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Résumé Objectifs L’objectif de ce travail était de réaliser une étude médico-économique comparant quatre masques laryngés (ML) à usage unique (LMA-Unique™, Ambu AuraOnce™, I-Gel™ et LMA-Suprême™) pour la prise en charge d’une chirurgie carcinologique du sein. Type d’étude Étude prospective, randomisée, monocentrique. Matériel et méthodes Des patientes de chirurgie sénologique programmée étaient randomisées dans 4 groupes correspondant aux ML. Au décours de l’induction, les modalités d’utilisation étaient recueillies, ainsi que les évènements peropératoires, liés aux ML induisant un surcoût anesthésique. En prenant le LMA-Unique™ comme référence, le coût « réel » (coût direct du ML + surcoût [Δcoût] lié aux évènements) a été calculé et une analyse coût-efficacité (ACE) a été réalisée, mettant en parallèle l’impact sur le coût et l’incidence des évènements (Δévènement). Résultats Au total, 178 patientes ont été incluses. D’après l’ACE, le modèle dominant (celui qui coûte le moins cher et qui s’accompagne d’un faible nombre d’évènements) était l’Ambu AuraOnce™ (Δcoût « réel » : –34,2 % et Δévènement : –30,6 %). Le LMA-Unique™ est dominé du fait d’un taux d’évènements élevé. L’I-Gel™ et LMA-Suprême™ étaient plus efficaces, mais d’un coût élevé (Δcoût « réel » : +16 % et +22,5 % respectivement). Pour compenser les surcoûts, il faudrait appliquer une baisse de prix d’au moins 50 %, selon les modèles, pour égaler le modèle dominant sur un critère coût-efficacité. Conclusions Sur un plan médico-économique, l’I-Gel™ et LMA-Suprême™ restent dominés en raison d’un coût direct élevé malgré leurs qualités et sécurité de leurs utilisations. Ce résultat ne tient pas compte des complications très rares et graves non rencontrées dans cette étude à l’effectif limité ; leur impact médical, voire économique, peut influencer le choix au-delà de la simple analyse coût-efficacité. Objective The main goal of this study was to achieve a medico-economic comparison between four disposable laryngeal masks (LM) (LMA-Unique™, Ambu AuraOnce™, I-Gel™ and LMA-Suprême™). Study design A prospective, randomized, monocentre study. Material and methods In a center, using routinely LMA-Unique masks, scheduled breast surgery patients were allocated into four groups according to the LM model. After the induction, the modalities of use were collected, as well as the intraoperative events that required additional anesthetic equipment. The real cost of each model was calculated (cost of the mask + extra cost related to complications). Using the LMA-Unique as a reference, we performed a cost-efficacy analysis. We realized a cost-efficiency analysis putting in parallel the impact on the cost and the incidence of the events. Results A total of 178 patients were included. According to the cost-efficacy analysis, the dominant model was the Ambu AuraOnce™ (Δreal cost: –34.2%, Δevents: –30.6%). The LMA-Unique™ was dominated because of a high morbidity rate. The I-Gel™ and LMA-Suprême™ models were more efficient but more expensive (Δreal cost: +16% and +22.5% respectively). To compensate for additional costs, it would be necessary to apply a price reduction of at least 50%. Conclusions Despite their better efficiency and safety, the latest generation laryngeal masks are still expensive in spite of a low rate of complication. These results do not take into account very rare and severe complications not met in this study in the limited size; then the economic and medical impact can influence the choice beyond the simple analysis cost-efficiency. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – To evaluate the impact of Cormack and Lehane grade on the Intubating Laryngeal Mask Airway (LMA-Fastrach™) using in women. Study design. – Open prospective study. Patients. – The study included 115 scheduled gynaecologic surgery women. Methods. – An LMA-Fastrach™ was systematically performed in patients with a Cormack''s grade≥3 or when Arné''s score was≥7 whatever the Cormack. After induction of anaesthesia and neuromuscular blockade, Cormack''s grade was assessed and LMA-Fastrach™ was inserted. Proper insertion was confirmed by the easiness of assisted ventilation and the normal aspect of the capnographic curve. Intubation through the LMA-Fastrach™ was carried out with the specific kit''s endotracheal tube. More than two attempts were considered as a failure of the technique and an alternative method was performed. The following parameters were noted: age, weight, height, clinical predictors for difficult intubation (Arne et al.''s score), number of LMA-Fastrach™ insertion, ventilation efficiency through LMA-Fastrach™, successful intubation with LMA-Fastrach™ and oesophageal intubation. Results. – Ventilation through the LMA-Fastrach™ was efficient in 97%. The success rate of intubation was 94.8% (86% on the first attempt). The success rate of ventilation and intubation were not statistically different according to the different Cormack''s grades. The obesity (BMI>30) did not change the success rate of ventilation and intubation through the LMA-Fastrach™. Conclusion. – In women with either predicted or unpredicted difficult intubation, the success rates of ventilation and intubation through the LMA-Fastrach™ don''t seem to be influenced by Cormack grade and obesity. [Copyright &y& Elsevier]

Dysphagia of greater than 48h duration is an indication for indirect laryngoscopy and when odynophagia and otalgia occur simultaneously, the possibility of subluxation of the arytenoids demands an urgent ENT assessment. The potential seriousness of laryngeal lesions following intubation obliges us to use the smallest compatible endotracheal tube. The occurrence of pain cervical surgical emphysema and fever suggests a pharyngeal lesion necessitating the suspension of oral feeding and the initiation of antibiotic therapy with anaerobic activity, while awaiting possible surgical intervention. There is no argument to use a tooth-guard for each intubation, but tooth fragility must be researched. The incidence of nasal fossa trauma is reduced with the use of nasal packs impregnated with local anaesthetic containing a vasoconstrictor. This allows the introduction of a small flexible lubricated tube. Laryngeal mask-induced sore throat is more common than the more serious injuries. The classical technique of introducing a laryngeal mask of appropriate size (4 for women, 5 for men) in which the cuff is inflated to a leak pressure of 20 cm H2O reduces this frequency. The facial mask may cause injuries especially with prolonged use. The incidence of pulmonary aspiration, linked to the action of drugs, raised intra-abdominal pressure; an emergent situation or difficult intubation is decreased with the performance of the Sellick maneuver at intubation, rapid induction and the neutralization of gastric acidity. A meticulous technique of insertion of the, individualized anaesthesia, particular vigilance at the time of decurarisation and position changes and a calm awakening assure its optimal use, unless the Proseal laryngeal mask modifies this point of view. [Copyright &y& Elsevier]

Objective: Assessment of the learning curve of a new device for blind orotracheal intubation: Intubating laryngeal mask.Study design: Prospective clinical study.Methods: Ten persons practicing anaesthesia (specialist, fellow, nurse) underwent videotape learning and manikin training required with the device. Each person had to carry out a tracheal intubation in ten consecutive patients undergoing scheduled surgery. No patient presented history or clinical sign of difficult airway management. Results were expressed as mean ± SD. Main percentages were provided with their 95 % confidence interval; the percentage comparison were performed using Chi 2 test. The significance level for overall analysis was p < 0.05.Results: One hundred patients were included. The overall success rate of tracheal intubation with the intubating laryngeal mask was 88 %. An easy learning curve was obtained according to the low failure rate that was observed. No failure was noticed after eight procedures. Significant diminution of the delay for tube insertion was observed during the practice (3 ± 1.30 min for the first procedure and 1.16 ± 0.60 min for the tenth procedure). Circumstances of the oral intubation were improved with muscle relaxation. Finally, all failure with the intubating laryngeal mask were followed by successful intubation using direct laryngoscopy.Conclusion: The intubating laryngeal mask is a new device for blind orotracheal intubation with an easy learning curve in patients without difficulty in airway management, even for non-selected operators. [Copyright &y& Elsevier]

Objective: The main goal of this study was to achieve a medico-economic comparison between four disposable laryngeal masks (LM) (LMA-Unique™, Ambu AuraOnce™, I-Gel™ and LMA-Suprême™)., Study Design: A prospective, randomized, monocentre study., Material and Methods: In a center, using routinely LMA-Unique masks, scheduled breast surgery patients were allocated into four groups according to the LM model. After the induction, the modalities of use were collected, as well as the intraoperative events that required additional anesthetic equipment. The real cost of each model was calculated (cost of the mask+extra cost related to complications). Using the LMA-Unique as a reference, we performed a cost-efficacy analysis. We realized a cost-efficiency analysis putting in parallel the impact on the cost and the incidence of the events., Results: A total of 178 patients were included. According to the cost-efficacy analysis, the dominant model was the Ambu AuraOnce™ (Δreal cost: -34.2%, Δevents: -30.6%). The LMA-Unique™ was dominated because of a high morbidity rate. The I-Gel™ and LMA-Suprême™ models were more efficient but more expensive (Δreal cost: +16% and +22.5% respectively). To compensate for additional costs, it would be necessary to apply a price reduction of at least 50%., Conclusions: Despite their better efficiency and safety, the latest generation laryngeal masks are still expensive in spite of a low rate of complication. These results do not take into account very rare and severe complications not met in this study in the limited size; then the economic and medical impact can influence the choice beyond the simple analysis cost-efficiency., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Background: This survey aimed to describe the current use of laryngeal mask (LM) and to define the difference of use according to a group defined like experts., Methods: A self-questionnaire available on Internet was sent by e-mail to French anesthesiologists. Results were compared by a Chi(2) test between anesthesiologists according to their expertise defined by a >750 LM use., Results: Nine hundred and fifty-three anesthesiologists answered to the survey. Only 19 reported never using LM and 37% of responders were defined as expert. More than half of the MAR used the ideal weight to set the size of the MLA to use. Pressure leak was sought by less than one-third of the MAR. In case of leakage, a mobilization of the ML or the patient's head was performed first. In second intention, nearly a quarter of MAR changed technique for the benefit of oral intubation. Only 50% of responders used LM as a rescue technique in case of difficult intubation and ventilation. Experts had less insertion failure and laryngospasm. Complications and medico-legal suites are few., Conclusions: Variability of practice may be explained by low-grade recommendations in the literature. LM insertion in case of difficult intubation/ventilation to provide adequate oxygenation and should be formally reminded to clinicians., (Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)