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Unlabelled: We compared the cuffed oropharyngeal airway (COPA) with the laryngeal mask airway (LMA) in 120 anesthetized adult patients. We compared 1) placement success rates, 2) airway interventional requirements, 3) airway stability in different head/neck positions, 4) cardiorespiratory tolerance, and 5) intra- and postoperative adverse events/symptoms. A standardized anesthesia protocol was followed by four anesthesiologists experienced with both devices. Observational data were validated by independent analysis of continuous video recordings. Postoperative interviews were double-blind to the device used. The LMA had a more frequent success rate than COPA (97% vs 55%, P < 0.00001), an overall higher success rate (100% vs 83%; P = 0.001), a shorter time to achieve an effective airway (49 vs 188 s; P < 0.00001), a higher oropharyngeal leak pressure (21 vs 16 cm H2O; P = 0.003), and a fewer number of chin lift airway interventions required (0.1% vs 42%; P < 0.00001). When comparing mean tidal volumes in different head/neck positions to assess airway stability, the quality of airway was unchanged in 98% patients with the LMA and 54% with the COPA (P < 0.00001). The incidences of intraoperative adverse events were similar. On removal, blood was detected more often on the COPA (3% vs 14%; P = 0.04). In the late postoperative period, more patients complained of adverse symptoms with the COPA than with the LMA (26% vs 57%; P = 0.001). Late postoperative symptoms occurred more frequently with the COPA (0.87 vs 0.34; P = 0.003). There was more late postoperative sore throat (14% vs 36%; P = 0.0003) and more jaw/neck pain (12% vs 26%; P = 0.0008) in patients managed with the COPA. This study demonstrates that the LMA offers advantages over the COPA in most technical aspects of airway management and in terms of postoperative morbidity., Implications: In this randomized, prospective study, we compared the laryngeal mask airway and the cuffed oropharyngeal airway in anesthetized patients. The laryngeal mask airway offers advantages in most technical aspects of airway management and in terms of postoperative morbidity.

We determined the outcome of acute rheumatic fever in 85 children from North India who had received regular antistreptococcal prophylaxis after their first attack. By the end of the 5-year follow-up, 33 patients had rheumatic heart disease. Mitral insufficiency, the most common valvular lesion, appeared in 91% of the patients, whereas mitral stenosis developed in only 18%. Initial carditis, congestive heart failure, cardiomegaly or moderate-to-severe mitral insufficiency significantly increased the risk of rheumatic heart disease (p less than 0.001). The recurrence rate of acute rheumatic fever in children who received continuous prophylaxis was 0.006 per patient-year. Most recurrence (92%) mimicked the first attack and produced further cardiac damage in five patients with carditis and in one patient with chorea. Cardiac status during the first attack of rheumatic fever and the continuity of prophylaxis were the major determinants of outcome. Statistical comparisons disclosed that with continuous prophylaxis, the prevalence rate, evolution and clinical spectrum of the sequelae of acute rheumatic fever in children from India do not differ significantly from those in the West.