ProSeal Laryngeal Mask Airway Research Articles

A Prospective Comparison of Insertion Characteristics of Laryngeal Mask Airway (LMA) ProSeal® Using Rotation Techniques vs Standard Techniques in Adults Undergoing Elective Surgery.

Airway management is the most essential skill in Anesthesiology and the inability to secure the airway is one of the most common reasons for anesthesia-related morbidity and mortality. This study aimed to evaluate and compare the insertion characteristics of laryngeal mask airway (LMA)ProSeal insertion using the standard introducer technique, 90-degree rotation technique, and 180-degree rotation technique in adult patients undergoing elective surgery. This prospective, interventional, randomized, comparative study was carried out in the Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, after obtaining hospital ethical committee approval for 18 months of duration. Patients in the age group 18-65 years, of either gender, fulfilling American Society of Anesthesiologists grade I or II criteria, scheduled for elective surgery under general anesthesia with controlled ventilation using the LMA ProSeal were included in the study. The patients were randomized into three groups: Group I - Standard Introducer technique (n=40); Group NR - 90-degree rotation technique (n=40); Group RR - 180-degree rotation technique or back to front (airway) technique (n=40). In this study, the majority (73.3%) of the patients were females with 31 patients in group I, 29 patients in group NR, and 28 patients in group RR. A total of 26.67% of male patients were included in the study. No significant difference in the gender distribution of the three groups was seen in the study. There was no incidence of failure in ProSeal laryngeal mask airway (PLMA) insertion in the NR group, while it was 2.50% in group I and 7.50% in group RR but the difference was not statistically significant. A statistically significant difference was seen in the incidence of LMA ProSeal blood staining (p=0.013). In the post-anesthesia care unit at 1 hour, the incidence of sore throat was 10% in patients with the NR group, 30% in the I group, and 35.44% in the RR group which was statistically significant. The study concluded that the 90-degree rotation technique was superior to both the 180-degree rotation and the introducer technique in adult patients in terms of insertion time, ease of insertion score, manipulation requirement, blood staining of PLMA, and post-op sore throat.

Comparison of Baska Mask Versus Proseal Laryngeal Mask Airway in Elective Surgeries Under General Anaesthesia: A Randomized Clinical Trial.

Background Baska Mask (BM) is a third-generation supraglottic airway device with a self-inflating cuff. This study aimed to evaluate the efficacy of the BM compared to ProSeal laryngeal mask airway (PLMA) regarding insertion time, ease of insertion, and oropharyngeal seal pressure in patients undergoing elective surgeries under general anesthesia for less than two hours. Methods This prospective, randomized, double-blind comparative study was done on 64 patients randomly divided into two groups, with 32 patients in the PLMAgroup (Group A) and 32 in the BM group (Group B). Individuals with a body mass index (BMI)of more than 30, a history of nausea/vomiting, or pharyngeal pathology were excluded from the trial. After induction with propofol 3-4 mg/kg, fentanyl 1-2 mcg/kg, and the neuromuscular blockade was achieved with atracurium 0.5 mg/kg, patientswere insertedwitheither BM (n= 32) or PLMA (n= 32). The primary outcome measure was the time taken for insertion and ease of insertion. Secondary outcome measures included the number of attempts, oropharyngeal seal pressure (OSP), and laryngopharyngeal morbidity (trauma to lips, blood staining, and sore throat) immediately and 24 hours postoperatively. Results Demographic data were comparable and statistically insignificant. Regarding time and ease of insertion, the BM could be inserted in a lesser time of 24±1.136 seconds compared to PLMA which took 28.59±1.682 seconds, with a high success rate in the first attempt which wasstatistically significant. The BMprovided a higher OSP(31.34 +1.638 cmH2O)when compared to PLMA(24.81±1.469 cmH2O) andwas statistically significant. Complications associated with insertion trauma to the lip, blood staining, and sore throat were more in PLMA (15.6%, 15.6 %, 9.4%, respectively) compared to the BM (6.3%, 3.1%, 3.1%, respectively), and statistically insignificant. Conclusion BM had higher first-attempt successful insertion with better OSP compared to PLMAin patients under controlled ventilation.

Comparative Study of I-Gel with Proseal Laryngeal Mask Airway for Minor Surgical Procedures Under Total Intravenous Anaesthesia in Pediatric Age Group

Comparative Study of I-Gel with Proseal Laryngeal Mask Airway for Minor Surgical Procedures Under Total Intravenous Anaesthesia in Pediatric Age Group

Comparison of Efficacy of Sevoflurane and Propofol for Insertion of Proseal Laryngeal Mask Airway in Adults

Comparison of Efficacy of Sevoflurane and Propofol for Insertion of Proseal Laryngeal Mask Airway in Adults

Airway management in “tubeless” spontaneous-ventilation video-assisted thoracoscopic tracheal surgery: a retrospective observational case series study

BackgroundSurgeon and anesthetist share the airway in a simpler way in the resection and reconstruction phase of tracheal surgery in tubeless spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS). Tubeless SV-VATS means stable spontaneous ventilation in the resection and reconstruction phase to anesthesiologist, and unobstructed surgical field to surgeon. What’s the ideal airway management strategy during “Visual Field tubeless” SV-VATS for tracheal surgery is still an open question in the field.MethodsWe retrospectively reviewed 33 patients without sleeve and carina resections during the study period (2018–2020) in our hospital. The initial management strategy for these patients was spontaneous ventilation for intrathoracic tracheal resection and reconstruction. We obtained and reviewed medical records from our institution’s clinical medical records system to evaluate the airway management strategy and device failure rate for tracheal resection in Tubeless SV-VATS.ResultsBetween 2018 and 2020, SV-VATS was first attempted in the 33 patients who had intrathoracic tracheal surgery but without sleeve and carina resections. All patients underwent bronchoscopy (33/33) and 8 patients (8/33) received partial resection before surgery. During the surgery, the airway device comprised either a ProSeal laryngeal mask airway (ProSeal LMA) (n = 27) or single lumen endotracheal tube (n = 6). During the resection and reconstruction phase, Visual Field tubeless SV-VATS failed in 9 patients, and breathing support switched to plan B which is traditional ventilation of a single lumen endotracheal tube for cross field intubation (n = 4) and ProSeal LMA alongside a high-frequency catheter (high-frequency jet ventilation, HFJV) (n = 5) into the distal trachea ventilation. Preoperative respiratory failure or other ventilation-related complications were not observed in this cohort.ConclusionBase on current analysis either ProSeal LMA or endotracheal tube is an effective airway management strategy for tubeless SV-VATS with appropriate patient selection. It also provides breathing support conversion option when there’s inadequate ventilation.

Usefulness of bougie-preloaded proseal laryngeal mask airway versus digital insertion technique in correct placement of the device.

Digital technique of proseal laryngeal mask airway (PLMA) insertion carries high chance of failed first attempt successful placement. We aimed to compare the number of attempts taken for correct placement of bougie-preloaded PLMA versus traditional digital insertion technique. Ease of insertion, time taken, hemodynamic responses during insertion, and evidence of trauma were also assessed. This prospective, randomized, open-label study was performed in 60 patients. All patients were administered general anesthesia according to a standardized protocol.After induction of general anesthesia in group P, proseal insertion was performed following the traditional digital technique. In group B, bougie-preloaded PLMA was used. A soft gum elastic bougie was passed through the gastric channel of PLMA, with 15cm protruding distally through the gastric port. Attempts at successful insertion and ease of insertion were noted. Time taken for successful insertion was significantly shorter in group B compared to group P (15.3 ± 4.5 vs. 57 ± 12.02 s, respectively). The first attempt success in group B was 90% versus 60% in group P. The number of moderate to hard insertion was significantly lesser in group B (10 vs. 40, respectively). Blood stain on device was seen in 3.3% in group B compared to 30% in group P. MAP at insertion and at 1, 3, and 5 min was significantly higher in group P. Heart rates were comparable. Bougie-preloaded proseal insertion has significantly higher first attempt insertion success rates and is significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.

Airway Management During Diagnostic Laparoscopic Surgery: A Comparison of I-Gel and Proseal Laryngeal Mask Airway.

Supraglottic airway devices (SADs) may be used during laparoscopic procedures in place of the often utilised endotracheal tube. The Proseal laryngeal mask airway (PLMA) is designed with an inflatable cuff, which provides an excellent oropharyngeal seal, and the I-gel is a newer SAD designed with a softer and noninflatable cuff and sharing similar features with PLMA. This study compared the ease of insertion, haemodynamic and ventilatory parameters as well as morbidities associated with these SADs when used for airway management during diagnostic laparoscopic procedures. Eighty American Society of Anaesthesiologist I and II patients aged 18-60 years undergoing diagnostic laparoscopic surgery under controlled ventilation had either I-gel or PLMA used for airway management. Anaesthesia was induced with standard dose of propofol, patient received atracurium, fentanyl and the SAD inserted. Pulse oximetry, capnography, noninvasive blood pressure, oropharyngeal leak pressure (OLP), and evidence of pharyngolaryngeal morbidity were assessed. Data were analysed using the Statistical Package for Social Sciences version 21.0. The quantitative variables were analysed using the Student's t test and the qualitative using the Chi-square test. A P value of less than 0.05 was considered significant. The success rates at first insertion for I-gel and PLMA were 95% and 80%, respectively (P = 0.04). The mean changes in mean arterial pressure following insertion were 9.6 mmHg (±4.7) and 10.6 mmHg (±8) for I-gel and PLMA, respectively (P = 0.02). The OLP during insufflation was higher in the PLMA (35.8 cmH2O) than in the I-gel group (27.9 cmH2O) (P = 0.57). In the I-gel group, 12.5% of the patients had oropharyngeal morbidities compared with 37.5% in the PLMA group (P = 0.009). Both I-gel and PLMA provide optimal ventilation during abdominal insufflation, with PLMA providing a better oropharyngeal seal, whereas I-gel has a better haemodynamic profile.

A COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSES OBSERVED DURING INSERTION OF PROSEAL LARYNGEAL MASK AIRWAY VERSUS ENDOTRACHEAL TUBE IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERALANAESTHESIA

In laproscopic surgeries use of supraglottic airway devices have become more effective in terms of anatomical position and degree of invasiveness compared to endotracheal tube for airway management. Our study aims to compare the efcacy of Proseal laryngeal mask airway (PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic cholecystectomy under general anaesthesia. Haemodynamic changes were compared in both the groups. A properly positioned PLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic cholecystectomy.

Usefulness of supplemental parasternal block for sternal keloid excision under general anesthesia in a child status post multiple cardiac surgeries

Sir A 12-year-old boy weighing 60 kg, with history of tricuspid atresia, had undergone right modified Blalock–Thomas–Taussig shunt, and patent ductus arteriosus ligation on day 1 of life. One year later he underwent bidirectional Glenn shunt, and extra cardiac Fontan surgery was done at 6 years. He presented now with a thick keloid in the midline sternotomy scar for keloid excision. Current screening echo showed tricuspid atresia, normally related great arteries with normal ventricular flow and unobstructed Glenn and Fontan flow profiles. Intravenous midazolam 1 mg, fentanyl 100 mcg and ketamin 60 mg were given and incremental bolus of propofol 10 mg (total 20 mg) was given till loss of response to verbal commands and relaxation of jaw. Airway was then secured with size 3 proseal laryngeal mask airway (PLMA) and correct placement was ensured with regular endtidal carbon dioxide (ETCO2) waveforms. Parasternal block was then given under ultrasound guidance at third and fifth intercostal spaces 2 cm lateral to midline bilaterally. Spread of injected solution causing separation of pectoralis major muscle from the rib and external intercostal muscle confirmed deposition of drug in the correct plane (Fig. 1). Ten milliliter of 0.25% bupivacaine was injected at each site.Figure 1: Superficial parasternal-intercostal plane block.Anesthesia was maintained with sevoflurane (1.5–2%) in air oxygen mixture under spontaneous ventilation. Intraoperatively patient remained stable with heart rate 86-98/min, systolic blood pressure 90–100 mmHg, oxygen saturation 96–98% and ETCO2 32-40 mmHg and had received 500 ml of Ringer lactate. At the end of surgery, which lasted for 2 h, PLMA was removed when patient was awake. He had good postoperative analgesia. Anesthetic goals in a child post-Fontan surgery include adequate hydration, avoidance of hypoxia, hypercabia, and acidosis and preservation of spontaneous ventilation whenever possible. If general anesthesia is mandated, low inspiratory pressures and minimal positive end expiratory pressures are to be used [1,2]. Sternotomy produces considerable pain which increases with chest wall movement and reduces pulmonary function with higher risk of development of postoperative hypoxia, atelectasis, and pneumonia [3]. Parasternal block is commonly advocated to provide supplemental anaesthesia intraoperatively and for postoperative analgesia following median sternotomy, breast surgery and cardioverter-defibrillator implantation [4,5]. The nerve targeted is the anterior branches of intercostal nerves which enters intercostal and pectoralis major muscles and innervates the antero-medial region of chest wall. Local anesthetic is injected deep to pectoralis major muscle and superficial to intercostal muscles or between internal thoracic muscle and transverses thoracis muscle. Therefore, these blocks are essentially described as superficial or deep parasternal-intercostal plane blocks, depending on where the target nerves are blocked. The anatomical injection site differentiates these techniques though both techniques provide analgesia to the antero-medial chest wall [5]. Supplemental regional block helps to reduce dose requirement of anesthetic agents intraoperatively. Use of supplemental parasternal block enabled us to keep the child spontaneously breathing under general anaesthesia using PLMA with use of lesser doses of anesthetic agents, thereby minimising drug adverse effects which could be deleterious in the presence of cardiac diseases. It is concluded that supplemental parasternal block provides good intraoperative and postoperative analgesia following anterior midline chest wall surgeries.

Comparison between LMA ProSeal and I-gel airway in anesthetized patients on spontaneous ventilation during daycare procedures: A prospective randomized study.

General anesthesia remains the most popular technique for ambulatory surgeries with patients, surgeons, and anesthesia providers. The supraglottic airway (SGA) devices result in fewer incidences of sore throat, laryngospasm, coughing, and hoarseness as compared to inserting a tracheal tube. This study was conducted to compare two second-generation SGA devices, LMA ProSeal and I-gel airway, in anesthetized patients on spontaneous ventilation during daycare procedures to establish the superior SGA device. This prospective randomized study was done on 90 patients of either sex aged 15-60 years, ASA grade I-II, Mallampatti grade I and II, and BMI between 20 and 30 kg/m2 scheduled for elective surgeries of duration less than 90 min. Patients were randomly allocated into two groups-group A (I-gel) and group B (LMA ProSeal). Insertion parameters, hemodynamic responses, oxygenation, ventilation, peak airway pressure (PAP), and postoperative complications were recorded. Statistical analysis was done using SPSS version 21.0 statistical analysis software. Mean insertion time of LMA ProSeal was found to be significantly higher as compared to I-gel (33.27 ± 3.88 vs 18.49 ± 3.18 s; P < 0.001). No significant difference was found between the groups in the number of attempts and of operators attempted for insertion, as well as in hemodynamic response, oxygenation, and ventilation. Postoperative complications were lesser in group A. I-gel is an easy-to-insert cuffless SGA device requiring lesser time for insertion, provides adequate ventilation with lesser postoperative complications and thus appears to be better than LMA ProSeal.

Comparison of Laryngeal tube suction II (LTS II) and Proseal laryngeal mask airway (PLMA) for controlled ventilation in anaesthetised and paralysed adult patients

Background: LTS II and PLMA are supraglottic devices that may be used for ventilation in patients with normal as well as difficult airways at risk of aspiration. Aim: Comparison of LTS II with PLMA during controlled ventilation in paralysed patients with respect to time to successful insertion, success rate of insertion, attempts at repositioning, airway leak pressure, ease of ventilation and Ryle’s tube insertion, fibreoptic laryngeal view and complications. Methods: Thirty patients were studied using a prospective, randomised cross-over design. Ethical committee clearance and informed consent were obtained from all patients. Anaesthesia was induced with propofol and fentanyl and neuromuscular blockade achieved with vecuronium. Patients were divided into two groups: Group LTS and Group PLMA. In each group, the first airway device was inserted, various parameters observed and then removed. The second airway device was then inserted and the same parameters noted. Anaesthesia was continued with the second device in position. Results: Success with insertion at first attempt and time to insertion were comparable with both devices [LTS II 27/30 (17.5 s) and PLMA 29/30 (15.5 s) respectively]. PLMA required repositioning in fewer patients and provided better fibreoptic view than LTS II. Ryle’s tube insertion failed in four patients with PLMA but in none with LTS II. No significant difference was found in the airway seal pressure [mean, PLMA (27 cm H2 O) and LTS II (26.4 cm H2 O)], ease of ventilation or overall complications. Conclusion: Insertion and ventilation are comparable with PLMA and LTS II. Ryle’s tube insertion is easier with LTS II but requires more repositioning attempts and does not provide a good view of the larynx

COMPARISON OF I-GEL WITH PROSEAL LMA IN ADULT PATIENTS UNDERGOING ELECTIVE SURGICAL PROCEDURES UNDER GENERAL ANAESTHESIA WITHOUT PARALYSIS

Comparison Of I-gel With Proseal Lma In Adult Patients Undergoing Elective Surgical Procedures Under General Anaesthesia Without Paralysis Objective: Supraglottic airway devices (SADs) have been widely used as an alternative to tracheal intubation during general anaesthesia. They are easily inserted, better tolerated, with fewer hemodynamic changes. This study compares the efcacy of two supraglottic devices (LMA Proseal and I-gel) in elective surgical procedure under general anaesthesia without paralysis. Material and Method: A prospective randomized study was conducted on 40 patients who were posted for elective short surgical procedures under general anaesthesia. They were randomly divided into two groups of 20 patients each, Group I (I-gel) and Group P (PLMA). All the patients were induced with general anaesthesia and the planned SAD was inserted with head in neutral position. Ease of insertion, number of insertion attempts, oropharyngeal seal pressure and incidence of adverse effects were assessed. Results: I-gel was signicantly easier to insert than Proseal (P &lt; 0.05). The mean time for insertion was more with Group P (40.8±09.61 secs) than with Group I (29.63±08.13 secs). Although the airway sealing pressure was signicantly higher with Group P (26.63±1.31 cm of H2O), the airway sealing pressure of Group I (20.97 ± 2.14 cm of H2O) was within normal limit. The success rate of rst attempt insertion was more with Group I. There was no evidence of airway trauma, regurgitation, and aspiration. Sore throat was signicantly more evident in Group P. Conclusion: I-Gel is better supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence, I-gel is better alternative than Proseal LMA.

Comparison Between two Supraglottic Airway Devices: Ambu AuraGain &amp; Pro Seal LMA

Context: Aims: To compare two supra glottic airway devices, Ambu auragain &amp; proseal LMA in terms of their working performance &amp; insertion characteristics during general anesthesia in patient undergoing elective laparoscopic surgery. Settings and Design: After written informed consent, 60 patients of ASA I &amp; II, aged 18 to 60 years, of either gender posted for laparoscopic surgery under general anesthesia were included in the study. Patients were divided into two groups of 30 patients each. Methods and Material: In group A: airway was secured with Ambu Auragain &amp; in group P: with Proseal LMA for general anesthesia. Working performance (in terms of oropharyngeal leak pressure) and insertion characteristics (insertion time, manipulations of device, number of attempts) were recorded at the time of induction. Haemodymanics (Heart rate, mean arterial blood pressure, SpO2) &amp; complications (if any) were recorded perioperatively. Statistical Analysis used: Student t test for quantitative data &amp; Chi square test for qualitative data. Results: Oropharyngeal leak pressure was significantly higher &amp; insertion time was significantly less in group A compared to group P (P&lt;0.0001). There was no statistically significant difference in insertion characteristics, demographic data, haemodynamics, ease of orogastric tube &amp; post operative complications in both the groups. Conclusions: AmbuAuragain provides higher oropharyngeal leak pressure with lesser insertion time compared to ProSeal LMA.&gt;&gt;0.0001). There was no statistically significant difference in insertion characteristics, demographic data, haemodynamics, ease of orogastric tube &amp; post operative complications in both the groups. Conclusions: AmbuAuragain provides higher oropharyngeal leak pressure with lesser insertion time compared to ProSeal LMA.

ANALYSIS OF THE BASKA MASK VERSUS PROSEAL LARYNGEAL MASK AIRWAY SEALING PRESSURE IN PATIENTS POSTED FOR LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

Background: Airway management by anaesthesiologist has come a long way from the invention of endotracheal intubation. Invention of supraglottic airway devices (SAD) provided alternative airway, without hazards of direct laryngoscopy and intubation. First generation SAD was considered airway tubes, and hence modications were made to them. PLMA (Proseal laryngeal mask airway) is a second generation SAD which has a gastric port along with the airway tube. BASKA mask is a novel 3rd generation SAD. We designed this study to compare the clinical efcacy of BASKA mask and PLMA for time for insertion, ease of insertion, airway sealing pressure and complications in anaesthetised patients undergoing positive pressure ventilation under general anaesthesia. The present randomi Methodology: zed control trial was conducted in 60 ASA-1 and ASA-2, aged between 18-60 years posted for elective laparoscopic surgeries under general anaesthesia. Patients were allocated into two equal groups, Group B-BASKA mask (n=30) and Group P- PLMA (n=30). All the data Collected were analysed. The demographic data, duration of insertion and airway sealing pressure were analysed using unpaired't' test. In our study we observed that, BASKA mask took lesser time to ins Results: ert in comparison to PLMA, the mean duration of insertion was 16.77±2.14 sec in BASKA Mask and 25.40±3.04 sec in PLMA Group. This difference was statistically signicant (p &lt; 0.0001). The Mean airway sealing pressure was 33±2.31 cm of H2O in BASKA mask group and 27.00±1.84 cm of H2O in PLMA Group, after 5 min of insertion and 31.33±2.06 cm of H20 in BASKA Mask and 26.90±1.79 cm of H2O in PLMA Group after 5 min of pneumoperitoneum. The airway sealing pressure was more in BASKA group which was statistically signicant both after 5 min insertion and 5 min of pneumoperitoneum. There were no signicant mean airway sealing pressures between 5 min after insertion and 5 min after pneumoperitoneum in both the groups. The ease of insertion was more in BASKA mask but it was statistically insignicant. The Laryngopharyngeal morbidity score between these groups were statistically insignicant. To conclude, we observed that BASKA mask took lesser time to insert Conclusion: than PLMA in anaesthetized paralysed adult patients. Mean airway sealing pressure was higher in BASKA mask than PLMA. The ease of insertion was more in BASKA mask but it was statistically insignicant. The LPM score between these groups were statistically insignicant.

Comparison of Gastric Insufflation Volume Between Ambu AuraGain and ProSeal Laryngeal Mask Airway Using Ultrasonography in Patients Undergoing General Anesthesia: A Randomized Controlled Trial.

Introduction: Ambu AuraGain and ProSeal laryngeal mask airway are second-generation supraglottic airway devices (SADs) with added advantage of gastric drain and better oropharyngeal sealing pressure. The primary objective was to study the difference in the gastric insufflation volume between Ambu AuraGain and ProSeal LMA in patients undergoing general anesthesia.Methods: This randomized controlled trial involving 120 adult patients scheduled under general anesthesia were randomized into either Ambu AuraGain or LMA ProSeal group. Gastric cross-sectional area was measured using ultrasonography at baseline, after mask ventilation, and at the end of surgery. Gastric volume was calculated from the measured cross-sectional area. Oropharyngeal sealing pressure, peak airway pressure, and postoperative complications were noted. Statistical analysis was done using SPSS version 22 (Armonk, NY: IBM Corp.) and p < 0.05 was considered statistically significant.Results: Demographic profile of the study groups was comparable. There was a significant difference in gastric volume between the groups at the end of surgery with 5.91 ml (±9.68 ml) in Ambu AuraGain group and 12.28 ml (±13.05 ml) in the LMA ProSeal group (p = 0.001). Similarly, there was a difference in volume between baseline and at the end of the surgery within the groups also (Ambu AuraGain group, p=0.0012; LMA ProSeal group, p=0.0015, respectively). Though the oropharyngeal sealing pressure and peak airway pressures were comparable, increased incidence of postoperative complications was observed with LMA ProSeal.Conclusion: Thus, Ambu AuraGain resulted in a lower gastric insufflation volume than LMA ProSeal with lesser incidence of postoperative complications.

A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotracheal intubation than PLMA insertion. The elevation in theseResults: hemodynamic parameters signicantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic response produced when PLMA was used forConclusion: securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.

Bronchial blocker through Proseal LMA - A useful approach for paediatric lung isolation.

Bronchial blocker through Proseal LMA - A useful approach for paediatric lung isolation.

The Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial.

The value of positive end-expiratory pressure (PEEP) in maintaining oxygenation during ventilation with a laryngeal mask airway (LMA) mask is unclear. To clarify the potential benefit or harm to PEEP application during positive pressure ventilation with a ProSeal LMA® mask, we compared the effect of PEEP versus zero end-expiratory pressure (ZEEP) on gas leakage and oxygenation. We hypothesized that a PEEP of 8 mbar (8.2 cm H 2 O) would be associated with an increased incidence of gas leakage compared to ZEEP. We designed a prospective, controlled, randomized, single-blinded, multicenter clinical trial. Patients >18 years of age with an American Society of Anesthesiologists (ASA) physical status I/II without increased risk of aspiration were enrolled if they were scheduled for elective surgery under general anesthesia with an LMA mask. Patients were randomized to a control group managed with ZEEP or an intervention group managed with a PEEP of 8 mbar. Both groups received positive pressure ventilation. The primary end point was the occurrence of gas leakage. The Student t test and χ 2 test were used for statistical analysis. A total of 174 patients were enrolled in the ZEEP group, and 208 were enrolled in the PEEP group. The incidence of gas leakage did not differ between the 2 groups (ZEEP: 23/174, 13.2%; PEEP: 42/208, 20.2%; P = .071; odds ratio [OR], 1.611; 95% confidence interval [CI], 0.954-2.891). However, more patients required reseating of the LMA mask in the PEEP group (ZEEP: 5/174, 2.9%; PEEP: 18/208, 8.7%; P = .018; OR, 3.202; 95% CI, 1.164-8.812). The need for endotracheal intubation did not differ between groups (ZEEP: 2/174, 1.1%; PEEP: 7/208, 3.4%; P = .190; OR, 2.995; 95% CI, 0.614-14.608). After positive pressure ventilation for 25 minutes, the mean peripheral oxygen saturation (Sp o2 ) was higher in the PEEP than in the ZEEP group (98.5 [1.9]% vs 98.0 [1.4]%; P = .01). Peak inspiratory pressure (PIP; 16 [2] vs 12 [4] mbar; P < .001) and dynamic compliance (57 [14] vs 49 [14] mL/mbar; P < .001) were both higher in the PEEP group than in the ZEEP group. Use of PEEP did not affect the overall incidence of gas leakage. However, PEEP did result in a higher incidence of attempts to reseat the LMA mask compared to ZEEP, whereas the incidence of rescue intubation did not differ between groups. We concluded that a PEEP of 8 mbar did not increase overall gas leakage during positive pressure ventilation with an LMA mask, but it did slightly improve gas exchange and compliance. Overall, our study does not provide strong arguments for using PEEP during ventilation with an LMA mask in elective surgery.

Comparison of Outcome of Proseal Laryngeal Mask Airway and Supreme Laryngeal Mask Airway in Patients Undergoing Surgery Under General Anaesthesia

Objective: To compare the proseal laryngeal mask airway's performance to that of the supreme laryngeal mask airway in patients undergoing surgery under general anesthesia. Study design: Descriptive-Comparative Study Settings:Department of Anesthesia, Jinnah Postgraduate Medical Centre Karachi Study duration:December 2020 to June 2021 Materials &amp; Methods: It was estimated that 154 patients of both genders were considering elective surgery while under the effect of general anesthesia. They were between the ages of 18 and 60. Patients were not allowed to participate in the trial if they had trouble breathing, were known to have lung or heart problems, were at danger of aspiration, or had a fractured neck spine. Following the acquisition of informed permission, the selected cases were then randomly separated into two groups, one labelled group P and the other designated group S. Group P patients were given a proseal laryngeal mask, which is a form of airway. A supreme laryngeal mask was used by those in Group S. During the first twenty-four hours, the researcher checked on each patient to see if they were coughing or had sore throats. Results: More than 96% of patients with Proseal and 88% of patients with Supreme-LMA were able to successfully insert the device on their first try in our study. When it came to inserting patients, the S-LMA group performed better than the others (19.17 2.69 min vs. 23.16 1.73 min). When comparing the adverse effects of Proseal-LMA and Supreme-LMA, we found that 27.27 Vs 20.78 percent reported cough, 18.18 Vs 12.99 percent blood stains, and 20.78 Vs 3.90 percent painful throat respectively. Conclusion: The results of this study show that the supreme laryngeal mask airway is superior than the proseal laryngeal mask airway in patients undergoing surgery under general anesthesia. Keywords: general anesthesia, supreme laryngeal mask airway, outcome.

A COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE WITH PROPOFOL VERSUS FENTANYL WITH PROPOFOL FOR INSERTION OF PROSEAL LARYNGEAL MASK AIRWAY IN ADULTS

Background and Objectives: Dexmedetomidine and Fentanyl are effective adjuvants used with Propofol to assess the hemodynamic response and insertion conditions of ProSeal Laryngeal Mask Airway. This study was conducted to do a comparative analysis between these two drugs with respect to PLMA insertion conditions, hemodynamic changes and adverse effects. 80 ASA grade I and II patients were randomly allocated into two groupsMaterials and methods: receiving Dexmedetomidine with Propofol(Group D) and Fentanyl with Propofol(Group F). The size of ProSeal LMA used in this study was Size 3. PLMA insertion condition was measured according to the Muzi scoring system.Score≤2 was considered optimal for PLMA insertion. 90% in Group D whereas only 65% of the cases in Group F had fullyRESULTS: relaxed jaw (p=0.0078). Hemodynamic stability was maintained in both the groups. But the attenuation to hemodynamic responses was statistically more significant in Group D. Dexmedetomidine is a better adjuvant used withConclusion: Propofol for insertion of PLMA with better hemodynamic profile and insertion conditions than Fentanyl.