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Prematürelerde görülen respiratuvar distres sendromunda surfaktanın klinik kullanıma girmesi ile birlikte prematüre bebeklerdeki yaşam oranı dramatik olarak artmıştır. Surfaktanın akciğerlere iletiminde kullanılan yöntemler zaman içerisinde daha az invaziv ve hatta invaziv olmayan yöntemlere doğru evrilmeye başlamıştır. Surfaktanın ince kateter ile uygulanması, bir larengeal veya suproglottik havayolu cihazı kullanılarak, farengeal uygulama ile ve aerosolize şekilde verilmesi gibi yeni yöntem çalışmaları giderek artmaktadır. Böylece, immatür akciğerin klasik olarak kabul edilen entübasyon, pozitif basınçlı ventilasyon ve mekanik ventilasyonun zararlı etkilerinden korunması hedeflenmiştir. İnce kateter ile surfaktan uygulanması metodu ile yapılan çok sayıda çalışma ve meta-analizin sonuçları entübasyon, surfaktan uygulanması ve pozitif basınçlı ventilasyon metotları ile karşılaştırıldığında mekanik ventilasyon ihtiyacı ve süresi, bronkopulmoner displazi insidansı ve neonatal mortalite oranlarında azalmaya neden olduğu gösterilmiştir. Ancak çalışmalarda premedikasyon yönetimi ve solunum desteği türü, uygulanan surfaktan türü gibi birçok konuda heterojenite mevcuttur. Supraglottik hava yolu cihazı, farengeal uygulama ve aerosolizasyon uygulamaları özellikle laringoskopinin dezavantajlarını ortadan kaldırması ve daha da az invaziv olmaları, daha az tecrübe ve yetenek gerektirmeleri nedenleri ile ince kateter ile surfaktan uygulanması yönteminden avantajlı olsalar da henüz rutin klinik kullanıma girmeleri için daha fazla veriye ihtiyaç vardır., The survival rate of premature infants has increased dramatically, after the beginning of surfactant use in newborn clinics for premature infants with respiratory distress syndrome. The surfactant delivery methods to the lungs have started to evolve into less invasive and even non-invasive methods over the time. Studies on new methods such as thin catheter surfactant administration, laryngeal or supraglottic airway device, pharyngeal instillation, and aerosolized techniques are increasing. The purpose of the less invasive or noninvasive methods is the protection of immature lungs from harmful effects of intubation, positive pressure ventilation and invasive mechanical ventilation. It has been reported in many studies and meta-analysis that TCA methods were related to lower need of mechanical ventilation, shorter duration of mechanical ventilation, and lower incidence of bronchopulmonary dysplasia or death, compared to intubation, surfactant, and positive pressure ventilation methods. However, there are heterogeneities in premedication policies and respiratory support type, and the type of surfactant applied in the studies. Laryngeal or supraglottic airway device, pharyngeal instillation, and aerosolized techniques have advantages over thin catheter, because they eliminate the disadvantages of laryngoscopy, they are less invasive than thin catheter and they require minimal experience and skills, but more data are needed for routine clinical use of these new methods.

The study aims to describe the anesthetic and airway management of baboons (Papio hamadryas) undergoing laparoscopic salpingectomy with a laryngeal mask airway (LMA) device. Eleven baboons received tiletamine-zolazepam and medetomidine; anesthesia was induced with propofol. An LMA was positioned for oxygen and isoflurane administration in spontaneous respiration. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end tidal carbon dioxide (EtCO2), minute volume (MV), and peripheral hemoglobin oxygen saturation (SpO2) were recorded before (PREPP) and immediately after abdomen insufflation (PP1), at 10 (PP2), 20 (PP3), and 30 (PP4) minutes during pneumoperitoneum, and after (POSTPP) pneumoperitoneum. The respiratory rate was significantly higher at all times compared to PREPP. The end tidal carbon dioxide concentration was significantly higher at PP2, PP3, PP4, and POSTPP, compared to the previous times. The higher values for RR and EtCO2 were registered at PP4: 22.7 (95% CI 17.6–27.8) breaths/min and 57.9 (95% CI 51.9–63.8) mmHg, respectively. The minute volume was significantly higher at PP4 and POSTPP compared to the other times. The higher value for MV was registered at POSTPP (269.1 (95% CI 206.1–331.8) mL/kg/min). This protocol is suitable for baboons undergoing laparoscopic salpingectomy. The LMA was easy to insert and allowed for good ventilation, gas exchange, and delivery of the anesthetic in spontaneous breathing baboons.

Background: Montgomery thyroplasty type I is a surgical technique indicated in vocal cord paralysis which consists of the paralyzed cord medialization, improving the voice quality. The objective of the study is to describe in detail the anesthetic method to obtain optimal post-medialization voice results. Methodology: Retrospective case series study including patients who underwent medialization thyroplasty using the modified Montgomery technique at the General University Hospital of Valencia between 2011 and 2021. The anesthetic technique consisted of general anesthesia with neuromuscular relaxation and a laryngeal mask. Pre- and post-surgical vocal functional data of maximum phonation times (MPT), G score, and Voice Handicap Index-30 (VHI-30) were evaluated. Results: All the patients presented an improvement in voice results, increasing MPT after surgery and a decrease in VHI-30 and G score postoperatively, with statistically significant differences between the pre- and post-surgical results (p-value < 0.05). There were no complications related to anesthesia or surgery. Conclusions: The use of general anesthesia with muscle relaxation in modified Montgomery thyroplasty may be a good option to consider. The use of a laryngeal mask for ventilation combined with a fiberoptic check allows direct visualization of the vocal cords intraoperatively, providing good functional voice results.

A máscara laríngea (ML) é um dispositivo supra-glótico que tem seu uso indicado em situações de manejo de vias aéreas difíceis, mas que atualmente é mais usada em procedimentos cirúrgicos pelos médicos anestesistas; no entanto seu uso também pode se dar através do profissional enfermeiro(a) devidamente capacitado, o qual está regulamentado pela Resolução do COFEN Nº 641/2020. O uso da máscara laríngea pelo enfermeiro ainda é pouco vivenciado nos atendimentos pré e intra hospitalar, porém vem aumentando nos últimos anos. Esta pesquisa teve como objetivo central identificar os conhecimentos dos enfermeiros(as) sobre a legislação, capacitações, indicações e contraindicações sobre o uso da máscara laríngea em situações de emergência no serviço intra hospitalar. Foi aplicado um questionário de perguntas e respostas relacionado ao conhecimento sobre a legislação vigente que regulamenta o uso da máscara laríngea pelo enfermeiro(a), em quais situações é indicado e contraindicado e se o profissional possui ou não capacitação para tal. Esta pesquisa foi realizada com 10 (dez) enfermeiros(as) que atuam no serviço há mais de um ano e que não estiveram afastados durante este período. Durante a análise dos dados observou-se que a maioria dos profissionais não possuíam capacitação para o uso da ML, poucos conheciam sobre a legislação, mas a grande maioria soube descrever situações nas quais estaria indicado seu uso e algumas contraindicações. Concluímos que o profissional enfermeiro ainda está muito limitado à atuação médica, sendo de fundamental importância a busca por capacitação e assim aumentando sua autonomia e consequentemente proporcionando uma qualidade de atendimento ainda maior ao paciente. The laryngeal mask (ML) is a supraglottic device that has its use indicated in difficult airway management situations, but which is currently more used in surgical procedures by anesthesiologists; however, its use can also be through the properly trained nurse professional, which is regulated by COFEN Resolution No. 641/2020. The use of the laryngeal mask by nurses is still little experienced in pre- and intra-hospital care, but has been increasing in recent years. The main objective of this research was to identify the nurses' knowledge about legislation, training, indications and contraindications about the use of the laryngeal mask in emergency situations in the intra-hospital service. A questionnaire of questions and answers related to knowledge about current legislation regulating the use of the laryngeal mask by the nurse was applied, in which situations is indicated and against indicated and whether or not the professional has the training to do so. This research was conducted with 10 (ten) nurses who have been working in the service for more than one year and who have not been away during this period. During the data analysis, it was observed that most professionals did not have training for the use of ML, few knew about the legislation, but the vast majority knew how to describe situations in which its use would be indicated and some contraindications. We conclude that the nursing professional is still very limited to medical practice, being of fundamental importance the search for training and thus increasing their autonomy and consequently providing an even greater quality of care to the patient. La máscara laríngea (ML) es un dispositivo supraglótico que tiene su uso indicado en situaciones difíciles de manejo de la vía aérea, pero que actualmente es más utilizado en procedimientos quirúrgicos por anestesiólogos; sin embargo, su uso también puede ser a través del profesional de enfermería debidamente capacitado, lo cual está regulado por la Resolución COFEN N° 641/2020. El uso de la máscara laríngea por parte de los enfermeros todavía tiene poca experiencia en la atención pre e intrahospitalaria, pero ha ido en aumento en los últimos años. El objetivo principal de esta investigación fue identificar el conocimiento de los enfermeros sobre legislación, formación, indicaciones y contraindicaciones sobre el uso de la máscara laríngea en situaciones de emergencia en el servicio intrahospitalario. Se aplicó un cuestionario de preguntas y respuestas relacionadas con el conocimiento sobre la legislación vigente que regula el uso de la máscara laríngea por parte del enfermero, en el que se indican situaciones y en contra de las indicadas y si el profesional tiene o no la formación para hacerlo. Esta investigación fue realizada con 10 (diez) enfermeros que han estado trabajando en el servicio por más de un año y que no han estado ausentes durante este período. Durante el análisis de los datos, se observó que la mayoría de los profesionales no tenían capacitación para el uso de ML, pocos conocían la legislación, pero la gran mayoría sabía cómo describir situaciones en las que su uso estaría indicado y algunas contraindicaciones. Concluimos que el profesional de enfermería todavía está muy limitado a la práctica médica, siendo de fundamental importancia la búsqueda de formación y así aumentar su autonomía y, consecuentemente, proporcionar una calidad de atención aún mayor al paciente.

Object To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia. Methods A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy. Results There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B. Conclusion Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

Objective To evaluate the respiratory function of asphyxiated infants resuscitated with i-gel supraglottic airway (SGA) vs. face mask (FM) in a low-resource setting. Methods In this sub-study from the NeoSupra trial, respiratory function during the first 60 inflations was evaluated in 46 neonates (23 with SGA and 23 with FM) at the Mulago National Referral Hospital, Uganda. The primary outcome was the mask leak (%). The secondary outcomes included inspired (VTi) and expired (VTe) tidal volumes, and heart rate response to ventilation. Results Median mask leak was 40% (IQR 22–52) with SGA and 39% (IQR 26–62) with FM (p = 0.38). Median VTe was 7.8 ml/kg (IQR 5.6–10.2) with SGA and 7.3 ml/kg (IQR 4.8–11.9) with FM (p = 0.84), while median VTi was 15.4 ml/kg (IQR 11–4-17.6) with SGA and 15.9 ml/kg (IQR 9.0–22.6) with FM (p = 0.68). A shorter time was needed to achieve heart rate > 100 bpm in SGA (median 13 s IQR 9–15) with respect to FM arm (median 61, IQR 33–140) (p = 0.0002). Conclusion Respiratory function was not statistically different between neonates resuscitated with SGA vs. FM. SGA was associated with faster heart rate recovery compared to FM in the subgroup of neonates with bradycardia. Further research is needed to investigate possible advantages of SGA on respiratory function at birth. acceptedVersion

Antecedentes: La incidencia de intubación difícil en población pediátrica es de 2 a 11casos por 1000 pacientes llevados a anestesia general, lo que conlleva riesgos potenciales comohipoxemia, parada cardíaca y muerte. Dentro de las estrategias para el manejo de la vía aérea difícilen los niños se encuentra el uso de fibroscopia flexible para guiar la intubación, que se puedecombinar con un dispositivo supraglótico con la finalidad de facilitar su inserción, superarobstrucciones de la vía aérea superior y permitir una ventilación simultánea. El objetivo de esteestudio fue comparar la intubación orotraqueal en simuladores pediátricos, utilizandofibrobroncoscopio flexible sin conductor versus el uso de la máscara laríngea AuraGain comoconductor, con el fin de demostrar si el uso de dicho dispositivo supra glótico tiene alguna ventajacomparado con intubar sin conductor. Métodos: 41 anestesiólogos y residentes de anestesiología,fueron asignados al azar para realizar una intubación orotraqueal en un simulador pediátrico,utilizando fibrobroncoscopio flexible sin conductor o utilizando como guía la máscara laríngeaAuraGain. Resultados: La intubación exitosa en el primer intento se consiguió en 38 de 41intubaciones en el grupo de fibrobroncoscopia sin conductor y en 32 de 41 intubaciones en el grupode fibrobroncoscopia con AuraGain, sin encontrar diferencias estadísticamente significativas. Elgrupo de fibrobroncoscopia sin conductor tuvo una mediana de tiempo de intubaciónsignificativamente más corta (41 segundos), comparado con el grupo de fibrobroncoscopia yAuraGain (67.5 segundos). Conclusiones: Usar el dispositivo AuraGain como conductor paraintubar simuladores pediátricos con fibra óptica no mejora la intubación al primer intento, laintubación global, ni la visualización glótica, comparado con intubar solo con fibra óptica. UsarAuraGain aumenta los tiempos de intubación, sin embargo, dichos hallazgos deben serconfirmados en estudios con humanos. Background: The incidence of difficult intubation in pediatric population is 2 to 11 casesper 1000 patients brought to general anesthesia, which carries potential risks such as hypoxemia,cardiac arrest and death. Among the strategies for the management of difficult airway in children isthe use of flexible fiberscopy to guide intubation, which can be combined with a supraglottic devicein order to facilitate its insertion, overcome upper airway obstructions and allow simultaneousventilation. The aim of this study was to compare orotracheal intubation in pediatric simulators, using a flexible fibrobronchoscope without driver versus using the AuraGain laryngeal mask as adriver, in order to demonstrate whether the use of such a supraglottic device has any advantagecompared to intubating without a driver. Methods: 41 anesthesiologists and anesthesiologyresidents were randomly assigned to perform orotracheal intubation in a pediatric simulator usingeither a flexible fibrobronchoscope without a driver or the AuraGain laryngeal mask as a guide.Results: Successful intubation on the first attempt was achieved in 38 of 41 intubations in thedriverless fibrobronchoscopy group and in 32 of 41 intubations in the fibrobronchoscopy withAuraGain group, with no statistically significant differences. The driverless fibrobronchoscopygroup had a significantly shorter median intubation time (41 seconds) compared to thefibrobronchoscopy and AuraGain group (67.5 seconds). Conclusions: Using the AuraGain device asa driver to intubate pediatric simulators with fiberoptics does not improve first-attempt intubation,overall intubation, or glottic visualization compared with intubating with fiberoptics alone. UsingAuraGain increases intubation times, however, such findings need to be confirmed in humanstudies.

Positive pressure ventilation via a facemask is a critical step in neonatal resuscitation but may be a difficult skill for frontline providers or trainees to master. A laryngeal mask is an alternative to endotracheal intubation for some newborns who require an advanced airway. We present the first case series in the United States in which a laryngeal mask was successfully utilized during resuscitation of newborns greater than or equal to 34 weeks’ gestation following an interdisciplinary quality improvement collaborative and focused training program.

Background Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH2O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH2O in the adult laryngeal masks from different manufacturers. Methods Two groups of 80 patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnce™ (Ambu®), LMA-Classic™ (Teleflex®) and LMA-ProSeal™ (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH2O was recorded. Results Mean (SD) volume of air required to achieve the intracuff pressure of 60 cmH2O in Soft Seal®, AuraOnce™, LMA-Classic™, LMA-ProSeal™ laryngeal mask size 3 were 11.80(1.88), 9.20(1.88), 8.95(1.50) and 13.50(2.48) ml, respectively, and these volumes in laryngeal mask size 4 were 14.45(4.12), 12.55(1.85), 11.30(1.95) and 18.20(3.47) ml, respectively. The maximum recommended volume resulted in high intracuff pressures (> 60 cmH2O) in all laryngeal mask types and sizes studied. Conclusion Pressure-volume curves of adult laryngeal masks are all in sigmoidal shape. Cuff designs and materials can effect pressure and volume correlation. Approximately half of the maximum recommended volume is required to achieve the intracuff pressure of 60 cmH2O except LMA-ProSeal™ which required two-thirds of the maximum recommended volume. Trial registration Thai Clinical Trials Registry, TCTR20150602001, May 28, 2015.

BACKGROUND The i-gel mask is a second-generation, single-use supraglottic airway device which does not have an inflatable cuff. The cuff consists of a thermoplastic elastomer and its mechanism of sealing still remains unclear. Various theories such as temperature-dependent changes in hardness and volume expansion as well as fluid absorption have been discussed. The aim of the present study is to investigate changes in volume, weight and density caused by temperature changes. MATERIAL AND METHODS Three i-gel masks (sizes 3, 4 and 5) were heated in a water bath from 10°C to 50°C in 5°C steps. The changes in weight, volume, and density were measured at each temperature step. In a second study, the identical parameters of masks (n = 5 of sizes 3, 4 and 5) used in patients were investigated. Results of volume and density between benchtop and patient measurements were examined for correlation. RESULTS All masks investigated, regardless of the size, showed a significant linear temperature-dependent volume expansion (sizes 3, 4 and 5: P < 0.001), a weight increase (sizes 3: P = 0.018; 4: P = 0.027; and 5: P = 0.006) and a linear decrease in density (sizes 3, 4 and 5: P < 0.001). There was a very strong correlation between the results of benchtop and patient measurements (volume: P < 0.001; density: P < 0.001). CONCLUSIONS We observed significant changes in all three properties investigated. Thus, a temperature-dependent volume expansion and weight increasement was observed, which can be considered as a further explanation for improved sealing after insertion.

Introduction: Following the introduction of the laryngeal mask in the 1980s, several similar devices have been developed, changing paediatric airway management under anaesthesia. This reflective article describes and examines the different paediatric supraglottic airway devices currently available in the U.K. Methodology: This perspective article is based on a narrative review of articles that discussed paediatric supraglottic airway devices using Cochrane, meddling, Ovid and pubmed databases as well as text books. Results: As new devices continue to be developed with a clear indication of clinical relevance and genuine advantages, so high quality research will also continue to be required in order to improve features in new devices. RESUMEN Introducción: Con posterioridad a la introducción de la máscara laríngea en los años 1980 se han venido desarrollando varios dispositivos similares, los cuales han cambiado el manejo de la vía aérea pediátrica en anestesia. Este artículo de reflexión describe y examina los distintos dispositivos supraglóticos para la vía aérea pediátrica disponibles actualmente en el Reino Unido. Metodología: Este artículo de opinión se basa en una revisión de los artículos que tratan el tema de los dispositivos supraglóticos para la vía aérea pediátrica, realizada en las bases de datos Cochrane, Medline, Ovid y PubMed y también en los libros de texto. Resultados: A medida que se desarrollan dispositivos nuevos con indicación clara de pertinencia clínica y ventajas genuinas, se necesitarán también estudios de alta calidad a fin de mejorar las características de dichos dispositivos.

Objective To compare airway management during induction of anaesthesia, spontaneous ventilation (SV) and controlled mechanical ventilation (CMV), using an endotracheal tube (ETT), laryngeal mask (LM), rabbit-specific supraglottic airway device (v-gel) or facemask (FM). Study design Prospective randomized crossover experiment. Animals Ten New Zealand White rabbits. Methods After premedication, rabbits were randomly allocated to four groups: 1) ETT; 2) LM; 3) v-gel or 4) FM. The required dose of propofol, duration and number of attempts to place an airway device and leakage during SV and CMV at different peak inspiratory pressures (6, 10, 12, 14 and 16 cmH2O) were recorded. Computed tomography (CT) of the head, neck and abdomen were performed before and after CMV. Results Significantly less propofol and time [2.0 ± 0.5 mg kg−1, 82 ± 34 seconds, p 25% of the tidal volume occurred at the lowest pressure in FM [median (range), 6 (6–8) cmH2O], which was significantly lower than with v-gel [16 (6–no leak at 16) cmH2O], LM [>16 (6–no leak at 16)] or ETT [>16 (no leak at 16) cmH2O] (p Conclusions and clinical relevance The v-gel is a practical alternative to LM and ETT for airway management and CMV, but can compress the larynx. The FM is easily placed, but significant leakage occurs during CMV.

Background In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis-atracurium dosage for laryngeal mask insertion has not been standardised. We aimed to determine the optimal dose of cis-atracurium using a sequential method for successful laryngeal mask insertion. Methods The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered cis-atracurium doses as follows: 150, 100, 70, 50, 30, and 20 μg·kg− 1. The main outcome involved the determination of the response to laryngeal mask airway insertion: ≥16 points and cis-atracurium for laryngeal mask airway insertion. Results The median effective dose of cis-atracurium was 26.5 μg·kg− 1 (95% CI 23.6–29.8) using the sequential method. Heart rate was decreased in the 50 μg·kg− 1 group compared to that in the 30 μg·kg− 1 group at timepoints T7, T8, and T10 (P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference was observed in the 20 μg·kg− 1 group. Systolic blood pressure was decreased in the 50 μg·kg− 1 group compared to that in the 20 μg·kg− 1 group at timepoints T2, T3, and T4 (P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg− 1 group than in the 30 μg·kg− 1 group at timepoint T3 (P = 0.0326). Conclusions The ED50 of cis-atracurium was 26.5 μg·kg− 1 for laryngeal mask airway insertion. Trial registration Clinicaltrial.gov Registry, NCT03668262, Registered on 11 September 2018.

Background and Aims: Orotracheal intubation (OTI) with fiberoptic bronchoscope (FOB) in spontaneous ventilation is one of the main techniques for patients with predicted difficult airway. Latest generation supraglottic airway devices have been designed to allow OTI through them. We assessed the safety and effectiveness of FOB-guided OTI through i-gel™ device which was inserted in spontaneously breathing patients with predicted difficult airway. Material and Methods: Eighty-five patients with difficult airway predictors were included. The i-gel was inserted under oropharyngeal local anaesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anaesthesia was induced in order to introduce the endotracheal tube guided by FOB. We recorded the i-gel insertion time (tgel), intubation time (tint), O2 saturation in pulse oximetry (SpO2) at different times: basal (t0), after 3 min of preoxygenation with a face mask at 100% FiO2 (t1), after i-gel mask insertion (t2) and after intubation (t3). Adverse events during the procedure were also recorded. Results: All patients were successfully intubated. SpO2 values were: 96.9 ± 1.2 (t0), 99.0 ± 0.9 (t1), 96.2 ± 2.4 (t2), 96.0 ± 2.5 (t3). tgel and tint were 38.0 ± 7.8 s and 36.5 ± 5.6 s, respectively. No serious adverse events were recorded and no patient suffered airway trauma. Conclusion: I-gel insertion in spontaneous ventilation secures the airway before achieving fiberoptic intubation without the occurrence of adverse events. More studies might be necessary in order to confirm the results presented, but we consider that the technique described is a safe and effective alternative to classic OTI with FOB in spontaneously breathing patients with predicted difficult airway.

Summary Background Dysphonia, with or without laryngeal changes, has been reported as a complication following prolonged intubation. In contrast, it is unknown if laryngeal changes also occur following short-term airway instrumentation. The objectives of this study were to determine the prevalence of laryngeal changes in patients undergoing short-term routine general anesthesia using an endotracheal tube (ETT) or supraglottic airway (SGA), and to identify predictors to these changes. Methods Standardized voice assessments were performed preoperatively, postoperatively, and at follow-up on adults undergoing general anesthesia for an elective procedure of less than three hours requiring an ETT or a SGA. The standardized voice assessment protocol comprised a rigid videolaryngostroboscopy, the Voice Handicap Index (VHI), and acoustic voice analysis. The effects of demographic and anesthetic characteristics and type of airway instrumentation on the videolaryngostroboscopic variables were studied using multilevel logistic regression. Multilevel linear regression was used to reveal preoperative versus postoperative changes in VHI and acoustic voice scores. Results Overall, the prevalence of postoperative laryngeal changes was low. Significant postoperative laryngeal changes were found for the variables right-sided vocal fold redness in the ETT group (P = 0.048) and right-sided vocal fold blood vessels in both groups (ETT versus SGA). However, after adjustment for all demographic and anesthetic characteristics in the regression model, the effect of the type of airway instrumentation (ETT versus SGA) on the variable right-sided vocal fold redness was no longer significant. Conclusions ETT and SGA short-term airway instrumentation are vocal fold function sparing techniques with negligible laryngeal changes.

Background and Aims: Optimum timing of laryngeal mask airway (LMA) removal after general anesthesia with isoflurane is debatable. The objective was to investigate the potential benefits of removing LMA ProSeal at ≤0.4 Minimum alveolar concentration (MAC) isoflurane over awake and “deep plane” extubation after short duration laparoscopic gynecological surgery. Material and Methods: In this prospective randomized trial 90 adult female patients undergoing elective laparoscopic surgery under general anesthesia using LMA ProSeal™ as airway device were included. At the end of surgery, LMA ProSeal™ was removed when the patient was awake, could open mouth following verbal command (Group A); at MAC ≤0.4 (Group B); or at MAC of 0.6 (Group C). Adverse airway events like nausea, vomiting, airway obstruction, coughing, bucking, laryngospasm were noted. Statistical analyses were done by SPSS statistical software (IBM SPSS Statistics for Mac OS X, Version 21.0. IBM Corp, Armonk, NY). Results: Baseline demographic characteristics were comparable in all three groups. Coughing or bucking at the time of LMA removal was higher in group A (P = 0.004). Snoring and airway obstruction after LMA removal was significantly higher in group C compared to group A and group B (P = 0.002 and P = 0.011, respectively). There was significant change in mean arterial pressure and heart rate between before and after LMA removal on group A (P = 0.008 and P < 0.001, respectively) but not in other groups. Conclusion: MAC ≤0.4 can be considered optimum depth of anesthesia for removal of LMA Proseal in adult patients undergoing isoflurane anesthesia.

Aim We compared the performance of personnel in a low‐resource setting when they used the I‐gel cuffless neonatal laryngeal mask or a face mask on a neonatal airway management manikin. Methods At Mulago Hospital, Uganda, 25 doctors, nurses and midwives involved in neonatal resuscitation were given brief training with the I‐gel and face mask. Then, every participant was observed positioning both devices on three consecutive occasions. The success rate and insertion times leading to effective positive pressure ventilation (PPV) were recorded. Participants rated the perceived efficiency of the devices using a five‐point Likert scale. Results The I‐gel achieved a 100% success rate on all three occasions, but the face mask was significantly less effective in achieving effective PPV and the failure rates at the first, second and third attempts were 28%, 8% and 20%, respectively. The perceived efficiency of the devices was significantly superior for the I‐gel (4.7 ± 0.4) than the face mask (3.3 ± 0.8). Conclusion The I‐gel was more effective than the face mask in establishing PPV in the manikin, and user satisfaction was higher. These encouraging manikin data could be a stepping stone for clinical research on the use of the I‐gel for neonatal resuscitation in low‐resource settings.

Objective To investigate the feasibility and efficacy of the Ambu® AuraOnce™ laryngeal mask (LMA) compared with endotracheal intubation (ETI) during supratentorial tumor resection in the right lateral decubitus position. Methods This was a randomized controlled trial of LMA compared with ETI in patients who were scheduled to undergo supratentorial tumor resection in the right lateral decubitus position. The patients were randomized to the LMA (n = 40) and ETI groups (n = 40). The hemodynamic parameters (primary outcome) and mechanical ventilation parameters, anesthetic dose, and complications as well as quality of anesthesia recovery (secondary outcomes) were compared. Results Patients in the LMA group exhibited lower mean arterial pressure (MAP) and heart rate (HR) compared with ETI. Nine and two patients received esmolol during intubation and extubation, respectively. The airway pressure (AP) in the LMA group was higher compared with the ETI group 60 minutes after the start of surgery. Compared with the ETI group, the sufentanil dose was lower by 24% and the anesthesia recovery rate was better in the LMA group. Conclusions LMA can improve hemodynamic stability in patients undergoing supratentorial tumor resection in the right lateral decubitus position. If there is a clinical need and no contraindication, LMA could replace ETI.

Laryngeal mask airway (LMA) is often performed for airway management. Correct placement of LMA can prevent severe leaks and even obstruction of the airway. Insertion under laryngoscope guidance has been used to achieve the ideal positioning of the LMA. Efficacy of LMA insertion by laryngoscope can be evaluated with cheap, safe, and easy to use method. This case series evaluates LMA insertion with McGrath video laryngoscope and Macintosh laryngoscope. We use 20 cases to evaluate oropharyngeal leak pressure, time taken for insertion, hemodynamic after insertion, first attempt insertion, ease of insertion, and adverse airway event after LMA insertion.

Background and Aims: Second-generation supraglottic airway devices are widely used in current anaesthesia practice. This randomised study was undertaken to evaluate and compare laryngeal mask airway: ProSeal laryngeal mask airway (PLMA), Supreme laryngeal mask airway (SLMA) and I-gel. Methods: Eighty-four adult patients undergoing elective surgery were randomly allocated to three groups: group P (PLMA), group I (I-gel) and group S (SLMA) of 28 patients each. Insertion times, number of insertion attempts, haemodynamic response to insertion, ease of insertion of airway device and gastric tube, oropharyngeal leak pressure (OLP) and pharyngolaryngeal morbidity were assessed. The primary outcome measure was the OLP after successful device insertion. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0 software using Chi-squared/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests. P < 0.05 was considered statistically significant. Results: The demographic profile of patients was comparable. OLP measured after insertion, 30 minutes later and at the end of surgery differed significantly between the three groups (P < 0.001). The mean OLP was 32.64 ± 4.14 cm·H2O in group P and 29.79 ± 3.70 cm·H2O in group S. In group I, the mean OLP after insertion was 26.71 ± 3.45 cm H2O, which increased to 27.36 ± 3.22 cm H2O at 30 minutes and to 27.50 ± 3.24 cm H2O towards the end of surgery. However, these increases were not statistically significant (P = 0.641). Device insertion time was longest for group P (P = 0.001) and gastric tube insertion time was longest for group I (P = 0.001). Haemodynamic response to insertion and pharyngolaryngeal morbidity were similar with all three devices. Conclusion: PLMA provides better sealing pressure but takes longer to insert. I-gel and SLMA have similar sealing pressures. I-gel insertion time is quicker.

Background: This study aims to evaluate the effectiveness and safety of lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation in hip surgery in the elderly. Methods: Thirty elderly patients who underwent hip surgery under the lower limb nerve block were randomly divided into 2 groups: slow induction of light general anesthesia and tracheal intubation group (group M), and laryngeal mask light general anesthesia group (group H). After undergoing total intravenous anesthesia without muscle relaxants, all patients received sciatic nerve, lumbar plexus, and paravertebral nerve blocks. The hemodynamic situations, dosage of anesthetics, time for awakening and extubation (or laryngeal mask removal), and incidence of respiratory adverse reactions in the induction period were recorded. Results: Compared with baseline levels, the difference in mean arterial pressure (MAP) value at each time point after intubation/laryngeal mask removal in both groups was not statistically significant (P > .05). Furthermore, the time for awakening and extubation/laryngeal mask removal, and anesthetic dosage were significantly decreased in group M, when compared with group H (P

Objective: To evaluate the clinical effects of single femoral nerve block (sFNB) combined with general anesthesia on geriatric patients receiving unilateral total knee arthroplasty (UTKA). Methods: Sixty geriatric UTKA patients who were treated in The First People's Hospital of Changzhou from January 2015 to August 2015 were randomly divided into an sFNB + laryngeal mask airway (FLA) group, an sFNB + tracheal intubation (FGA) group and a tracheal intubation (GA) group. Their clinical parameters and indices were recorded. They were scored by the Visual Analogue Scale (VAS). Results: All patients completed this study. FLA and FGA groups used less propofol, remifentanil and fentanyl than GA group (P

Background Laryngeal mask UNIQUE® (LMAU) is supraglottic airway device with good clinical performance and low failure rate. Little is known about the ideal position of the LMAU on the magnetic resonance imaging (MRI) and whether radiological malposition can be associated with clinical performance (audible leak) in children. The primary aim of the study was to evaluate incidence of the radiologic malposition of the LMAU according to size. The secondary outcome was the clinical performance and associated complications (1st attempt success rate, audible leak) in LMAUs in correct position vs. radiologically misplaced LMAUs. Methods In prospective observational study, all paediatric patients undergoing MRI of the brain under general anaesthesia with the LMAU were included (1.9.2016–16.5.2017). The radiologically correct position: LMAU in hypopharynx, proximal cuff opposite to the C1 or C2 and distance A (proximal cuff end and aditus laryngis) ≤ distance B (distal cuff end and aditus laryngis). Malposition A: LMAU outside the hypopharynx. Malposition B: proximal cuff outside C1-C2. Malposition C: distance A ≥ distance B. We measured distances on the MRI image. Malposition incidence between LMAU sizes and first attempt success rate in trainees and consultant groups was compared using Fisher exact test, difference in incidence of malpositions using McNemar test and difference in leakage according to radiological position using two-sample binomial test. Results Overall 202 paediatric patients were included. The incidence of radiologically defined malposition was 26.2% (n = 53). Laryngeal mask was successfully inserted on the 1st attempt in 91.1% (n = 184) cases. Audible leak was detected in 3.5% (n = 7) patients. The radiologically defined malposition was present in 42.9% (n = 3) cases with audible leak. The rate of associated complications was 1.5% (n = 3): laryngospasm, desaturation, cough. In 4.0% (n = 8) the LMAU was soiled from blood. Higher incidence of radiological malposition was in LMAU 1.0, 1.5 and LMAU 3, 4 compared to LMAU 2 or LMAU 2.5 (p

WOS: 000367513200005, PubMed: 26614141, Objective: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. Methods: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. Results: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 +/- 14.0, 104.3+/-20.5 cm H2O and 105.2 18.4 cm H2O respectively (p >0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 3.9; 3.3 1.1 and 6.6 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. Conclusion: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

WOS: 000379432200014, Jarcho-Levin syndrome (JLS) is a rare disease involving costovertebral anomalies and is accompanied by hydrocephalus, neural tube defect, and cardiac, renal and gastrointestinal problems. Due to respiratory system pathologies, there is a high mortality rate at young ages. Due to its rarity and little information in the literature related to anesthetic practice for this syndrome, we present our anesthetic experience of inguinal hernia surgery in a patient with JLS.

Background and Aims: The ProSeal™ laryngeal mask airway (PLMA) has a soft cuff which tends to fold on itself during insertion, resulting in reduced first-attempt success rate. We compared the standard introducer technique of PLMA insertion with a novel method to prevent folding of the cuff using a Rusch™ Stylet Methods: This randomised superiority trial included 120 American Society of Anesthesiologists I–II patients between 18 and 80 years, undergoing elective surgeries under general anaesthesia using a PLMA for airway management.The PLMA was inserted using the standard introducer tool in sixty patients (Group IT), while in sixty other patients, a Rusch™ Stylet was inserted through the drain tube up to its tip. (Group ST). The primary outcome was first-attempt success rate. Secondary outcomes included overall insertion success, number of attempts, total time to successful insertion, presence of air leaks, haemodynamic response to insertion and quality of fit assessed using Brimacombe's fibre-optic scoring. Continuous variables were compared using independent t-test or Mann–Whitney U-test and categorical variables were analysed using Chi-square test or Fisher's exact test. Results: First-attempt success rate of insertion was higher in Group ST compared to Group IT (95% vs. 82%, P= 0.04). Favourable grade of placement was better in Group ST (86.7% vs. 52.5%, P< 0.001). Overall insertion success rates and haemodynamic responses were comparable between the groups. Conclusions: PLMA insertion using the stylet tool has a higher first-attempt insertion success and superior placement compared to insertion using the conventional introducer tool.

The LMA Protector™ is the latest CE marked single use supraglottic airway device. This airway device provides access and functional separation of the respiratory and digestive tracts. There are two ports (male, female ports) to provide suction in the laryngeal region and insertion of the gastric tube. The aim of our study is to assess the ease of use, airway quality, device positioning, airway leak and complications associated with initial clinical experience in LMA Protector™ usage. This is an initial investigation of LMA Protector™ airway device. We conducted a preliminary assessment in the anaesthetised women who underwent minor gynaecological procedures with spontaneous ventilation in order to evaluate the performance of the airway device. Insertion was successful on first and second attempts in 23 (88.5%) and 3 (11.5%) respectively. Median [IQR (range)] insertion time was 19 [17-21(14-58)] seconds. Airway leak pressure was 25.5 [23-29(21-30] cmH2O. On fibreoptic examination via the device, vocal cords were visible in all 26 patients. There were no alternative airway use or airway manipulations required during maintenance of anaesthesia. Six patients had sore throat 24 h after procedures and there was no dysphagia or hoarseness. This pilot study of the LMA protector shows that the device is easily inserted with fast insertion time, providing a reliable and adequate airway seal. Clinicaltrials.gov Registration NCT02531256 . Retrospectively registered on August 21, 2015.

Summary Objective The aim of this study was to evaluate the practical application and safety of the i-gel and LMA-Supreme laryngeal masks for airway management during pelvic operations in adults. Methods Ninety patients undergoing general anesthesia for elective pelvic operations (ASA Grades I-II) were randomly divided into two groups, the i-gel group and the Supreme group. The laryngeal mask was inserted after induction, and the relevant examination grading indexes were recorded. Results The Supreme group required less time for laryngeal mask insertion and gastric tube indwelling time. Gastric tube indwelling was easier, compared with those in the i-gel group ( p = 0.03), but the i-gel group had fewer complications ( p = 0.03). There were no significant differences in the degree of difficulty in insertion, airway sealing pressure, PETCO 2 , Ppeak, and laryngeal mask alignment accuracy between the two groups ( p > 0.05). There was no statistically significant difference in fibrobronchoscopy grading between the two groups ( p > 0.05). Conclusion The i-gel and LMA-Supreme laryngeal masks are safe and effective for airway management in patients during pelvic operations.

Background Tracheal stent is a good way to maintain a patent airway in case of stenosis. Although anesthesia techniques for the placement of a stent in the trachea of patients with tracheal stenosis have been reported, the management of general anesthesia in patients with a tracheal stent is not well established. Case presentation We report the anesthetic management in the patient with a partly fractured tracheal stent. A 65-year-old man with colon cancer was scheduled for colectomy under general anesthesia. Eight years ago, a tracheal stent was placed because of lung cancer. Preoperative evaluation revealed that a part of the tracheal stent had penetrated the esophagus. We induced general-epidural anesthesia via spontaneous breathing through a laryngeal mask airway to avoid mediastinal emphysema caused by positive pressure ventilation. The patient has been followed up for 2 years without any respiratory complications. Conclusion General anesthesia can be safely induced under spontaneous ventilation through a laryngeal mask airway in a patient with a fractured tracheal stent.

Introduction: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. Material and Methods: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia. These patients were randomly divided into two groups i.e. OPA group and LMA group of 50 patients each. Hemodynamic parameters i.e. systolic blood pressure (SBP) and heart rate (HR) were recorded during exchange of ETT with OPA™ or LMA™. Coughing / bucking during removal of OPA™ and LMA™, and presence of post operative sore throat for both the groups were also graded and recorded. Data within the groups have been analyzed using paired “t” test while those between the groups were analyzed using unpaired “t” test. Chi square test was used to analyze grades of coughing and post operative sore throat. Results: In both groups, hemodynamic parameters rose significantly as OPA™/LMA™ was placed (P < 0.05) and then started declining. Hemodynamic parameters continued to fall in LMA group after extubation. However in OPA group, hemodynamic parameters continued to rise even after extubation and declined only when OPA™ was removed. There was no statistical significant difference between the LMA and OPA group in respect to coughing and post operative sore throat. Conclusion: LMA™ is superior to OPA™ for exchange of ETT as it provides greater hemodynamic stability.

Background: The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-Unique™. Methods: One 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. Results: Successful 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. Conclusions: Rotational 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. Resumo: Justificativa: A técnica de inserção usando a manobra tripla das vias aéreas permitiu a inserção mais rápida da ML. Este estudo comparou três técnicas diferentes de inserção da máscara laríngea Unique™. Métodos: Foram incluídos no estudo 180 pacientes ASA I-II, entre 18-65 anos. Os pacientes foram aleatoriamente designados para grupos de manobra das vias aéreas padrão, rotacional e tripla. No grupo padrão (n = 60), a máscara laríngea (ML) foi inserida com a técnica digital intraoral. No grupo tripla (n = 60), a ML foi inserida com a técnica de manobra tripla das vias aéreas (abertura bucal, extensão da cabeça e elevação da mandíbula). No grupo rotacional (n = 60), a ML foi inserida com a técnica de inserção de trás para frente, como uma cânula de Guedel. Inserção bem-sucedida na primeira tentativa, tempo de inserção bem-sucedida, avaliação por fibra óptica, morbidade das vias aéreas e respostas hemodinâmicas foram avaliados. Resultados: O sucesso da inserção na primeira tentativa foi de 88,3% para o grupo padrão, 78,3% para o grupo rotacional e 88,3% para o grupo tripla. A taxa de sucesso global (definida como inserção bem-sucedida na primeira e segunda tentativas) foi de 93% para o grupo padrão, 90% para o grupo rotacional e 95% para o grupo tripla. O tempo de inserção bem-sucedida foi significativamente menor no grupo tripla (média [intervalo] 8,63 [5-19]s), em comparação com o grupo padrão (11,78 [6-24]s) e o grupo rotacional (11,57 [5-31]s). A avaliação por fibra óptica, a morbidade das vias aéreas e as respostas hemodinâmicas foram semelhantes em todos os grupos. Conclusões: As técnicas de inserção rotacional e de manobra tripla das vias aéreas são alternativas aceitáveis. A técnica de manobra tripla das vias aéreas apresenta taxas mais altas de sucesso global e permite um tempo menor de inserção da ML e, portanto, deve ser considerada em situações de emergência. Keywords: Insertion technique, Laryngeal mask, Supraglottic airway device, Palavras-chave: Técnica de inserção, Máscara laríngea, Dispositivo supraglótico

Background Airway management to ensure sufficient gas exchange is of major importance in emergency care. The accepted basic technique is to maintain an open airway and perform artificial ventilation in emergency situations is bag-valve mask (BVM) ventilation with manual airway management without airway adjuncts or with an oropharyngeal tube (OPA) only. Endotracheal intubation (ETI) is often referred to as the golden standard of airway management, but is associated with low success rates and significant insertion-related complications when performed by non-anaesthetists. Supraglottic devices (SADs) are one alternative to ETI in these situations, but there is limited evidence regarding the use of SAD in non-cardiac arrest situations. LMA Supreme (LMA-S) is a new SAD which theoretically has an advantage concerning the risk of aspiration due to an oesophageal inlet gastric tube port. Methods Forty paramedics were recruited to participate in the study. Adult (>18 years) patients, unconscious due to medical or traumatic cause with a GCS score corresponding to 3–5 and needed airway management were included in the study. Our aim was to study the feasibility of LMA-S as a primary airway method in unconscious patients by advanced life support (ALS) trained paramedics in prehospital care. Results Three regional Emergency Medical Service (EMS) services participated and 21 patients were treated during the survey. The LMA-S was placed correctly on the first attempt in all instances 21/21 (100%), with a median time to first ventilation of 9.8 s. Paramedics evaluated the insertion to be easy in every case 21/21 (100%). Because of air leak later in the patient care, the LMA-S was exchanged to an LT-D in two cases and to ETI in three cases (23.81%) by the paramedics. Regurgitation occurred after insertion two times out of 21 (9.52%) and in one of these cases (4.76%), paramedics reported regurgitation inside the LMA-S. Conclusion We conclude that the LMA-S seems to be relatively easy and quick to insert in unconscious patients by paramedics. However, we found out that there were ventilation related problems with the LMA-S. Further studies are warranted.

The Airtraq (R) Laryngoscope is a novel intubation device which allows visualisation of the vocal cords without alignment of the oral, pharyngeal and tracheal axes. We compared the Airtraq (R) with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty-five anaesthetists were allowed up to three attempts to intubate the trachea in each of three laryngoscopy scenarios using a Laerdal (R) Intubation Trainer followed by five scenarios using a Laerdal SimMan (R) Manikin. Each anaesthetist then performed tracheal intubation of the normal airway a second time to characterise the learning curve. In the simulated easy laryngoscopy scenarios, there was no difference between the Airtraq (R) and the Macintosh in success of tracheal intubation. The time taken to intubate at the end of the protocol was significantly lower using the Airtraq (R) (9.5 (6.7) vs. 14.2 (7.4) s), demonstrating a rapid acquisition of skills. In the simulated difficult laryngoscopy scenarios, the Airtraq (R) was more successful in achieving tracheal intubation, required less time to intubate successfully, caused less dental trauma, and was considered by the anaesthetists to be easier to use.

ResumenSe programa a un paciente afectado por dolor lumbar para la inserción percutánea electiva de un espaciador interespinoso bajo anestesia local en posición prona. A la mitad de la cirugía el paciente presentó dolor severo que le impidió mantenerse quieto, con lo cual fue necesario utilizar anestesia general para terminar la operación. Pudimos insertar con éxito una vía aérea con máscara laríngea clásica en posición prona y la cirugía se llevó a buen término sin problemas.AbstractA patient suffering from low backache was electively posted under local anaesthesia by the surgeon for insertion of percutaneous inter-spinous spacer in lumbar spine in prone position. In the middle of surgery, the patient developed severe pain and was unable to keep still requiring general anaesthesia to complete the operation. We successfully inserted classic laryngeal mask airway in the prone position and the operation was completed uneventfully.

Difficult airway management represents a challenge in anaesthesia. In the last decades airway difficulty awareness has improved as a result of better anticipation and decision-making. Airway algorithms and protocols have a more prominent role in training and in clinical anaesthesia practice. In addition, several new instruments and therefore new techniques have been developed. These have improved possibilities for the clinician to secure the airway. Clinicians should become familiar with this equipment and techniques by using them on a regular basis in elective cases. The instruments available must be selected by the characteristics of the patient population, the local circumstances and the experience of the anaesthesiologist. The aim of this paper is to provide some practical guidelines with respect to airway difficulty predictors and airway instrument choice.

Bedside percutaneous tracheostomy (PCT) for patients in intensive care units (ICU) is gaining popularity. Recently, the use of a laryngeal mask airway (LMA) to facilitate PCT has been described. We present a series of 18 patients where an LMA was inserted prior to PCT. This was successful in all but one patient. PCT could not be performed in this patient as oxygen desaturation had developed after inserting the LMA. The reason for this was probably an oedematous larynx, secondary to long-term intubation. Major bleeding in two patients [one of whom required packed red blood cell (RBC) transfusion] required surgical intervention and two patients had minor bleeding. No complications were related to the insertion or presence of the LMA during PCT, with the exception of the one patient cited above. The use of an LMA during PCT is a method of treatment worth noting in ICU patients. This technique may provide suitable conditions for performing PCT and is free from the complications associated with the presence of an endotracheal tube.

Tomasz Gaszynski Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland Background: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods: Twenty-four super-obese patients (body mass index >50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. Keywords: super-obese, intubation, ventilation, laryngeal mask, standard laryngoscope, video laryngoscope&nbsp

Background: The aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA) with the classic laryngeal mask airway when used by novice personnel. Methods: There were 114 patients enrolled into this study who underwent general anesthesia were randomly allocated into one of 2 groups; LMA group (n = 57) or SLIPA group (n = 57). After insertion, insertion success rate, insertion time, and hemodynamic responses to insertion were accessed. After surgery, postoperative airway morbidity (sore throat, dysphonia, dysphagia) were evaluated. Results: The SLIPA was successfully inserted in 96% of patients (55/57) and the LMA in 93% (53/57) (P = 0.408). First attempt success rates were 88% (44/57) and 77% (50/57) in the SLIPA and the LMA (P = 0.142). The successful insertion time in SLIPA group (33.4 ± 11.0 sec) was significantly shorter than that of LMA group (38.8 ± 16.6 sec) (P = 0.048) and the insertion time at the first attempt was also shorter in SLIPA group (31.0 ± 6.3 sec) than LMA group (34.7 ± 8.6 sec) (P = 0.013). There was no statistically significant difference between the two groups in hemodynamic responses and postoperative airway morbidity. Conclusions: The SLIPA was similar to the LMA in insertion success rate, hemodynamic response, and postoperative airway morbidity by novice personnel. The insertion time at the first attempt and successful insertion time of the SLIPA were significantly shorter than those of the LMA. Therefore, the SLIPA could be a useful alternative to the LMA as primary SGA for novice personnel. (Korean J Anesthesiol 2012; 63: 136-141)

The study aims to compare the performances (ease of insertion, time to establish effective ventilation and maximal inflation pressure) of classic™ (cLMA), ProSeal™ (PLMA) and Supreme™ (SLMA) Laryngeal Mask Airway when used in a neonatal airway management manikin by inexperienced delivery room trainees. The quality of the three devices, as perceived by participants, was also evaluated.Health-care professional trainees were given a brief supervised training with the three devices. Every trainee was then observed positioning each of the three different LMAs in a single occasion. Success rate, time (IT) and maximal inflation pressure (PI(max)) were recorded by a single unblinded observer. A 4-point scale was used to rate participants' perceived quality.A total of 40 health-care professional trainees participated in the study. There were five, three and one failed insertions at the first attempt with the cLMA, PLMA and SLMA, respectively. No failures to establish an effective airway within three attempts were recorded. The success rate at first attempt was comparable among the three devices. The mean IT was significantly lower with the SLMA as compared with PLMA (p0.01), but not to cLMA. The mean PI(max) was higher with SLMA than with cLMA and PLMA (p0.01). The ease of insertion as well as the effectiveness of ventilation were perceived by the participants as superior with SLMA as compared with cLMA and PLMA (p0.01).Neonatal SLMA is superior to PLMA in terms of time to establish effective ventilation; furthermore, maximal inflation pressure and quality perceived by the operator are higher with neonatal SLMA than with cLMA and PLMA. These manikin data could provide a useful guide for planning potential future clinical research involving the newly developed supraglottic device in neonates.

2nd Joint EuroHaptics Conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems -- MAR 22-24, 2007 -- Tsukuba, JAPAN, WOS: 000253449500016, PubMed ID: 18343254, Background: Magnetic resonance imaging (MRI) for pediatric patients often requires deep sedation or anesthesia because they must remain completely immobile for a relatively long period to obtain high-quality images. Objective: The aim of this study was to compare the effectiveness of propofol IV or inhalation of sevoflurane anesthesia with the laryngeal mask airway (LMA) for children undergoing MRI. Methods: Children aged 2 to 6 years with American Society of Anesthesiologists' physical status of I to 11 who were scheduled for MRI were enrolled in this study and randomly divided into 2 groups. The propofol group was administered propofol 4 mg/kg IV followed by infusion of 150 mu g/kg . min(-1). Patients in the sevoflurane group were induced with sevoflurane 8% by face mask and maintained with an air/oxygen mixture followed by sevoflurane 1.5%. Data recorded included age, weight, scan time, LMA insertion, removal, and recovery times, hemodynamic parameters, complications, pediatric anesthesia emergence delirium (PAED) scale score, child movement, and MRI interruption. A higher PAED score indicated a higher level of delirium. Results: Eighty-eight children were enrolled and randomized to treatment. Nine children were excluded from analysis due to protocol violations. After completion of the study, there were 37 children in the propofol group (male/female, 18/19; mean [SDI age, 42.1 months; weight, 15.2 [4.9] kg; scan time, 20.5 [4.6] min) and 42 in the sevoflurane group (male/ female, 15/27; mean [SDI age, 44.4 [26.1] months; weight, 15.1 [5.2] kg; scan time, 20.6 [4.8] min). No significant differences were found between the study groups with regard to age, weight, scan time, and hemodynamic parameters at baseline and during the study period. Mean LMA insertion, removal, and recovery times were significantly longer in the propofol group (4.8, 5.2, and 8.8 minutes, respectively) than in the sevoflurane group (3.3, 2.5, and 3.9 minutes, respectively) (P < 0.05). The mean PAED score in the propofol group was significantly lower than that in the sevoflurane group (mean [SDI, 6.1 [4.0] vs 10.5 [3.7]; P < 0.05). The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group (4 [11%] vs 0, respectively; P < 0.05). No episodes of hypotension or bradycardia occurred during the study, and alterations in the propofol infusion rate or sevoflurane concentration were not necessary. One child vomited in the sevoflurane group during the postoperative period. Conclusions: This small study found that sevoflurane, at the doses used in this study, provided shorter induction and faster recovery times than IV propofol for LMA anesthesia in these selected children undergoing MRI. The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group. Sevoflurane was associated with a significantly higher score on the PAED scale, indicating greater emergence delirium., Virtual Real Soc Japan, IEEE, IEEE Robot & Automat Soc, IEEE TCVG

Patients with tracheal stenosis have a high incidence of difficult or failed tracheal intubation. Airway management with the laryngeal mask airway during fibreoptic laryngoscopy was used in two children with acquired subglottic stenosis during spontaneous breathing. The laryngeal mask airway may be superior to tracheal intubation or use of a face mask during anaesthesia management in severe subglottic stenosis. Ventilation may be improved and the use of a laryngeal mask airway can reduce or eliminate some of the problems associated with the other methods of airway management, such as further damage to stenotic tissue and gastric distention.

Congenital laryngeal stenosis is a rare condition, which can be diagnosed in the early neonatal period. Manifest stenosis can be life threatening. Severe ("critical") types of stenosis require securing an adequate airway just after the birth, as well as early tracheotomy as a life-saving procedure. This paper presents a case report of a preterm newborn with severe laryngeal stenosis diagnosed at birth. It was not possible to secure the airway even with endotracheal tubes of the smallest diameter, thus a laryngeal mask (LMA) was placed to provide adequate ventilation and oxygenation. Anaesthesia was administered in the same way during the tracheotomy procedure, which was performed in the earliest hours of the baby's life.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:21:43Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:33:47Z : No. of bitstreams: 1 2-s2.0-31144471478.pdf: 63088 bytes, checksum: f4f8b5af93b0c0badc46b0f0ee28cfd3 (MD5) Made available in DSpace on 2014-05-27T11:21:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-01 CET-SBA Departamento de Anestesiologia Universidade Estadual Paulista, Botucatu, São Paulo , Distrito de Rubiao Junior s/no, Botucatu, SP 18618-970 CET-SBA Departamento de Anestesiologia Universidade Estadual Paulista, Botucatu, São Paulo

Laryngeal mask is a supraglothic instrument for ventilation of patients who are under anesthesia. Insertion of laryngeal mask requires maintaining sufficient depth of anesthesia to avoid airway reflex (gagging, coughing and spasms). The present study investigated two techniques of anesthesia with propofol-atracurium and thiopental-atracurium to facilitate insertion of the laryngeal mask, term of recovery and postoperative nausea and vomiting. In this prospective, randomized and double-blinded clinical trial, 224 patients undergoing elective laparoscopic class ASA one and two were studied. Patients were divided into two groups of 112 patients - one group with propofol anesthetic and thiopental-atracurium. Then after the induction of anesthesia neuromuscular hemodynamic changes, airway reflex (gagging, coughing and spasms), the ease of insertion of laryngeal mask and the frequency of patient movements' were recorded. The data were analyzed by SPSS V.18. Results indicated that anesthetic technique with propofol-atracurium provides better and more comfortable condition for insertion of laryngeal mask significantly (P

Background and objective: To compare the application of the cuffed oropharyngeal airway and the laryngeal mask airway on anaesthetized adult patients undergoing minor outpatient surgery. Methods: One hundred patients received intravenous fentanyl, propofol and N2O for the induction and maintenance of anaesthesia. The patients were randomly divided into two groups: a cuffed oropharyngeal airway group (n = 50) and a laryngeal mask airway group (n = 50). After insertion of the device, fibreoptic laryngoscopy was attempted and the degree of success scored. We then compared the first application success rate of both procedures while judging airway intervention requirement, fibreoptic scores, adverse airway events and haemodynamic tolerance. Results: Both devices had an almost similar first-time placement rate (cuffed oropharyngeal airway 84% versus laryngeal mask airway 96%). The cuffed oropharyngeal airway required a higher number of airway interventions (P < 0.001). The laryngeal mask airway had a significantly better fibreoptic view compared with the cuffed oropharyngeal airway (P < 0.001). However, the number of adverse airway events was lower in the cuffed oropharyngeal airway group; there were no significant differences in adverse events and haemodynamic variables between the said two groups. Conclusions: The results suggest that the cuffed oropharyngeal airway was an effective alternative airway in spontaneously breathing patients during short procedures.