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We reported a successful airway management in a patient with a diagnosed cervical spinal injury with a non-intubating laryngeal mask AuraOnceTM. Its use was as a rescue airway device after failed orotracheal intubation with direct laryngoscopy and difficulty with facemask ventilation in a 46-year-old trauma patient. The decision was made to use the non-intubating laryngeal mask as a conduit for the placement of an orotracheal tube, which was done successfully. This alternative use of the Ambu AuraOnce laryngeal mask could be of great value to healthcare workers in resource-poor countries where advanced airway devices are not readily available. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative nausea and vomiting remain in force as one of the challenges not yet resolved by experts in perioperative medicine. Objective: To determine the occurrence of postoperative nausea and vomiting according to the use of laryngeal mask or endotracheal tube in patients operated by augmentation mastoplasty. Material and methods: Descriptive, prospective study in patients operated by augmentation mastoplasty, in the Service of Reconstructive Surgery of the «Hermanos Ameijeiras» Hospital in which the influence of the laryngeal mask (ML) or endotracheal tube (ET) on the incidence of nausea was compared and postoperative vomiting. Results: 96 patients divided into two groups of 48 each were evaluated. The average age was 25.50 for the ML group and 25.86 in the TE group. Postoperative nausea and vomiting were found in 16.7% of the ML group and 12.5% of the TE group in the intraoperative, on arrival the Recovery room of 8.3% for the ML and 6, 3% for the TE, while at the recovery room in both groups it was 4.2%. During the period of hospitalization in the ML group the incidence was 4.2% while for the TE group it was 2.1%. In the rescue were presented in both the ML group and the TE, 2.1%. Conclusions: No significant diff erences were identified with the use of laryngeal mask or endotracheal tube in the incidence of postoperative nausea and vomiting in the operating room, upon arrival at PACU, upon discharge from the same, during hospitalization and rescue in PACU. [ABSTRACT FROM AUTHOR]

Introduction: In 2001, the ProSeal laryngeal mask was introduced into the clinical practice. Its basic structure is similar to the classical laryngeal mask, but its principal modification is the property to separate the respiratory tract from the gastrointestinal tract. It presents a successful placing at the first attempt in the 85% of the cases. Methods: It was analyzed the information from 100 ASA 1, 2 and 3 patients, ranging from 18 to 82 years old, programmed for laparoscopic surgery. The ProSeal laryngeal mask (PLMA) was used as the device for the airway. Results : The patients were divided into a 52% of women and a 48% of men, with an average age of 45 years old (ranging from 18 to 82 years old) and with an average weight of 68 kg (with a range between 50 and 92 kg). The peak (airway) pressure in pneumoperitoneum was of 22 cm H2O (ranging from 19 to 28 cm H2O). Neither leaks nor problems were observed in ventilation. Conclusion: The ProSeal laryngeal mask is a secure device in laparoscopic surgery, since it keeps the peak pressure within normal limits, making patient's ventilation secure and diminishing the incidence of pulmonary aspiration due to the gastric draining tube. [ABSTRACT FROM AUTHOR]

Objective: We compared the usefulness of the laryngeal mask (LM) vs. the endotracheal tube (ET) for the management of the upper respiratory tract in patients subjected to mastectomy. Material and methods: It was studied a total amount of 207 patients subjected to modified radical mastectomy, with a physical condition ranging from ASA I to III. The patients were divided into two groups: Group I, LM, 104 patients and Group II, ET, 103 patients. Both groups were managed through general anesthesia balanced with sevoflurane, fentanyl, and vecuronium. The ventilation was kept by a semi-closed circuit with controlled mechanical ventilation. Results from the 104 patients of the Group I (LM): in 7 patients the placing of the LM was very difficult, and it was impossible in another one, due to escapes in ventilation. Therefore, it was necessary to practice tracheal intubation; the pharyngeal pain was present in the 10% of the patients. In the Group II (ET), with 103 patients, intubation was found difficult in 17 patients, and it was necessary to use fibrolaryngoscopy in 2 of the patients; pharynx pain was present in the 55% of the patients (p < 0.05). In the ET placing, it was found an increase in cardiac frequency with a significant statistical difference (p < 0.05). The medicine (drugs) consumption was lower for the ML Group with a significant statistical difference for vacuronium (p < 0.05). Conclusion: The use of LM in patients subjected to mastectomy is safe and useful. It presents advantages over ET. We noticed a great usefulness in the use of LM in this kind of surgeries, where the complication possibility is reduced to a minimum and the patients go home with fewer problems in the upper respiratory tract. [ABSTRACT FROM AUTHOR]

Objective: To present a case of management of difficult non predictable airway in elective surgery under general anesthesia. In this case, the author, reflects on the surgery evaluation, since it is very frequent to count on a little time to assess it at urgency surgeries. Therefore, when it is present, its management and conservation must be evaluated according to its knowledge and the existing tools. Clinical case: Male patient of 34 years old programmed for open cholecystectomy. Obese through Mallampati II evaluation, short neck, Patil Aldreti lower than 6 centimeters. Rest: normal. The patient is monitored and begins with the medication for intubation with direct laringoscopy, being observed a Cormack-Lehane IV. Two failed attempts of intubation are made, after that there are two attempts more with failed McCoy No. 4 sheet. Finally, there is an airway management through a disposable laryngeal mask, beginning a surgical procedure which lasted for 2:30 hours, without complications. Conclusions: The present case shows us the importance of knowing predictive factors of a difficult airway. We must be constantly updated about this medical problem, as well as about the available guides and strategies in order to obtain the best possible results. This is not so easy, but it is actually possible if we count on knowledge, ability or skills, techniques and technological resources. [ABSTRACT FROM AUTHOR]

Objective: To compare the capability of laryngeal mask, Combitube and endotracheal tube to avoid gastric reflux by measuring endotracheal pH. Methods: We tested forty-five patients under general anesthesia for elective surgery, ASA I and II, older than 18 years, with spontaneous breathing and on supine position. The patients were randomly allocated to three groups: laryngeal mask (n = 15), Combitube (n = 15) and endotracheal tube (n = 15). All patients were premedicated with midazolam 0.1 mg/kg and fentanyl 1-2 g/kg. Then, they were induced with penthotal sodium 4-6 mg/kg and succinilcolyne 1 mg/kg being precurarized with pancuronium 0.8 mg/kg. For maintenance isofluorane 2-2.5% and fentanyl 2-3 g/kg were used; no other muscle relaxant was used. Using a probe, a sample of endotracheal secretion was obtained thirty minutes after the surgery began. A reactive strip was used to measure pH (Spezialindikator pH 2.0-9.0 Merck). Results: In the group of patients with laryngeal mask, the mean pH was 6.57 (sd ± 0.65), in the group with Combitube, pH was 8.33 (sd ± 0.24) and in the group with endotracheal tube it was 8.33 (sd ± 0.75). Conclusions: Combitube and the endotracheal tube have been demonstrated to be effective to avoiding gastric reflux, while the laryngeal mask is less effective. [ABSTRACT FROM AUTHOR]