Time For Successful Insertion Research Articles

Clinical Performance of I-gel® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison.

Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.

Comparison of insertion characteristics of LMA ProSeal and Ambu AuraGain in adult patients under controlled ventilation: A randomised study.

Supraglottic devices are preformed or flexible, and the insertion characteristics of the two types may be different. This study aims to compare the insertion characteristics of Ambu AuraGain (AAG), preformed) and LMA ProSeal (PLMA), flexible, requires an introducer tool for placement. Forty American Society of Anesthesiologists (ASA) physical status I/II patients of either sex between 18 and 60 years with no anticipated airway difficulty were randomly allocated to either group AAG or PLMA (n = 20 each). Pregnant females, known case of chronic respiratory disorders and gastroesophageal reflux were excluded. After induction of anaesthesia and muscle relaxation, appropriately sized AAG or PLMA was inserted. Time for successful insertion (primary outcome), ease of device insertion and gastric drain insertion, first attempt success rate (secondary outcomes) were recorded. Statistical analysis was done using SPSS version 20.0. Quantitative parameters were compared using Student's t-test, and qualitative parameters were compared using Chi-square test. A P value of <0.05 was considered significant. Time taken for successful insertion of PLMA was 22.94 ± 6.12 s and for AAG was 24.32 ± 4.96 s, (P = 0.458). Device insertion was significantly easy in PLMA group (P < 0.002). First attempt success rate was achieved in 17 (94.4%) cases in PLMA group compared to 15 (78.9%) cases in AAG group (P = 0.168). Ease of drain tube insertion was comparable among the groups (P = 0.298). The haemodynamic variables were also comparable. PLMA is easier to insert as compared to AAG, but the insertion time and first attempt success rate are similar. The preformed curvature in AAG does not provide any added advantage over the non-preformed PLMA.

Clinical utility of i-gel® and BlockBuster™ supraglottic devices for airway management in postburn injury contracture neck patients under general anesthesia: A randomized controlled trial.

Post burn injury contracture (PBC) neck patients pose a unique challenge for the anesthesiologists. The use of supraglottic device (SGDs) for managing such patients is being increasingly used. We compared i-gel® and LMA BlockBuster™ in PBC adult patients under general anesthesia (GA). The study included 63 subjects with mild/moderate PBC neck of either sex with American Society of Anesthesiologists Physical Status I and II under GA. Patients with intraoral pathology, mouth opening <2.5 cm, and severe contracture were excluded. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups. The primary objective of the study was the time for successful insertion. First attempt success rate, oropharyngeal leak pressures (OLP), and complications were also assessed. Mean insertion time was significantly less in Group I as compared to Group B (17.35 ± 1.43 vs. 21.32 ± 1.10 s; P < 0.001), OLP in Group B was significantly higher as compared to Group I (34.03 ± 1.33 vs. 25.23 ± 3.04 cm of H2O; P < 0.001). Group I was found to be statistically easier to insert as compared to Group B (P = 0.011) with reduced requirement of airway maneuvering to insert the device (P = 0.017). Groups were similar in terms of complications. SGDs are attractive option for airway management in mild/moderate degree of PBC neck. i-gel® having shorter insertion time with easier insertion can be favorable at times of emergency while use of LMA BlockBuster™ can be preferred to reduce the risk of aspiration owing to higher OLP.

Evaluation of the New SingularityTM Air versus Ambu® Aura GainTM: A Randomized, Crossover Mannequin Study.

Background: This randomised crossover mannequin study aimed to compare the insertion time for the newly developed SingularityTM Air and the Ambu® AuraGainTM. The SingularityTM Air includes a bendable tube in order to allow optimal passform. Methods: Fifty anaesthetists with a minimum of 100 supraglottic airway device insertions were recruited and randomly assigned to start either with the SingularityTM Air or with the Ambu® AuraGainTM. Participants watched a tutorial video the day before the assessment and received a standardized introduction immediately before the assessment. The primary outcome was the time for successful insertion. Secondary parameters were the overall insertion success rate, the numbers of insertion attempts (maximum three), the glottic view through a flexible bronchoscope, and the success rate for gastric tube insertion. Results: Fifty participants were eventually recruited and randomly assigned to insert both devices according to the randomization. The insertion time was 24 s for SingularityTM Air as compared to 20 s for Ambu® AuraGainTM (p < 0.001). Overall insertion rate was 92% for the SingularityTM Air as compared to 100% for the Ambu® AuraGainTM (p could not be derived as one variable is a constant). The primary insertion success rate was better for the Ambu® AuraGainTM than for the SingularityTM Air (94% versus 68%; p: 0.002, respectively). Conclusion: The time for successful insertion and the insertion success rate for the newly developed SingularityTM Air is inferior to that for the Ambu® AuraGainTM.

Time to ventilation and success rate of airway devices in microgravity: A randomized crossover manikin-trial using an underwater setting.

Medical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity. In this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant free-floating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt. A total of 20 participants performed placement of each device in both gravity conditions in an Airway mannequin. The fastest time to initial ventilation in simulated microgravity was possible with the laryngeal tube (18.9±8seconds) followed by laryngeal mask (20.1±9seconds). The I-gel® supraglottic airway device required substantially more time for successful insertion in simulated microgravity (35.4±25seconds) as did endotracheal tube intubation by direct laryngoscopy (70.4±35seconds). Simulated microgravity conditions prolonged time to initial ventilation by 3.3seconds (LM), 3.9seconds (LT), 19.9seconds (I-gel) and 43.1seconds (endotracheal intubation, ETI) when compared to poolside attempts in normogravity. In simulated microgravity conditions, use of the laryngeal tube or laryngeal mask provided the quickest time to initial ventilation, without deliberate tethering of the mannequin and rescuer to a fixed surface. Endotracheal intubation required significantly longer procedure times and, thus, was considered insufficient for clinical use in microgravity.

Comparative evaluation of Air-Q blocker and Proseal laryngeal mask airway in patients undergoing elective surgery under general anaesthesia: A randomised controlled trial.

Background and Aims:The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic airway device (SAD) with capability to serve as a conduit for intubation. As there is limited data on Air-Q blocker, the present study was performed to compare the efficacy of Air-Q blocker and Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery.Methods:A total of 90 American Society of Anesthesiologists (ASA) physical status I and II patients were randomly allocated to Air-Q blocker or PLMA group. Oropharyngeal leak pressure (OLP), insertion success, insertion time, ease of orogastric tube (OGT) insertion, fibreoptic visualisation of the glottis, haemodynamic and ventilation parameters, and complications at emergence and postoperatively were investigated.Results:OLPs were higher in PLMA group as compared to Air-Q blocker group (P = 0.002). Still, the OLP (27.5 ± 5.8 cm H2O) was clinically effective in Air-Q blocker group. The mean time for successful insertion was significantly shorter for Air-Q blocker than PLMA (P = 0.019). The number of attempts to insert both the devices was comparable (P ≥ 0.05). Air-Q blocker provided a significantly better fibreoptic score than PLMA (P = 0.038). The two groups were comparable in terms of ease of OGT insertion, haemodynamics and ventilation parameters, and complications at emergence and postoperatively.Conclusions:Air-Q blocker provides a clinically effective OLP though PLMA provides a slightly better sealing function in patients undergoing laparoscopic and non-laparoscopic surgeries under general anaesthesia requiring neuromuscular blockade. Air-Q blocker has shorter insertion time and a better fibreoptic view of glottis as compared to PLMA.

Comparison of Fiberoptic-Guided Tracheal Intubation Through Intubating Laryngeal Mask Airway (ILMA) FastrachTM and Ambu® Aura-i™: A Randomized Clinical Study.

Background and aimThe primary aim of the study was to compare the intubation characteristics and effectiveness of intubating laryngeal mask airway (ILMA) and Ambu® Aura-i™ as a conduit for facilitating fiberoptic-guided intubation.MethodsEighty patients were enrolled in the randomized-controlled hospital-based study. After inducing general anesthesia, an appropriately sized ILMA (group 1)/Ambu Aura-I (group 2) was placed. Fiberoptic assessment of the glottic view was done followed by fiberoptic-guided tracheal intubation. The time taken for the insertion of ILMA/Ambu Aura-i, glottic view grading, time taken for fiberoptic-guided intubation, ease of intubation, time taken for the removal of ILMA/Ambu Aura-i were recorded. Data analysis was done using the two-tailed independent t-test, paired t-test, and Fisher’s exact probability test.ResultAnthropometric and airway parameters were similar in both groups. The success rate of the insertion of both devices was 100%. In group 1, the mean time taken for the insertion was 20.53±1.91, and it was 13.98±2.4 in group 2 (P<0.001S). Fiberoptic assessment of the glottic view in group 1 (ILMA group) was grade 1 in 80% of the patients, whereas it was 92% in group 2 (Ambu Aura-i) (P=0.54). The mean time taken for fiberoptic-guided intubation was 14.95±1.85 in group 1 and 14.15±1.37 in group 2 (P>0.001). No significant difference was observed according to the number of attempts in intubating through ILMA/Ambu Aura-i. Seventy-five percent (75%) in group 1 and 87.5% in group 2 were successfully inserted on the first attempt (𝑝 = 0.33). The time taken for the removal of the device was 11.87 +1.265 seconds in group 1 and 11.25±1.58 seconds in group 2 (P=0.054).ConclusionThe Ambu Aura-i scores superiorly over ILMA in requiring less time for successful insertion on the basis of statistical analysis and hence appears to be a better independent ventilatory device.

Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

BackgroundPrehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations. MethodsThis prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded. ResultsDifferences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better. ConclusionConsidering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial

BackgroundAlthough many techniques have been introduced to facilitate nasogastric tube (NGT) insertion using anatomic landmarks and a group of devices, there is a lack of general consensus regarding a standard method. The current study purposed to investigate if SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) increases the success rate of NGT correct placement versus neck flexion lateral pressure (NFLP) method.MethodsA randomized controlled trial study was conducted in two university affiliated intensive care units (tertiary referral center). Three hundred and ninety-six critically ill patients older than 18 years of age were randomly divided into SORT (n = 200) and NFLP (n = 196) groups. The technique was classified as “failed” after the third unsuccessful attempt. Patient characteristics, success rate for the first attempt, time required for the successful first attempt and overall successful insertion time, various complications including kinking, coiling and bleeding and ease of insertion were noted as main outcomes measured.ResultsEase of insertion was significantly better in the SORT group compared to the NFLP group (P < 0.001). The number of failed attempts was significantly higher in the NFLP group (7.5%) vs the SORT group (3.0%) (P = 0.046). The pattern of complications was not different between two study groups (P = 0.242). The odds of stage II (odds ratio (OR) = 49.9; 95% confidence interval (CI) 25.2 to 98.6), stage III (OR = 67.1; 95% CI 14.9 to 302.8)) and stage IV (OR = 11.8; 95% CI 3.4 to 41.2) ease of insertion were much higher in NFLP compared to SORT group, after adjusting for age and body mass index (BMI). The odds of failure was not significantly different in NFLP group compared to SORT group (OR = 2.3; 95% CI 0.85 to 6.3), after adjusting for age and BMI.ConclusionsSORT technique may be considered as a promising method for successful NGT insertions in critically ill patients. However, more trials are needed to confirm the results of this study. The decision must account for individual patient and clinical factors and the operator’s experience and preference.Trial registration: The study was registered at government registry of clinical trials in Iran (http://www.IRCT.ir) (number: IRCT20091012002582N18, 13 March 2018)

Comparison of the standard and triple airway maneuvering techniques for i-gel™ placement in patients undergoing elective surgery: a randomized controlled study.

The i-gel is a supraglottic airway device with non-inflatable cuff which can suffer insertion failure if its standard placement technique is implemented. The aim of this study was to compare the placement technique proposed by the manufacturer of i-gel with the triple airway maneuver in terms of successful device insertion time and first-attempt success. After ethics committee approval, 103 ASA I-III patients were randomly allocated to the standard or triple airway maneuver groups. In the standard Group, the i-gel was inserted in the sniffing position while, in the triple group, it was inserted using the triple airway maneuver consisting of head tilt, jaw thrust, and open mouth. The time taken for successful insertion, first-attempt success rate, i-gel position, airway complications, and hemodynamic responses were assessed. Between the two groups patient characteristics were similar. Time for successful insertion was significantly shorter in the triple group (20 ± 7s) than with the standard technique (32 ± 11s; p < 0.001). Successful insertion at the first attempt was 78% and 92% for the standard and triple group, respectively (p = 0.092). The i-gel position, airway complications, and hemodynamic responses were similar in both groups. The triple airway maneuver required less i-gel insertion time as compared with the standard placement technique. First-attempt success rates were similar with both techniques, although the triple airway maneuver was superior to the standard method as a rescue technique in failed insertions. We therefore recommend use of the triple airway maneuver in i-gel insertion.

Impact of visually guided versus blind techniques of insertion on the incidence of malposition of Ambu® AuraGain™ in paediatric patients undergoing day care surgeries: A prospective, randomised trial.

Background and Aims:In adults, video laryngoscopy is recommended for supraglottic airway device (SGAD) placement as it results in better device position and higher oropharyngeal leak pressures. In children, there is a paucity of studies evaluating the impact of visually guided techniques on SGAD placement. Aim of the study was to evaluate the usefulness of visual-guided techniques of SGAD placement in children.Methods:Totally, 75 children, scheduled for elective surgery, were randomly allocated into three groups, that is, standard (S), direct laryngoscopy (DL), and video laryngoscopy (VL). Ambu AuraGain was placed blindly in group S, and under visual guidance with video laryngoscopy and direct laryngoscopy in groups VL and DL, respectively. Ambu AuraGain position was determined by flexible videoendoscope. First attempt success rate, time for successful insertion, oropharyngeal leak and any complications were studied.Results:Incidence of malposition was not significantly different in group S (44%), DL (48%), and VL (64%); P = 0.32. The first attempt success rate was 100% in DL and 92% each in S and VL. Time to insert (seconds) was significantly higher in VL (37.9 ± 21.6), compared to S (18.4 ± 7.9) and DL (27.4 ± 14.5); P <0.001. Incidence of oropharyngeal leak, impact on ventilation, and complications were similar in all three groups.Conclusion:In this study, there was no advantage of visually guided techniques for Ambu AuraGain placement in children.

Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial

BackgroundThe insertion of a laryngeal mask airway (LMA) is difficult in children due to the unique features of their airways. Muscle relaxants have been reported to facilitate LMA insertion in adults; however, there is a lack of evidence supporting this in children. This trial is designed to assess the feasibility of LMA insertion with and without the use of muscle relaxants in pediatric patients under general anesthesia.Methods/designThis is a prospective, double-blind, single-center, parallel-arm, non-inferiority, randomized controlled trial to be conducted with participants aged 2–7 years who are undergoing elective ophthalmic surgery under general anesthesia. Participants are randomly assigned to one of two groups based on whether muscle relaxants are used (MR group, n = 64) or not used (Saline group, n = 64) prior to LMA insertion. The primary outcome is the oropharyngeal leak pressure (OLP) at a fixed gas flow of 3 L/min. The secondary outcomes are intubation time for successful insertion, ease of insertion and mask bagging, intubation attempt for successful insertion, successful insertion rate on the first attempt, fiberoptic view of the LMA position, postoperative complications, and changes in hemodynamic and ventilatory parameters.DiscussionWe will compare the OLPs to determine whether the muscle relaxant provides better conditions for the manipulation of the LMA. This is the first randomized controlled trial to investigate whether muscle relaxants are beneficial to the clinical performance of LMA insertion in pediatric patients under general anesthesia. This trial will be a resource for improving the process and safety of pediatric LMA insertion under general anesthesia.Trial registrationClinicalTrials.gov, NCT03487003. Registered on 18 April 2018.

Does prewarming of i-gel improve insertion and ventilation in anaesthetised and paralysed patients? A prospective, randomised, control trial.

Context:I-gel are supraglottic airway devices with non-inflatable gel-like cuff that is believed to mould to body temperature, to seal the airway. Hence a pre-warmed i-gel may seal faster, provide better ventilation and superior leak pressure.Aims:To determine if pre-warming i-gel to 40°C improves insertion and efficacy of ventilation.Methods and Materials:A prospective, randomised, controlled trial was done on 64 patients requiring anaesthesia with muscle relaxation for short duration. For those in group W, i-gel warmed to 40°C for 15 minutes before insertion was used, whereas for those in group C, i-gel kept at room temperature (approximately 23°C) was used. The airway sealing pressure over time, number of attempts and time taken for a successful insertion were noted.Statistical Analysis:Mean sealing pressure between two groups was compared using independent sample t-test. Repeated Measures ANOVA was used to analyse mean sealing pressure at 0, 15 and 30 min. P value ≤0.05 was considered statistically significant.Results:Sealing pressure improves over time in both the groups but the mean sealing pressure was higher in group C when compared to group W at all points of time, however this was clinically and statistically insignificant. Ease of insertion, time for successful insertion, insertion attempts, intra-operative manoeuvres were all comparable between the groups with no adverse effects.Conclusions:Pre-warming of i-gel to 40°C does not improve the success rate of insertion or provide a higher sealing pressure in anaesthetised and paralysed patients when compared to i-gel at room temperature.

Proseal Laryngeal Mask Airway versus Endotracheal Intubation for Laparoscopic Surgery: A Randomized Controlled Study

Context: Proseal LMA (laryngeal mask airway) is an useful modification of the classical LMA, which provides better hemodynamic stability and protection against intra operative as well as postoperative complications when used in laparoscopic procedures. Aims: To compare the efficacy of Proseal laryngeal mask airway (LMA) and endotracheal tube (ETT) in patients posted for laparoscopic surgery under general anaesthesia Settings and Design: This prospective randomized comparative study conducted in collaboration with a tertiary care level hospital. study was conducted on 100 ASA I-II class patients posted for laparoscopic surgery under general anaesthesia Methods and Material: A total of 100 patients posted for various laparoscopic surgeries were allocated into 2 groups of 50 each. After preoxygenation and induction, Proseal LMA was inserted in group A patients and patients in group B were intubated with ETT. Attempts for successful insertion, time taken for successful insertion, hemodynamic variations at various events and protection provided against both intra operative and postoperative complications were studied Statistical analysis used: Qualitative data was analysed using chi-square test or Fischer analysis and quantitative data analysed using paired or unpaired t test. Results: First attempt insertion success rate was 84% for PLMA insertion as compared to 76% for endotracheal intubation, Time for successful insertion was 15.54 sec in PLMA group and 20.20 sec in ETT group. Mean heart rate changes during PLMA insertion and removal were 5.52 and 7.10 respectively, and 9.56 and 11.46 at the same events with ETT. Mean systolic blood pressure changes during PLMA insertion and removal were 3.76 and 3.92 respectively and 13.92 and 23.20 at same events with ETT. No events of gastric regurgitation or pulmonary aspiration observed in both groups. PLMA provided better protection against postoperative complications like cough (6%) and sore throat (6%) as compared to ETT with 44% and 24% incidence respectively. Conclusions: Proseal LMA can be considered as a safe and effective alternative to endotracheal intubation in patients undergoing various laparoscopic procedures under general anesthesia. Key words: Proseal LMA, endotracheal tube, hemodynamic stability, pulmonary aspiration

Effects of domestic wire-reinforced epidural catheter on complications related to anesthesia during labor analgesia

Objective To evaluate the effects of the domestic wire-reinforced epidural catheter on complications related to anesthesia during labor analgesia. Methods A total of 2 407 parturients, aged 18-40 yr, weighing 50-100 kg, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, scheduled for elective operations under combined spinal-epidural anesthesia for labor analgesia, were divided into 2 groups using a random number table: common epidural catheter group(group Ⅰ, n=1 203)and wire-reinforced epidural catheter group(group Ⅱ, n=1 204). After successful epidural puncture, the appropriate amount of local anesthetics was injected into the subarachnoid space, and the corresponding epidural catheter was then inserted, and the depth was 3 cm.Paresthesia during catheterization, unexpected catheter displacement, difficult extubation, catheter bending, epidural bleeding, successful insertion at first attempt, successful insertion time, the number of successfully delivered doses and consumption of patient-controlled analgesia solution were recorded.The patients were followed up after operation for nerve damage. Results Compared with group Ⅰ, the incidence of paresthesia during catheterization, unexpected catheter displacement and catheter bending was significantly decreased, the occurrence of epidural bleeding was reduced, the success rate of insertion at first attempt was increased, successful insertion time was shortened, the incidence of difficult extubation was increased(P 0.05). Conclusion Complications related to anesthesia are reduced when the domestic wire-reinforced epidural catheter is used for labor analgesia. Key words: Catheterization; Anesthesia, epidural; Intraoperative complications.

本邦における医師・救急救命士・看護師の骨髄内輸液路確保手技の比較(Comparison of intraosseous routes insertion between doctors, EMTs, and nurses in Japan: training course using chicken bones)

要旨【目的】骨髄内輸液路（以下，骨髄路）確保は，小児の心停止や重症患者に対して有用であるが，本邦で施行可能な職種は医師のみである。医師，救急救命士（以下，救命士），看護師の職種ごとの骨髄路確保成功率と手技時間を比較検討した。【方法】用手で行う骨髄針（以下，MAN–IO）と，電動式骨髄穿刺キット（以下，EZ–IO）を用いて，各挿入方法ビデオを閲覧後，鶏肉の大腿骨に挿入した。外傷コース受講生291名の全手技をビデオで撮影し，成功率，施行時間を測定した。【結果】248名が解析対象となった。成功率は職種間で有意差を認めなかった（MAN–IO 1回目：医師60.9% vs. 救命士68.1% vs. 看護師61.1%，p=0.53；EZ–IO 1回目：医師80.4% vs. 救命士78.7% vs. 看護師75.9%，p=0.80）。成功時の穿刺時間も職種間で有意差を認めなかった（MAN–IO：医師12.5s vs. 救命士11.5s vs. 看護師13.4s，p=0.49；EZ–IO：医師5.34s vs. 救命士5.25s vs. 看護師4.84s，p=0.58）。【結語】救命士や看護師も，医師と同等に骨髄路確保ができることが示された。本邦の救命士の輸液路確保手技として，骨髄路確保は有用と考えられる。

Comparison of I-gel with Baska Mask Airway for Controlled Ventilation in Obese Patients Undergoing Ambulatory Surgery: A Prospective Randomized Trial

The ideal supraglottic airway device must have high airway seal pressures during spontaneous and positive pressure ventilation also low resistance to the flow of gases. This study compared the utility of I-Gel with Baska Mask during general anesthesia in obese patients undergoing elective ambulatory surgeries. The study was conducted on sixty obese patients with body mass index (BMI) of ≥ 25 and ≤ 40 kg.m2, ASA I, II, III, 18-60 years old of either sex scheduled for short duration (<3 hr). I-gel was successfully inserted in 25 patients on the first attempt and in 2 patients on the second attempt (overall success rate = 90%). Baska mask was successfully inserted in 27 patients on the first attempt and in 2 patients on the second attempt (overall success rate = 96.97%). Successful insertion time was significantly shorter in the I-gel group. Oropharyngeal sealing pressure (OSP) was significantly higher following Baska mask insertion. Intra- and postoperative airway morbidity rates were not significantly different between both groups. So Concluded that both I-gel and Baska mask are suitable for ventilation in obese patients, but Baska mask gave a better laryngeal seal.

Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients

BackgroundNasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. ResultsSuccess rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. ConclusionUse of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Comparison of three different insertion techniques with LMA-Unique™ in adults: results of a randomized trial

BackgroundThe triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-Unique™. MethodsOne hundred and eighty ASA I–II patients aged 18–65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n=60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n=60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n=60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. ResultsSuccessful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5–19]s) compared with the standard (11.78 [6–24]s) and rotational group (11.57 [5–31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. ConclusionsRotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations.

Use of McGrath MAC Videolaryngoscope to Assist Transesophageal Echocardiography Probe Insertion in Intubated Patients.

Transesophageal echocardiography (TEE) probe insertion with the conventional blind insertion technique may be difficult in anesthetized and intubated patients. The use of a videolaryngoscope may facilitate the insertion of the TEE probe. The aim of this study was to compare the conventional technique with the use of the McGrath MAC videolaryngoscope for TEE probe insertion in terms of success rate, duration of insertion, and complications in patients undergoing cardiovascular surgery. A prospective, randomized study. Training and research hospital. Eighty-six adult patients undergoing cardiovascular surgery were included. Eighty-six adult patients were randomized into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope group (n = 43). Success rates, duration of insertion, complications, and hemodynamic changes during insertion were recorded. The success rate of TEE probe insertion at the first attempt was higher in the McGrath videolaryngoscope group (90.5%) than in the conventional group (43.9%) (p = 0.012). The mean duration for successful insertion of the TEE probe at the first attempt was longer in the McGrath videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for successful insertion of the TEE probe was similar in both groups. Pharyngeal injuries were observed more frequently in the conventional group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe tip in the conventional group was higher than in the McGrath group (21.9% v 4.8%). There were no statistical differences between the 2 groups in systolic blood pressure, mean arterial pressure, diastolic blood pressure, and heart rate before and after TEE insertion. The use of the McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery patients increases the success rate and reduces pharyngeal injuries compared to the conventional technique. The use of the McGrath MAC videolaryngoscope for TEE insertion causes similar hemodynamic changes as in the conventional blind insertion technique.