Supraglottic Device Insertion Research Articles

Tissue displacement assessment by ultrasound predicts peri-laryngeal leak after supraglottic device insertion (I-gel)

Background and aims Supraglottic airway devices (SADs) have revolutionized airway management during general anesthesia, and they fill the niche between the face mask and endotracheal tube in terms of both airway anatomy and degree of invasion. The aim of this study was assessment of peri-laryngeal leak after insertion of I- gel using ultrasound (US) pulse Doppler mode. Methods Hundred patients scheduled for elective surgery after I-gel placement were recruited. Airway leak pressure was detected by using closed circuit in anesthesia workstation and increasing the pressure to 20 mm Hg. Parameters were noted include, leak as observed in the monitor, leak as assessed using the US machine, fiberoptic visualization of the SAD and grading and end tidal CO2 (ETCO2). Results In ultrasound we have detected peri-laryngeal tissue displacement in 18 patients (18%) out of which 10 patients have grade 3 or 4 on fiberoptic examination (Fig. 2). Among these ten patients, eight patients have inadequate ventilation required reinsertion of I-gel. Conclusion Tissue displacement assessment by ultrasound can be used as a noninvasive alternative to predict leak following supraglottic device insertion (I-gel) placement with the added advantage of no interruption of ventilation.

The Impact of Implementing the Vortex Approach on Airway Management Performance in Stressed Medical Students: A Randomized Controlled Simulation Study.

BACKGROUND The ability to manage airways in emergencies is paramount, especially for less experienced medical students. Although the Vortex Approach, a useful scheme to support decision-making during airway management, promises structured guidance, there's limited research on its benefits among students. Our study aimed to evaluate student proficiency in a simulated difficult airway scenario and assess the advantages of the Vortex Approach. MATERIAL AND METHODS Medical students initially practiced on low-fidelity mannequins. Subsequently, they were divided into Vortex (n=48) and control groups (n=48). The Vortex group received specialized training. Both groups encountered a simulated scenario focusing on proper ventilation and supraglottic device insertion when traditional intubation failed. Performance was assessed using the airway management outcome score (AMOS). RESULTS The Vortex-trained group demonstrated superior capabilities. Fewer participants exceeded 3 lifeline interventions (4.2% vs 16.7%, P=0.046). The Vortex group consistently optimized subsequent attempts (31.3% vs 10.4%, P=0.01) and reduced prolonged apnea episodes (47.9% vs 81.3%, P=0.0009). Their AMOS scores were notably higher (56.3% vs 27.1%, AMOS=2, P=0.002), reflecting better patient outcomes (41.7% vs 10.4%, P=0.0005). CONCLUSIONS There is a marked need to enhance airway management skills among senior medical students. The Vortex Approach, even after brief exposure, yields significant skill improvements, underscoring its potential as a pivotal component in medical training. Integrating it into the curriculum could bridge the evident skill gap, optimizing future patient care.

Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies.

To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir's subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

Deep sedation using propofol target-controlled infusion for gastrointestinal endoscopic procedures: a retrospective cohort study

BackgroundPropofol sedation is effective for gastrointestinal endoscopic procedures, but its narrow therapeutic window highlights the importance of identifying an optimal administration technique regarding effectiveness and safety. This study aimed to determine the incidence of significant adverse events in adult patients scheduled for gastrointestinal endoscopy under anaesthetist-performed sedation using propofol target-controlled infusion and determine the existence of associations between these events and potentially related variables.MethodsThis single-centre, retrospective cohort study took place in a tertiary referral university hospital. Medical records of 823 patients (age > 18 years, American Society of Anesthesiologists physical status classification scores I–III) who had undergone elective gastrointestinal endoscopy under propofol target-controlled infusion sedation during September 2018 were reviewed. Outcomes included hypoxia, hypotension, and bradycardia events, requirement of vasoactive drugs, unplanned tracheal intubation or supraglottic device insertion, and need for advanced cardiac life support.ResultsThe most frequently encountered adverse event was oxygen desaturation < 95% with an incidence of 22.35%. Vasoactive drug administration, hypotension, and oxygen desaturation < 90% followed, with incidences of 19.2, 12.64, and 9.92%, respectively. Only 0.5% of patients required advanced airway management. Multivariate analysis revealed an association between hypotension events, colonoscopic procedures, and propofol doses (odds ratio: 3.08, 95% confidence interval: 1.43 to 6.61; P = 0.004 and odds ratio: 1.14, 95% confidence interval: 1.00 to 1.29; P = 0.046). A strong dose-effect relationship was found between hypoxia and obesity; patients with body mass index ≥40 were nine times (odds ratio: 10.22, 95% confidence interval: 2.83 to 36.99) more likely to experience oxygen desaturation < 90% events.ConclusionsPropofol sedation using target-controlled infusion appears to be a safe and effective anaesthetic technique for gastrointestinal endoscopic procedures with acceptable rates of adverse events and could be more widely adopted in clinical practice.

Low skill fibreoptic intubation using i-gel™ and air-Q™ in simulated difficult airways: A randomised study in manikin and in patients

Background:Fibreoptic intubation via a supraglottic device (SAD) is ‘low skill fibreoptic intubation’ (LSFOI). ‘Standard’ second generation SADs (i-gelTM) have a gastric port. ‘Specialised’ second generation SADs (air-QTM) are designed to facilitate LSFOI and have wider ventilation ports. Our hypothesis was that performance of LSFOI differs between i-gelTMand air-QTMin a manikin with a simulated difficult airway.Methods:Our primary outcome was fibreoptic intubation success rate. Our secondary outcomes included SAD insertion and LSFOI times. A difficult airway was simulated by applying a hard cervical collar to a manikin. Anaesthetists performed LSFOI serially using both SADs in a random sequence. In the manikin study, 80 anaesthetists were recruited. To test the robustness of the conclusion from our manikin study, we repeated the study in 22 anaesthetised patients. Patients were fitted with the same cervical collar and randomly allocated to either devices. We used McNemar’s statistical test to analyse our primary outcome of successful intubations and paired nominal data. A Wilcoxon signed-ranks test was used to analyse nonparametric paired data and a Mann–Whitney U test was used for unpaired data analysis where appropriate. A p-value of &lt;0.05 was considered statistically significant.Results:In the manikin study, the i-gelTMwas superior to the air-QTMfor successful tracheal intubation (98.8% vs 83.8%, respectively; p=0.002) and LSFOI times (34.0 s vs 36.0 s, respectively; p=0.012). In the patient study, LSFOI success rates were not significantly different between i-gelTMand air-QTM(100% vs 91.6%, respectively; p=0.545) but intubation times were shorter (52.5 s vs 60.0 s, respectively; p=0.036).Conclusion:In conclusion, we obtained LSFOI success rates for the i-gelTMor air-QTMof 98.8% and 83.8% respectively in a manikin; and 100% and 91.6% respectively in patients. It is in fact ‘low skill’ as many participants were successful despite no prior experience with LSFOI. The i-gelTMis superior for LSFOI compared with the air-QTM. This is despite being a ‘standard’ second generation SAD as compared to a ‘specialised’ second generation SAD (air-QTM).Trial Registration:The manikin and patient studies were conducted after being approved by the SingHealth Centralised Institutional Review Board (CRB reference number 2014/2039 and 2016/2069, respectively). The patient study was registered at ClinicalTrials.gov (ID: NCT02663843).

Airway management in morbidly obese with cervical instability using awake insertion of supra glottic device and Aintree intubation catheter

We report airway management of a morbidly obese with possible difficult mask ventilation and previous cervical fixation, posted for bariatric surgery under general anesthesia. We achieved insertion of the supra glottic device (SGD ) under conscious sedation. Endotracheal intubation was further facilitated using Aintree intubation catheter (AIC) and flexible endoscope assisted intubation via the SGD. Consent from the patient and the IEC approval was obtained prior topublication. We reviewed evidence-based anaesthetic concerns and described our airway management. Our aim was to maintaining continuous oxygenation and achieve a secure airway with minimal neck move-ment. This further guides anesthesia practitioners caring for the obese patients withanticipated difficulty in mask ventilation and additionalrisks and need for continuous oxygenation. Keywords: Obese, bariatric, difficult airway, mask ventilation, BMI, neck circumference, Aintree, Cervical instability

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

Abstract PR417

Background & Objectives: Gastric volumes of more than 0.4 ml/kg at induction of general anaesthesia is associated with increased risk of pulmonary aspiration. Prevention of pulmonary aspiration is one of the important aspects of safe anaesthetic practices and several measures have been proposed to reduce this risk. This prospective randomised double blind, placebo controlled trial was carried out to compare the effects of metoclopramide, octreotide and placebo on gastric volume when given as premedication prior to induction of anaesthesia. Materials & Methods: Forty five ASA I or II patients scheduled for elective surgery under general anaesthesia were randomly allocated into three groups. Group 1 received 50 ml of intravenous(IV) normal saline (placebo), Group 2 received 10 mg IV metoclopramide diluted in 50 ml saline, and Group 3 received 50 µg IV octreotide diluted in 50 ml saline. All study drugs were infused 30 minutes prior to induction of general anaesthesia. After endotracheal intubation or insertion of supraglottic device, a nasogastric tube size 14G was inserted into the stomach for collection of gastric content. Gastric volumes, blood sugar levels pre and post drug administration as well as the side effects of the studied drugs were recorded. Results: Metoclopramide decreased gastric volume significantly (p < 0.05; 95% CI for median difference: 1.1 – 6.7 ml) compared with both octreotide and saline. Octreotide however did not significantly alter gastric volume (p > 0.05; 95% CI for median difference: 5 – 32 ml) compared with placebo (saline). Mean sugar level was raised from 5.52 to 6.53 after octreotide administration, (p < 0.05). One patient experienced mild abdominal cramps with administration of octreotide. There was no incident of pre-induction nausea, vomiting or adverse drug reactions. Conclusion: Metoclopramide is found to be effective in reducing gastric volume, as compared to octreotide and placebo when given as premedication prior to general anaesthesia. There is no difference between placebo and 50 µg octreotide in reducing gastric volume in these patients.