throat, hoarseness and dysphonia. Result: Haemodynamic response to device insertion were comparable in both the groups (p >0.05). Mean insertion time for the I-gel (11.47 ± 1.914 sec) was significantly lower than that of the PLMA (13.53 ± 3.92 sec) (P = 0.0002). I-gel was easier to insert with a better anatomic fit. The success rate at first attempt of insertion were 29/30 (96.67%) for I-gel & 28/30 (93.3%) for LMA - ProSeal (P=0.0002). Ease of gastric tube insertion was significantly higher in I-gel group (P = 0.116). Blood staining of the device, trauma (tongue, lip and dental) and 24 hrs complications after surgery were more with Group A. Conclusion: I-Gel is better than LMA-Proseal in terms of faster insertion and ease of insertion with a low incidence of pharyngolaryngeal morbidity