Supraglottic Airway Devices Research Articles

The reality of advanced airway management during out of hospital cardiac arrest; why did paramedics deviate from their allocated airway management strategy during the AIRWAYS-2 randomised trial?

BackgroundAIRWAYS-2 was a large multi-centre cluster randomised controlled trial investigating the effect on functional outcome of a supraglottic airway device (i-gel) versus tracheal intubation (TI) as the initial advanced airway during out-of-hospital cardiac arrest. We aimed to understand why paramedics deviated from their allocated airway management algorithm during AIRWAYS-2. MethodsThis study employed a pragmatic sequential explanatory design utilising retrospective study data collected during the AIRWAYS-2 trial. Airway algorithm deviation data were analysed to categorise and quantify the reasons why paramedics did not follow their allocated strategy of airway management during AIRWAYS-2. Recorded free text entries provided additional context to the paramedic decision-making related to each category identified. ResultsIn 680 (11.7%) of 5800 patients the study paramedic did not follow their allocated airway management algorithm. There was a higher percentage of deviations in the TI group (399/2707; 14.7%) compared to the i-gel group (281/3088; 9.1%). The predominant reason for a paramedic not following their allocated airway management strategy was airway obstruction, occurring more commonly in the i-gel group (109/281; 38.7%) versus (50/399; 12.5%) in the TI group. ConclusionThere was a higher proportion of deviations from the allocated airway management algorithm in the TI group (399; 14.7%) compared to the i-gel group (281; 9.1%). The most frequent reason for deviating from the allocated airway management algorithm in AIRWAYS-2 was obstruction of the patient’s airway by fluid. This occurred in both groups of the AIRWAYS-2 trial, but was more frequent in the i-gel group.

Anesthetic management of a patient with Osler-Weber-Rendu syndrome with multiple pulmonary arteriovenous malformations and pheochromocytoma for femoral artificial bone replacement: a case report

BackgroundOsler-Weber-Rendu syndrome is characterized by mucocutaneous telangiectasia and arteriovenous malformations in organs. Anesthesia for patients with Osler-Weber-Rendu syndrome is challenging due to complications and physiological changes.Case presentationThe case was a 49-year-old female with Osler-Weber-Rendu syndrome, multiple pulmonary arteriovenous malformations and pheochromocytoma who presented for femoral bone head fracture with metastatic adenocarcinoma. The patient was scheduled to undergo bone tumor resection and artificial bone replacement, being positioned laterally with a planned operation duration of 5 h. Anesthesia was managed with spinal and epidural anesthesia, combined with sedation by sevoflurane using a supraglottic airway (SGA) device under spontaneous breathing. Her intraoperative and postoperative courses were uneventful.ConclusionNeuraxial anesthesia combined with general anesthesia using an SGA device to maintain spontaneous ventilation in order to minimize the risk of rupture of pulmonary arteriovenous malformations could be an option.

When is it Safe to Use a Supraglottic Airway Device? Advanced Uses for SGA Devices

When is it Safe to Use a Supraglottic Airway Device? Advanced Uses for SGA Devices

Comparison of Ease of Insertion of Supraglottic Airway Devices I-Gel Vs LMA-Proseal in Paediatric Elective Surgeries

Comparison of Ease of Insertion of Supraglottic Airway Devices I-Gel Vs LMA-Proseal in Paediatric Elective Surgeries

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.

No: 7610 Management of difficult airway in a pediatric patient using two endotracheal tubes with a supraglottic airway device and a flexible bronchoscope

No: 7610 Management of difficult airway in a pediatric patient using two endotracheal tubes with a supraglottic airway device and a flexible bronchoscope

A combination of supraglottic airway and bronchial blocker for one-lung ventilation in infants undergoing thoracoscopic surgery

ObjectivesOne-lung ventilation (OLV) for children under the age of two years is difficult. The authors hypothesize that a combination of a supraglottic airway (SGA) device and intraluminal placement of a bronchial blocker (BB) may provide an appropriate choice. DesignA prospective method-comparison study. SettingSecond Affiliated Hospital of Xi'an Jiaotong University, China. Participants120 patients under the age of two years undergoing thoracoscopic surgery with OLV. InterventionsParticipants were randomly assigned to receive intraluminal placement of BB with SGA (n = 60) or extraluminal placement of BB with endotracheal tube (ETT) (n = 60) for OLV. Measurements and main resultsThe primary outcome was the length of postoperative hospitalization stay. The secondary outcomes were the basic parameters of OLV and investigator-defined severe adverse events. The postoperative hospitalization stay was 6 days (interquartile range, IQR 4–9) in SGA plus BB group compared with 9 days (IQR 6–13) in ETT plus BB group (P = 0.034). The placement and positioning duration of SGA plus BB was 64 s (IQR 51–75) compared with 132 s (IQR 117–152) of ETT plus BB (P = 0.001). The values of leukocyte (WBC) and C-reactive protein (CRP) of SGA plus BB group on the first day of post-operation were 9.8 × 109/L (IQR 7.4–14.5) and 15.1 mg/L (IQR 12.5–17.3) compared with 13.6 × 109/L (IQR 10.8–17.1) and 19.6 mg/L (IQR 15.0–23.5) of ETT plus BB group (P = 0.022 and P = 0.014). ConclusionThere were few if any significant adverse events in the intervention group (SGA plus BB) for OLV in children under the age of two years, and this method seems worthy of clinical application. Meanwhile, the mechanism for this novel technique to shorten the length of postoperative hospitalization stay needs to be further explored.

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.

Intramuscular alfaxalone with or without buprenorphine or hydromorphone provides sedation with minimal adverse effects in healthy rabbits (Oryctolagus cuniculus) in a randomized blinded controlled trial.

To evaluate the effects of alfaxalone administered IM with or without buprenorphine or hydromorphone in healthy rabbits (Oryctolagus cuniculus). 24 male rabbits undergoing elective orchiectomy between August 21, 2021, and November 6, 2021. In this controlled clinical trial, rabbits were randomly assigned to receive alfaxalone (4 mg/kg, IM) alone (group A; n = 8) or with buprenorphine (0.03 mg/kg, IM; group BA; 8) or hydromorphone (0.1 mg/kg, IM; group HA; 8). Vital signs and sedation scores were recorded immediately prior to (T0) and 10 minutes after (T1) treatment. Ease of IV catheter placement and pain scores were also evaluated. All rabbits received ketamine (2.5 mg/kg, IV), midazolam (0.13 mg/kg, IV), and meloxicam (0.5 mg/kg, SC) before orchiectomy but after IM treatments. Results were compared across groups with ANOVA or Fisher exact tests and across time with paired t tests. Sedation score, median time to recumbency, and ease of catheter placement did not differ among groups. Supraglottic airway device placement was possible for 1 rabbit in group A, 1 in group BA, and 2 in group HA. Mean respiratory rate at T1 versus T0 was significantly decreased for groups BA (63.8 vs 128.6 breaths/min) and HA (66.7 vs 123.2 breaths/min). Mean postoperative pain scores were significantly lower for rabbits in group HA (0.58), compared with those in groups A (2.25) and BA (2.06). All 3 treatments provided reliable sedation; however, alfaxalone (4 mg/kg, IM) combined with hydromorphone (0.1 mg/kg, IM) may be a better choice for painful procedures.

CODE BLUE in a patient with tracheal stent: Are we fully equipped?

Sir, Airway stents have long been used to maintain luminal integrity of compromised airway in case of obstruction and malignancy.[1] The complications associated with airway stent placement are malposition, haemorrhage, airway rupture during placement, migration, impaction, formation of granulation tissue, and stent fracture.[2] We present here a challenging case of an airway emergency in a patient with a tracheal stent inserted for a malignancy. A 29-year-old woman diagnosed with adenoid cystic carcinoma of trachea 2 years back had undergone debulking of tumor, tracheal stenting with a metallic stent, and chemo-radiotherapy elsewhere. On the second day of admission, CODE BLUE was activated in view of acute onset biphasic stridor, with air hunger and low oxygen saturation. Despite resuscitation measures, the patient had persistent tachycardia, tachypnea, and hypoxia with non-rebreathing mask (15 L/min of O2). A review of Computed Tomography (CT) neck revealed a tracheal narrowing 1.7 cm distal to vocal cords with narrowest diameter of 6 mm [Figure 1a], complicating an imminent intubation for the patient. She was pre-oxygenated with a non-invasive ventilation mask. Intravenous boluses of fentanyl 75 mcg, muscle relaxant (suxamethonium 100 mg) was given and intubated with a 5.0 mm ID cuffed endotracheal (ET) tube through direct laryngoscopy. A chest x-ray confirmed the position of the ET tube but it fell short of bypassing the tracheal stent, which was reflected in decreased tidal volumes and increased peak pressure. As the length of the 5.0 mm ET tube (23 cm) was not enough to bypass the stent, we had to increase the length by rail roading another 6.5 mm ID tube at the distal end, after removing the connector [Figure 1b]. This step significantly improved the tidal volumes (350-400 ml) without much rise in peak pressure with marked improvement in the oxygenation of patient in the blood gas analysis. Patient underwent bronchoscopic biopsy and excision of mass around the stent after putting on veno-venous extracorporeal membrane oxygenation for oxygenation. Post-procedure ET tube was removed after suctioning and intubated with 7.0 mm ID ET tube for postoperative ventilation and eventually extubated.Figure 1: (a) image showing CECT neck with tracheal stent in situ. (b) image showing the proximal end of 6.5 mm ID tube is cut and railroaded over 5.0 mm ID tube to increase the lengthSecuring airway in an in-hospital CODE blue needs quick thinking and swift action. This case highlights a unique situation where a tracheal stent precluded a “conventional intubation.” A tracheostomy could damage the stent and a supraglottic airway device risked aspiration.[3] A fibre-optic bronchoscope is essential and the best available option to ensure correct position of the tube within the stent or just above the stent. It can also avoid stent-related complications but is not readily available everywhere.[4] No formal guidelines are available in terms of airway management with tracheal stents in situ. A literature search also revealed paucity of data with regard to management in similar case scenarios. Microlaryngeal surgery (MLS) tubes can be made available in the CODE BLUE kits anticipating such scenarios, as they are longer than conventional ET tubes with same internal diameter.[5] This case though uncommon highlights the need to incorporate airway management in cases of tracheal stents as part of our teaching curriculum. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation

Introduction While various supraglottic airway devices are available for use during out-of-hospital cardiac arrest (OHCA) resuscitation, comparisons of patient outcomes by device are limited. In this study, we aimed to compare outcomes of OHCA patients who had airway management by emergency medical services (EMS) with the iGel or King-LT. Methods We used the 2018-2021 ESO Data Collaborative public use research datasets for this retrospective study. All patients with non-traumatic OHCA who had iGels or King-LTs inserted by EMS were included. Our primary outcome was survival to discharge to home, and secondary outcomes included first-pass success, return of spontaneous circulation (ROSC), and prehospital rearrest. We examined the association between airway device and each outcome using two-level mixed effects logistic regression with EMS agency as the random effect, adjusted for standard Utstein variables and failed intubation prior to supraglottic airway insertion. Average treatment effects were calculated through propensity score matching. Results A total of 286,192 OHCA patients were screened, resulting in 93,866 patients eligible for inclusion in this analysis. A total of 9,456 transported patients (59.8% iGel) had associated hospital disposition data. Use of the iGel was associated with greater survival to discharge to home (aOR:1.36 [1.06, 1.76]; ATE: 2.2%[+0.5, +3.8]; n = 7,576), first pass airway success (aOR:1.94 [1.79, 2.09]; n = 73,658), and ROSC (aOR:1.19 [1.13, 1.26]; n = 73,207) in comparison to airway management with the King-LT. iGel use was associated with lower odds of experiencing a rearrest (aOR:0.73 [0.67, 0.79]; n = 20,776). Among patients who received a supraglottic device as a primary airway, use of the iGel was not associated with significantly greater survival to discharge to home (aOR:1.26 [0.95, 1.68]). Among patients who received a supraglottic device as a rescue airway following failed intubation, use of the iGel was associated with greater odds of survival to discharge to home (aOR:2.16 [1.15, 4.04]). Conclusion In this dataset, use of the iGel during adult OHCA resuscitation was associated overall with better outcomes compared to use of the King-LT. Subgroup analyses suggested that use of the iGel was associated with greater odds of achieving the primary outcome than the King-LT when used as a rescue device but not when used as the primary airway management device.

The role of supraglottic airway devices in obstetric anaesthesia.

To discuss the role of supraglottic airway devices as rescue and primary airway devices in pregnant patients. General anaesthesia in pregnant patients is associated with increased incidence of difficult and failed intubation, especially when performed for caesarean deliveries. The Difficult Airway Society and the Obstetric Anaesthetists' Association guidelines for the management of failed intubation recommend the use of second-generation supraglottic airway devices as a rescue airway strategy when failed intubation occurs. This practice is now widely accepted and embedded in routine teaching and clinical practice. On the other hand, there is little but growing evidence describing the use of supraglottic airway devices as the primary airway device and an alternative to endotracheal intubation for patients undergoing elective and emergency caesarean deliveries under general anaesthesia. Most of the published research supporting this practice was done on carefully selected patients who were nonobese and who did not have gastroesophageal reflux or anticipated difficult airway. Despite demonstrating high insertion success rates and low complication rates, these studies were underpowered and have thus far, failed to provide robust data on the true risk of aspiration in this setting. Based on current scientific data, the evidence for the safe use of supraglottic airway devices as primary airway devices during general anaesthesia for caesarean deliveries is not compelling. However, their use as rescue airway devices remains a well established strategy supported by international guidelines.

Effect of Intermediate Airway Management on Ventilation Parameters in Simulated Pediatric Out-of-Hospital Cardiac Arrest: Protocol for a Multicenter, Randomized, Crossover Trial.

Most pediatric out-of-hospital cardiac arrests (OHCAs) are caused by hypoxia, which is generally consecutive to respiratory failure. To restore oxygenation, prehospital providers usually first use basic airway management techniques, i.e., bag-valve-mask (BVM) devices. These devices present several drawbacks, most of which could be avoided using supraglottic airway devices. These intermediate airway management (IAM) devices also present significant advantages over tracheal intubation: they are associated with higher success and lower complication rates in the prehospital setting. There are, however, few data regarding the effect of early IAM in pediatric OHCA. This paper details the protocol of a trial designed to evaluate the impact of this airway management strategy on ventilation parameters through a simulated, multicenter, randomized, crossover trial. The hypothesis underlying this study protocol is that early IAM without prior BVM ventilations could improve the ventilation parameters in comparison with the standard approach, which consists in BVM ventilations only.

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.

To Assess the Occurrence and Causes of Sore Throat after Supraglottic Airway Device Use: A Prospective Observational Study

Abstract Introduction: Postoperative sore throat (POST) is one of the most common complaints of patients in the postoperative period who underwent general anesthesia (GA). It can be caused by both supra and infraglottic airway devices. While infraglottic airway devices are well known to be a major cause of POST, it can also be seen in supraglottic airway devices (SGADs). Aim: The aim is to observe for sore throat following insertion of SGAD. Study Design: The study design involves prospective observational study. Study Setting: Justice K. S. Hegde Charitable Hospital, NITTE (DU), Deralakatte, Mangalore, Karnataka, India. Materials and Methods: Out of 105 patients who underwent GA with SGAD, incidence, and severity of POST were assessed at 1st h, 6th h, 12th h, 24th h, and 48th h postoperatively using the scoring system of Harding and McVey. Causes of POST were also determined in this study. The Chi-square test was used for statistical analysis. Results: In this study, overall, 22.9% of POST was found in patients undergoing GA with SGAD, where the severity of POST was mild in 75% and moderate in 25%. Incidence and severity of POST both decreased with time postoperatively. Duration of SGAD in place and type of surgery were the two main causes associated with POST. Conclusion: There was a significant occurrence of POST following SGAD with mild-to-moderate severity. POST usually resolves by itself without the need for any treatment. Knowing the causes priorly may help us in being cautious about POST, and avoid patient discomfort postoperatively.

Comparison of Endotracheal Intubation through ILMA and Baska Mask: A Randomised Clinical Study

Introduction: Since their introduction, Supraglottic Airway Devices (SADs) have established a role in both routine as well as emergency airway management of difficult airways in both children and adults. But anaesthesiologist may need to secure the airway by inserting an Endotracheal Tube (ETT) at any time. Aim: To evaluate success rate of Baska mask and Intubating Laryngeal Mask Airway (ILMA) for ETT insertion through them by conducting a prospective and randomised study. Materials and Methods: The Randomised Clinical Study was conducted in sixty American Society of Anaesthesiologists (ASA) status I-II patients scheduled for elective surgical procedures requiring endotracheal intubation through either Baska mask or ILMA. In both the groups, standard induction and insertion technique of SAD was used. Re-inforced ETT was used in the first attempt and Polyvinyl Chloride (PVC) ETT in the second attempt for intubation through both SADs. The total time for intubation, number of attempts taken to insert the SAD and ETT through it, haemodynamic response and adverse events were studied. Results: Patients in both the groups were comparable demographically with respect to sex, as a status, age and weight. Successful intubation was achieved in 33.3% (n=10/30) on first attempt through Baska mask compared to 86.7% in ILMA (n=26/30) (p=0.001). The overall intubation success rate was also lower with Baska group (56.7%; n=20/30) compared to ILMA (100%; n=30/30) (p&lt;0.001). The haemodynamic parameters during intubation were also significantly higher in the Baska group as compared to the ILMA group. There were no differences in the other secondary outcomes. Conclusion: The first pass and overall success rate of intubation through the Baska mask were inferior to those of ILMA.

AutoFlow® (volume-guaranteed mode) versus volume-controlled ventilation for the laparoscopic surgery with BlockBuster supraglottic airway: A randomized controlled trial

Abstract Background and Aims: Supraglottic airway devices used in laparoscopic surgeries must be efficient to counter the increased peak airway pressure (PAWP) and airway leakage that can occur in laparoscopic surgeries. Hence, the implication of AutoFlow in ventilator strategy is propounded nowadays that facilitates low PAWP and high dynamic compliance to achieve targeted tidal volume and end-tidal carbon dioxide (ETCO2). BlockBuster™ Laryngeal mask furnishing minimum airway leak. The primary objective was to compare PAWP using the two modes of ventilation through the BlockBuster LMA after intubation, pneumoperitoneum, and Trendelenburg position. The secondary objective was to observe hemodynamic vitals. Methodology: In this single-center randomized controlled trial, we recruited 80 American Society of Anesthesiologists grade I and II adult patients undergoing elective laparoscopic surgeries. They were randomized by computer-generated method into two groups: volume-controlled AutoFlow® (VCAF) and volume-controlled (VC) group. Ventilation settings for both groups set to tidal volume 5–6 ml/kg of predicted body weight, positive end-expiratory pressure 5 cm H2O, I: E ratio 1:2, and respiratory rate 12–16/min to maintain targeted ETCO2 of 30–35 cm H2O. Intraabdominal pressure was set to 14 mmHg during pneumoperitoneum and 15° Trendelenburg position. Results: Mann–Whitney U-test for continuous variables and t-test for categorical variables. Data were presented as median (interquartile range). P &lt;0.05 was considered statistically significant. During laparoscopic surgeries with BlockBuster™ PAWP at pneumoperitoneum was (20 cm H2O vs. 27 cm H2O) and Trendelenburg position (19 cm H2O vs. 27 cm H2O) was significant lower with VCAF (AutoFlow® ventilation) than with VC (P &lt; 0.05). Conclusion: PAWP is significantly low in AutoFlow mode as compared to volume control mode with BlockBuster LMA. In addition, LMA BlockBuster provides good sealing pressure.

Content Validation of Questionnaire for Survey on Practice Preferences of Indian Anaesthesiologists in Difficult Intubation and “Cannot Intubate, Cannot Ventilate” Situations (CICV)

Introduction: American Society of Anaesthesiologists (ASA) and Difficult Airway Society (DAS) have provided guidelines on management of difficult intubation and Cannot Intubate, Cannot Ventilate (CICV) situations. There have been many advances in equipment available to anaesthesiologist in difficult airway like Supraglottic Airway Devices (SGA), VideoLaryngoscope (VL) and optical stylet. The knowledge and practice of these guidelines are important for patient safety in difficult airway scenario. Aim: To validate the questionnaire to assess practice preferences in difficult intubation and CICV in Indian anaesthesiologist. Materials and Methods: This questionnaire-based observational survey was carried out between April 2021 to June 2021 at Department of Anaesthesia, DY Patil School of Medicine, Navi Mumbai, Maharashtra, India. Nineteen questions were framed based on the literature related to difficult intubation and CICV practices. This questionnaire sent to 20 experts to grade each question on relevance, clarity, simplicity and ambiguity on a likert scale of 4 as provided in information sheet. Sixteen out of 20 experts responded. Nineteen questions were framed based on the literature related to difficult intubation and CICV practices. The questionnaire was expanded to 22 questions after pilot testing with 10 senior expert anaesthesiologists suggestion of including the question on apneic oxygenation. The collected responses were used to calculate Item-wise Content Validity Index (I-CVI), Scale-wise Content Validity Index (S-CVI) and Modified Kappa Statistics (MKS) in Microsoft excel sheet. Results: S-CVI for relevance, simplicity, clarity and ambiguity was 0.77, 0.77, 0.77 and 0.73, respectively. S-CVI/average or Average Congruency Percentage (ACP) was 0.95, 0.95, 0.95 and 0.94 for relevance, simplicity, clarity and ambiguity, respectively. Question 4, 14, 20, 22 received I-CVI of 0.75 in terms of relevance, clarity, simplicity and ambiguity and modified as per experts instructions. Conclusion: The survey questionnaire developed to assess practice preferences in difficult intubation and CICV fulfilled the content validity criteria both by qualitative and quantitative analyses.

Standard Technique versus Rotational Technique of Insertion of Baska Mask®

Background and Aims: Baska Mask® is a new third-generation supraglottic airway device (SGAD). The placement of Baska Mask® using the standard technique causes posterior displacement of the tongue, leading to incorrect positioning and insertion failure. The rotation technique may alleviate this obstacle during insertion by decreasing resistance between the airway and tongue. The primary objective of this study was to compare the insertion time between the standard versus rotational technique of Baska Mask®, and the secondary outcome measures were ease of insertion, number of attempts and postoperative airway morbidity with both techniques. Methods: One hundred consenting adults of the American Society of Anaesthesiologists I-II, aged 20–65 years of either gender scheduled for a variety of surgical procedures under general anaesthesia in a tertiary care hospital (May 2019 to November 2020), were included in the study. The patients were randomly allocated to Group S and Group R using the standard and rotation techniques, respectively. All statistical analyses were done using the SPSS (Statistical Package for the Social Sciences) software. The comparison of quantitative variables between the study groups was done using the Student's t-test and Mann–Whitney test. For comparing categorical data, the Chi-square χ 2 test was performed. Results: The mean insertion time was significantly higher with the standard compared to the rotation technique of Baska Mask (20.90 ± 3.13 vs. 14.84 ± 1.11 s, P = 0.000). Device insertion was easy in rotation compared to the standard technique (P = 0.031). The number of attempts required for insertion was more with the standard technique than with the rotation technique (P = 0.011). Conclusion: Although the standard technique of Baska Mask® remains the first choice, the rotational technique of Baska Mask® has a higher success of insertion with fewer complications than the standard technique; hence, it can be accepted as an alternative.

Clinical Performance of I-gel versus Ambu AuraGain in Paediatric Patients undergoing General Anaesthesia: A Randomised Clinical Study

Introduction: Newer second-generation Supraglottic Airway Devices (SADs) are easy to insert and provide a smooth induction of anaesthesia with minimal haemodynamic pressor response. The paediatric I-gel and Ambu AuraGain are newer SADs that are increasingly being used as alternatives to endotracheal intubation in the paediatric population. Aim: To compare the clinical performance of I-gel and Ambu AuraGain in children undergoing general anaesthesia with respect to ease of insertion, haemodynamic changes, and the frequency and severity of postoperative sore throat. Materials and Methods: This randomised clinical study included 100 children aged 2 to 10 years, belonging to American Society of Anaesthesiologists (ASA) Grade I and II, scheduled for elective surgery under general anaesthesia. They were randomly allocated to Group I (I-gel) and Group A (Ambu AuraGain), comprising 50 patients each. The time taken for SAD placement, the number of attempts, ease of insertion, and the requirement of additional airway manipulations during insertion were observed. Haemodynamic Parameters Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), SpO2 , and End-tidal Carbon Dioxide [ (EtCO2 ) ]) during the procedure were observed. The frequency and severity of postoperative sore throat were assessed between both groups. Descriptive statistics were applied to all data and reported in terms of mean, Standard Deviation (SD), and percentages, and appropriate statistical tests of comparison were applied. Results: In this study, the demographic data of patients, such as age, weight, gender, and ASA status, were comparable in both groups. There was no statistically significant difference in the time taken for successful SAD placement and the number of attempts required to do the same. Ambu AuraGain was easier to insert than I-gel (p-value&lt;0.05). I-gel required a significantly higher number of additional airway manipulations during insertion compared to Ambu AuraGain (20% in Group I versus 4% in Group A). Haemodynamic parameters were comparable between both groups at all time intervals. The frequency and severity of postoperative sore throat were statistically non significant between I-gel and Ambu AuraGain. Conclusion: Both the I-gel and Ambu AuraGain are reliable and safe devices for maintaining an adequate airway in paediatric patients. However, Ambu AuraGain was easier to insert and required fewer airway manipulations than I-gel during insertion, making it a favourable choice.