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Background: Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy., Method: Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed., Results: Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67)., Conclusion: For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ankylosing spondylitis (AS), a type of chronic spondyloarthritis, significantly increases patients' risk of cervical spine fracture. We describe the anesthetic management of a 32-year-old male with AS who was scheduled to have bilateral mandibular third molar extractions under general anesthesia. To minimize the potential for cervical spine damage, a laryngeal mask airway was used for airway management while the patient's head was held firmly during surgery. Additionally, he developed a postoperative surgical infection that was attributed to his continued immunotherapy with infliximab. In patients with AS, postoperative infection control as well as cervical spine protection throughout the perioperative period is important., (© 2022 by the American Dental Society of Anesthesiology.)

Objective: Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management., Methods: A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I2 statistic. Sensitivity and age-subgroup analyses were explored., Results: Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I2 = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I2 = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I2 = 0%; moderate quality)., Conclusion: Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required., (© 2021 by the American Dental Society of Anesthesiology.)

Background: Rapid Sequence Airway (RSA) describes the administration of an induction agent and paralytic followed by the intended primary placement of an extraglottic airway device rather than an endotracheal tube. The purpose of this study was to determine the success rates for prehospital RSA. The secondary goal was to determine aspiration rates among patients managed with RSA., Methods: Adult and pediatric prehospital RSA cases between 2005 and 2017 reported to an airway quality assurance registry from one ground and one air agency were reviewed. Success was defined as the ability to adequately ventilate patients after extraglottic device placement. Aspiration was defined as radiologic evidence (chest x-ray or CT scan) within 48 hours of hospital presentation., Results: 68 patients underwent RSA with a King LTS-D (n = 24), LMA-Supreme (n = 28), Combitube (n = 2), LMA-Unique (n = 8) and iGel (n = 6). Age ranged from 1 year to 73 years with 10 patients less than 18. RSA was successful in 64 (94%) cases; 56 (88%) were successful on first pass and 63 (98%) within 2 attempts. The RSA procedure occurred in an aircraft in 14 (21%) of cases and 71% of patients were in cervical precautions. Duration of EGD insertion prior to hospital arrival ranged from 5 to 102 minutes with an average of 34.5 minutes. Aspiration data was available for 46 patients of whom 4 (8.7%) were found to have evidence of aspiration., Conclusion: Overall and first pass RSA success rates were high and aspiration rates were low in this quality assurance registry despite predictors of airway difficulty. RSA may be a reasonable alternative to RSI for prehospital airway management that merits further research.

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a "cannot intubate, cannot ventilate" scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices., (© 2021 by the American Dental Society of Anesthesiology.)

Purpose: Patients undergoing tonsillectomy and adenoidectomy traditionally receive anesthesia with endotracheal intubation (ETT) for airway management. The laryngeal mask airway (LMA) may be used instead and may be associated with less airway stimulation and shorter operating room times. The purpose of this study was to report on a large cohort of patients undergoing tonsillectomy and/or adenoidectomy while using the LMA for airway maintenance during anesthesia., Methods: Patients undergoing tonsillectomy and adenoidectomy between January 6, 2017 and January 6, 2020 with a LMA were reviewed for safety outcomes. We compared two cohorts of patients with LMA and ETT to analyze the effect on operating room times., Results: Our study identified 1042 patients who met criteria for review. The incidence of cases requiring conversion to ETT (1.2%) and laryngospasm (0.3%) in our cohort is lower than previously suggested by the literature. The patients who underwent surgery with the LMA spent less time in the operating room (p = 0.004) compared to the ETT group., Conclusion: The use of the LMA may be a safe and effective option for airway management during tonsillectomy and adenoidectomy. There may be a benefit of OR time reduction in patients undergoing anesthesia with an LMA compared to ETT., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In a case of sudden cardiac arrest (SCA) in a health facility there is a procedure to summon a resuscitation team. Nurses are obliged to begin cardiopulmonary resuscitation with chest compressions and implement ventilation using the bag valve mask of 30:2 compressionventilation ratio. Nurses are not allowed to implement methods of advanced airway management. However, the laryngeal mask airway (LMA) was designed for people inexperienced in intubation who would be able to provide advanced airway management quickly and effectively after a short training. It is advisable to check how nurses, who in case of SCA are often the first responders, deal with advanced airway management., Aim: The aim of the study was to evaluate the quality of ventilation using the bag valve mask and the LMA Air-Q SP by professionally active nurses., Materials and Methods: The study was conducted on a 38-person group of professionally active nurses working or affiliated with the District Health Care Facility in Piotrków Trybunalski. After a short pre-training lecture the nurses were assigned to ventilate the manikin with the bag valve mask (BVM) using 30:2 compressionventilation ratio and then asynchronously with the use of the LMA Air-Q SP., Results: The average time elapsed from the beginning of CPR to the onset of ventilation was 18 ± 5,4 s. as for the BVM and 16,15 ± 4,4 s regarding the LMA. Minute ventilation achieved with the BVM was 3,47 ± 1,43 l / min, and in case of the LMA it amounted 5,54 ± 1,73 l / min. There was no case of gastric insufflation in case of the LMA, while as for the BVM it occurred in five cases. There are very few studies focused on the LMA Air-Q SP, but some research (Jagannathan, Alexandera or Gruber) devoted to the use of the LMA in nurses, demonstrate that ventilation with the use of the LMA is effective and ensure more appropriate ventilation parameters than with the use of the BVM., Conclusions: The nurses achieved better ventilation results when using the LMA. Attempts to insert the LMA were shorter than in case of the BVM., (© 2018 MEDPRESS.)

Objectives: Airway management during adenoidectomy is traditionally performed through endotracheal intubation (ETT). Laryngeal mask airway (LMA) may be less stimulating to the airway and allow for shorter overall operating room time. Previous studies report LMA use during adenotonsillectomy. There has been no prior evaluation of LMA use during adenoidectomy alone. In this study, we attempt to identify the rate and contributing factors of LMA failure during adenoidectomy., Methods: All pediatric patients undergoing adenoidectomy between January 1, 2016 and June 30, 2017 were reviewed. Demographic and clinical data were collected and analyzed to determine the need for conversion to ETT and the occurrence of any complications., Results: Our study revealed 139 pediatric patients who underwent adenoidectomy during the study period. 110 patients had adenoidectomy performed with LMA and 27 patients had ETT. Two patients (1.8%) required conversion to ETT because of difficulty with ventilation when the mouth gag was in place. There were no complications. Mean operating room time was 20 min less in the LMA group (P < 0.05)., Conclusions: The use of an LMA in adenoidectomy may be a safe and effective alternative to ETT. More study is required to determine overall complication rates., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Study Objective: A few randomized trials have compared LMA Supreme™ with LMA ProSeal™ and i-gel™ in children but their conclusions varied widely. This systematic review and meta analysis has compared the former device with the latter two devices., Design: Meta-analysis and systematic review using the Mantel-Haenszel method and pooled mean difference using inverse variance method., Setting: Meta-analysis of published prospective randomized controlled trials., Patients: Paediatric patients undergoing surgery under general anaesthesia., Intervention: LMA Supreme™ with LMA ProSeal™ or i-gel™ as airway management device., Results: Electronic database searching revealed four randomized trials where LMA Supreme™ has been compared with LMA ProSeal™ and three trials where a comparison was made between LMA Supreme™ and i-gel™ in paediatric population. LMA Supreme™ provided similar oropharyngeal leak pressure when compared to LMA ProSeal™ [mean difference (95% CI) 1.57 (-1.33, 4.47)cm H 2 O; p=0.29] and i-gel™ [mean difference (95% CI) 1.18 (-2.11, 4.47)cm H 2 O; p=0.48]. First insertion success rate is also similar when LMA Supreme™ is compared to LMA ProSeal™ [RR (95% CI) 1.03 (0.97, 1.1); p=0.74] and i-gel™ [RR (95% CI) 0.99 (0.95, 1.03); p=0.51]. Device insertion is significantly faster with LMA Supreme™ than i-gel™ [mean difference (95% CI) 1.87 (0.93, 2.81) s; p<0.0001]., Conclusion: We suggest that LMA Supreme™ may be an alternative to LMA ProSeal™ and i-gel™ in children for airway management during general anaesthesia., (Copyright © 2017. Published by Elsevier Inc.)

Objective: The use of pneumoperitonium and the placement of patients in Trendelenburg position are commonly cited reasons for the potential development of intraoperative regurgitation of gastric contents and the need for an endotracheal tube in laparoscopic surgery. The main objective of the current investigation was to evaluate the presence of regurgitation of gastric contents in the oropharynx of patients having laparoscopic gynecological surgery with a laryngeal mask airway (LMA)., Design: Prospective, observational clinical investigation., Interventions: Not applicable., Measurements: Healthy subjects having a laparoscopic gynecological surgery under general anesthesia with a ProSeal LMA were included in the study. An insufflation pressure of 15 mm Hg was established as the maximum intra-abdominal pressure for the pneumoperitonium, and patients were placed in Trendelenburg position at a 15° angle. The pH of secretions extracted from subjects' hypopharynx was measured at multiple time points during the surgical procedure. A pH of oropharynx secretions ≤4.1 indicated the regurgitation of gastric contents., Main Results: Eighty subjects were recruited and completed the study. The median (range) of pH measurements at any time (T3-T9) was 6.5 (5.5-7.0). The median (range) for the lowest pH for each subject was 6.0 (5.5-7.0). The lowest detected pH in the hypopharynx was not correlated (Spearman ρ) with total surgical time (P = .9), total pneumopertitonium time (P = .17), or total Trendelenburg position time (P = .47)., Conclusions: Our current results suggest that the use of an LMA in healthy patients undergoing laparoscopic gynecological surgery may be safe. Future studies to confirm or refute our findings are warranted., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The sniffing position (neck flexion by head elevation and head extension) is commonly used for insertion of a laryngeal mask airway. However, the appropriate degrees of head elevation and head extension are unclear. In the present study, the success rate of ProSeal™ laryngeal mask airway (LMA ProSeal) insertion using two degrees of head elevation was evaluated., Methods: This prospective randomized, controlled study included 80 adult patients aged 18 to 90 years. In the 3 cm (n = 40) and 6 cm (n = 40) groups, the LMA ProSeal was inserted while the head was elevated 3 cm and 6 cm, respectively, using a pillow of the corresponding height. The success rate, and incidence of blood staining on cuff, sore throat and hoarseness were assessed. The alignments of laryngeal and oral axes were also evaluated., Results: The first attempt success rate was higher in the 3 cm than the 6 cm group (87 % vs. 60 %, P = 0.014). In 86 % of patients in the 6 cm group and 50 % of patients in the 3 cm group in whom the second attempt failed, the third insertion attempt was successful by using a pillow height of the opposite group. The alignments of the two axes were not different between the two groups (P > 0.05)., Conclusions: The first attempt success rate of ProSeal laryngeal mask insertion was higher with 3 cm than 6 cm head elevation in adult patients., Trial Registration: Identifiers: NCT02058030 (08/05/2015), Unique Protocol ID: phdkim1.

Introduction: The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia., Methods: 150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety., Results: Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel., Conclusion: The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme., (Copyright: © Singapore Medical Association.)

Aim: We aimed to compare the effects of three different supraglottic airway devices, the classic LMA, PLA, and V-gel, on hemodynamics and QTc in rabbits under general anesthesia., Method: The rabbits were divided into four groups: Group C (n=5) control group with no airway device used, Group L (n=5, classic LMA), Group P (n=5, CobraPLA) and Group V (n=5, V-gel-rabbit). Basal values of heart rate (HR), mean arterial pressure (MAP) and ECG for QTc interval were measured and the measurements were evaluated at 1, 5, 15, and 30 minutes after inserting the airway device, Results: The values of HR, MAP and QTc in Group V at minutes 1 and 5 were significantly different to those in Group L and Group P (p<0.05)., Discussion: The classic-LMA and cobraPLA cover a wide part of the perilaryngeal area with cuffs inflated to about 60 cmH2O of pressure resulting in mucosal compression. As V-gel rabbit does not have a cuff, it covers a smaller part of the laryngopharyngeal area, and thus does not cause mucosal compression, and the hemodynamic response is weaker., Conclusion: When comparing hemodynamic responses to other supraglottic airway devices, the response to V-gel rabbit is minimal and we consider that similar studies using the I-gel on humans are required (Fig. 5, Ref. 31).

Objective The aim of this study was to explore North American neonatal health care professionals' (HCPs) experience, confidence, skill, and training with the laryngeal mask airway (LMA). Study Design This was a cross-sectional survey. Results The survey was completed by 2,159 HCPs from Canada and the United States. Seventy nine percent had no clinical experience with the LMA, and less than 20% considered the LMA an alternative to endotracheal intubation (EI). The majority had received LMA training; however, 28% of registered nurses, 18% of respiratory therapists, 17% of physicians, and 12% of midwives had never inserted an LMA in a mannequin. Less than a quarter of respondents agreed that the current biennial Neonatal Resuscitation Program instruction paradigm is sufficient for LMA training. All groups reported low confidence and skill with LMA insertion, and compared with all other groups, the respiratory therapists had the highest reported confidence and skill. Conclusion This survey study, which is the first of its kind to include midwives, demonstrates that neonatal HCPs lack experience, confidence, skill, and training with the LMA, rarely use the device, and in general, do not consider the LMA as an alternative to EI. These findings contribute to, and support the findings of previous smaller studies, and in conjunction with the diminishing opportunities for EI, highlight the need for programs to emphasize the importance of the LMA for neonatal airway management and prioritize regular LMA training, with focus that parallels the importance placed on the skills of EI and mask ventilation. Key Points Lack of training for laryngeal mask airway use in neonatal resuscitation. Neonatal health care professionals rarely use the laryngeal mask airway as an alternate airway device. Neonatal health care professionals lack confidence and skill with the laryngeal mask airway. [ABSTRACT FROM AUTHOR]

Fiberoptic bronchoscopy in children requires sedation, while routinely employed techniques for oxygenation under sedation don't provide airway protection. LMA during FOB can provide safer ventilation with good operative views. Although the use of laryngeal mask airway for FOB was described in 1982, its application has not been established in pediatric patients. The aim of our study was to compare the safety and efficacy of LMA-assisted bronchoscopy compared to nasal airway with oxygenation-assisted bronchoscopy. The study was conducted on 12 patients, 6 in each group. Data collected includes monitoring of oxygen saturation, hemodynamics, ETCO2, and complications. LMA group children had lower episodes of desaturation as compared to nasal airway group. ETCO2 values were maintained and rate of complications were less in LMA group. Hemodynamic stability in both groups were comparable. Hence the use of LMA allows better airway conduit, with stable O2 saturation and ETCO2 values than nasal airway-assisted bronchoscopy. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and endotracheal intubation is the commonest method of securing a definitive airway for administering anaesthesia. However, it is associated with tachycardia and hypertension and an increase in intraocular pressure. Various pharmacologic and non-pharmacologic methods have been tried to limit the pressure responses and intraocular pressure changes following the insertion of endotracheal tube. One such attempt is the use of laryngeal mask airway, which has been shown to be an effective means of securing a clear airway in fasting patients for elective surgery. Its insertion requires neither the visualization of cords nor the penetration of larynx, making the placement less stimulating than tracheal tube insertion and it may provoke less sympathetic response and catecholamine release Methodology: Sixty patients, of 18-60 years of age, of either sex undergoing elective surgical procedures at Kidwai Memorial Institute of Oncology, Bangalore requiring general anaesthesia were selected randomly. The study was conducted in our institute from December 2019 to February 2021. Patients were randomly divided into 2 groups. In Group 1, appropriate size of LMA was inserted blindly without laryngoscopy using standard technique whereas in Group 2, appropriate size of endotracheal tube was used to intubate trachea under direct laryngoscopy using macintosh laryngoscope. Results: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. Conclusion: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. There was statistically significant rise in hemodynamic parameters and IOP following laryngoscopy and intubation. [ABSTRACT FROM AUTHOR]

INTRODUCTION- Laryngeal mask airway (LMA), which is a useful alternative for airway management during spontaneous or controlled ventilation. It can also be used for difficult airway management and emergency resuscitation especially by untrained personnel .It is also found to be useful in many patients to provide general anaesthesia. Supraglottic airway devices also eliminate many other problems associated with tracheal intubation. AIMS AND OBJECTIVES:-To observe the hemodynamic response and ease of insertion of cLMA, proseal LMA or I-GEL in terms of:-* Attempts required for supraglottic device insertion * Duration required for supraglottic device insertion * Ease of insertion * Hemodynamic responce during insertion To observe any adverse effect during cLMA, proseal LMA or I-GEL insertion. MATERIAL AND METHODS:-It is an observational hospital based study conducted at Department of Anaesthesiology Gandhi Medical College and associated Hamidia Hospital, Bhopal M.P., from January 2020 to July 2021. A total of 75 patients were included in study and divided into three groups (25 each). OBSERVATION AND RESULTS:-The mean time taken for device insertion in group1 was17.56±1.66seconds, in group 2 it was 19.56±1.66 seconds and in group 3 it was 12.36±2.08seconds. The insertion time in group 3(I-gel group) was shorter than other 2groups which was statistically significant with p<0.0001. DISCUSSION:- In our study, the mean insertion time for classic LMA was 17.56±1.66 secs, for P-LMA it was 19.56±1.66 sec and for I gel it was 12.36±2.08 secs which was shortest among the 3 devices and difference was statistically significant (p value <0.0001). This significant shorter time to insert I gel as compared to classic LMA or proseal LMA could be attributed to the absence of an inflatable cuff in I-gel and anatomically designed thermo elastic laryngeal mask. Similar results were found in study of Reyhan polat et alwho compared I-gel and classic LMA and found insertion time for I-gel was 11.6±2.4 sec and for classic LMA it was 13.1±1.8 sec, Anjan D et alwho compared I gel and proseal LMA and found insertion time for I gel was 14.9 secs and for proseal LMA it was 20 secs, Gaurav C etal who compared I gel and proseal LMA and found insertion time for I gel was 11.12±1.81 secs and in proseal LMA it was 15.13±2.91 secs. CONCLUSIONS:-From this study we concluded that all the devices classic LMA, proseal LMA and I--gel are safe and effective supraglottic airway devices, whereas I-gel is relatively easier and faster to insert when compared to classic LMA and proseal LMA . Insertion is smooth without any trauma to anatomical structures in both I-gel and classic LMA with majority being inserted in the first attempt in all three groups. [ABSTRACT FROM AUTHOR]

Objectives: Uncertainty about the effect of age on the success rate of laryngeal mask airway (LMA) insertion led us to conduct the present study to evaluate the success rate of LMA in airway management in different age groups. Materials and Methods: A total of 183 patients, who were admitted to Shohada hospital (Tabriz, Iran) during 2018-2019, were enrolled in this descriptive, cross-sectional, prospective study. The patients were selected through the convenience sampling method and divided into 4 age groups. After anesthesia, patients were compared in terms of duration and number of LMA insertion attempts and LMA insertion complications. The data were analyzed using SPSS20 through one-way ANOVA and the Chi-square test at P < 0.05). Results: There were significant statistical differences between different age groups regarding resistance against LMA insertion (P = 0.008) so that insertion was most comfortable and easy in the first attempt in the adult group compared to other groups. However, no significant statistical difference was observed between different groups in terms of the rate of air leakage (P = 0.129), the duration of successful LMA insertion (P = 0.119), and the number of LMA insertion attempts (P = 0.091). Regarding LMA insertion complications, laryngospasm was significantly higher in the middle-age and aged group (P = 0.009), and blood observation on LMA was significantly higher in the pre-school and child group (P = 0.005). Conclusions: According to the results of this study, no difference was found between different groups in terms of successful LMA insertion and post LMA insertion complications. [ABSTRACT FROM AUTHOR]

Background & Objective: With the extensive use of the laryngeal mask airway (LMA) for anesthesia as well as in emergency airway management, learning alternative techniques of insertion is essential for the safe and quick use of the device in some cases. The smooth and quick insertion of LMA leads without repeated attempts reduce the consequent complications. We compared standard technique with 180° rotation with inflated cuff technique for LMA Classic insertion. Methodology: This study was done in Basrah University Medical Center from 1st January 2019 to 31st December 2019. During this period, in 397 patients LMA was used for general anesthesia. Out of these, in 197 patients we used 180° rotation technique of insertion of LMA with fully inflated cuff and in 200 patients the standard method was used as a control group. The patients' ages ranged between 15 and 45 y, and they were scheduled to undergo short surgical procedures and to require general anesthesia. Results: Three hundred and ninety-seven (397) participants were enrolled in this study with a mean age of 35.7 ± 14 y. Of those, 154 (38.8%) were males. The new method showed higher sensitivity and accuracy rate (97.4%, 95.9%, respectively) compared to the standard method. Conclusion: The new method is a suitable technique that enhanced the ease of LMA insertion and successfully placed the device within a shorter time without complications compared to the standard method of insertion. [ABSTRACT FROM AUTHOR]

Background: Laryngeal mask airway (LMA) is a useful airway device which provides an alternative to ventilation through a face mask or endotracheal tube during ophthalmic surgery. It can be removed either when a child awakens or deeply anesthetized. But there is little evidence for best practice on the timing of their removal after ophthalmic surgery in the pediatric population. It has been studied by various investigators but with conflicting results and conclusions. Objective: The aim of this study was to evaluate the effect of depth of anesthesia (awake or deep anesthesia) on the incidence of airway associated complications during LMA removal. Methodology: A prospective observational cohort study was conducted from January to April 2018. Sixty-two American Society of Anesthesiologists physical status I and II pediatric (aged 2– 8 years) patients who underwent ophthalmic procedures under general anesthesia with LMA were recruited. Grouping (awake group or deep group) was done based on independent decision of on duty anesthetist and halothane 1– 1.5% was used as maintenance anesthesia. The incidence of airway-related adverse events like coughing, upper airway obstruction (Laryngospasm), breath holding, desaturation, excessive salivation, biting, vomiting, and retching with LMA removal were evaluated. Collected data were entered into Epi Info™ version 7.0 and transported to the SPSS version 22 for analysis. Fisher's exact test and Chi-square test were used to analyze dependent variables and P-values less than 0.05 were considered statistical significance. Results: There were no significant differences in airway-related adverse events. The incidence of coughing (12.9%, 6.5%), upper airway obstruction (41.9%, 35.5%), breath holding (9.7%, 3.2%), desaturation (16.1%, 22.6%), excessive salivation (19.4%, 12.9%), and biting (6.5%, 0%) between awake and deep groups respectively with (p > 0.05). Laryngospasm, vomiting, and retching did not occur in either group. Conclusion: There was no significant difference in the incidence of airway-related adverse events whether the LMA was removed in a deep or awake condition. [ABSTRACT FROM AUTHOR]

Background: Airway maintenance procedures during anesthesia are usually associated with a rise in intraocular pressure (IOP). This is an important issue especially in vulnerable patients. In the present study we compared the rise in IOP with two different group of airway devices i.e. Laryngeal mask airway Supreme (LMA-S) and endotracheal intubation (ETT) using C-MAC® videolaryngoscope (VLS). Methodology: The present study was conducted on 100 adult patients of ages >18 yrs, of either sex, belonging to American Society of Anesthesiologist (ASA) I and II, scheduled to undergo non-ophthalmic elective surgery under general anesthesia. Patients were divided into two equal groups of 50 each, Group A and Group B. In group A (n = 50), lubricated appropriate sized LMA-S was inserted and in Group B (n=50), lubricated appropriate sized ETT was inserted by an anesthesiologist using VLS. IOP was measured in right eye just before insertion of device and subsequently at 1 min, 3 min, 5 min and 10 min after insertion of device. Hemodynamic parameters were recorded along with IOP measurement. Results: Both the groups were comparable regarding demographic data (p > 0.05), ASA grade (p = 0.069), and Mallampati grade (MPG) (p = 0.646). Airway establishment time (p = 0.011) was significantly less with C-MAC VLS. IOP were comparable at all measurement times, e.g., 1 min (p = 0.216), 3 min (p = 0.093), 5 min (p = 0.859) and 10 min (p = 0.060) after insertion of each device. Hemodynamic parameters measured were also comparable between two groups (p > 0.05). Conclusion: Both LMA Supreme and intubation using C-MAC® videolaryngoscope are safe regarding rise in intraocular pressure. Both methods can be safely used for airway management in suitable patients. [ABSTRACT FROM AUTHOR]

Objectives: The laryngeal mask airway is used for provision of anesthesia for various surgical procedures as well as in emergency management of airway. It is a useful rescue tool in cases of failed intubation. Its insertion is associated with lesser complications. With advancement in medical equipment new versions of LMA with additional benefits are available. In this study evaluation of frequency of excellent LMA insertion conditions with use of ketofol or propofol as induction agent has to be evaluated. Purpose of the study is to identify which agent will provide favourable conditions for insertion, with least complications. Study Design: Randomized control trial. Setting: Departments of Anesthesia and Intensive Care Allied Hospital and Aziz Fatimah Hospital, Faisalabad. Period: From 01-01-2017 to 30-06-2018. Material & Methods: Approval from ethical review committee was obtained. 230 children presenting for elective surgery were enrolled into study using non-probability consecutive sampling. Two groups consisting of 115 each were generated by randomization. Group P received propofol and Group PK received 2:1 propofol ketamine mixture. Ease of LMA insertion was assessed on the basis of degree of muscle relaxation and adverse reactions to LMA insertion. Data was collected and analysed using SPSS version 18. Results: Results were presented in terms of frequency of excellent LMA insertion conditions. It showed that ketofol provides better LMA insertion as compared to propofol alone with p value of 0.007, which is significant. Conclusion: The study concluded that use of ketofol provides excellent insertion conditions for LMA insertion in children presenting for elective surgery. [ABSTRACT FROM AUTHOR]

In this study, we aimed to compare the efficacy of laryngeal mask airway (LMA) versus endotracheal tube in the early rescue surfactant administration in premature neonates with respiratory distress syndrome (RDS). This randomized, clinical trial evaluated 60 premature neonates with RDS. Numbered envelopes randomly assigned 30 neonates to the intervention group to receive 2.5 ml/kg/dose surfactant (Curosurf) via LMA and 30 to the control group to receive 2.5 ml/kg/dose surfactant via an endotracheal tube using the INSURE technique, exclusively during the first two hours of life. There were no differences in the requirement for mechanical ventilation (23.3% vs. 20%, P=0.75), requirement for second dose surfactant (13.3% vs. 6.7%, P=0.67), bronchopulmonary dysplasia (13.3% vs. 6.7%, P=0.67), pneumothorax (6.7% vs. 0%, P=0.49), and intraventricular hemorrhage (10% vs. 10%, P=1) between neonates who received surfactant via LMA versus those who received surfactant via endotracheal tube. LMA seems to be an effective and less invasive alternative to endotracheal intubation for surfactant delivery in premature neonates with RDS. [ABSTRACT FROM AUTHOR]

Introduction The most common methods for maintaining a free airway during anesthesia in children are the traditional airway without a cuff, COPA - airway, laryngeal mask airway and endotracheal tube. In contrast to the main methods of maintaining the airway, the LMA and COPA-airway began to be widely used relatively recently. Therefore, one of the main tasks of our work was to assess the comparative effectiveness and safety, to determine the advantages and disadvantages, to develop recommendations for their use. Material and methods Depending on the type of airway control, patients were randomized into 3 groups: (n = 66) - children with an endotracheal tube, (n = 26) - children with a laryngeal mask (LMA), (n = 67) - children with COPA airway. The installation of LMA and COPA - airway we carried out only after reaching the surgical stage of anesthesia, when the laryngeal and pharyngeal reflexes disappeared. Results a study conducted on this issue shows that LMA, COPAairway and endotracheal intubation are effective and safe means of maintaining the free flow of the respiratory tract in children with general anesthesia. The main differences between them are only in the degree of protection of the respiratory tract from aspiration, simplicity and invasiveness of the method, and convenience and comfort for the anesthesiologist. Compared with endotracheal intubation with a cuffed tube, when the child's airway is as tight as possible and protected, when using LMA and COPAairway, the risk of aspiration is not excluded and the probability of gas leakage increases. When using LMA and COPA-airway there is a time limit for the duration of the operation. They can be used only for short and medium duration operations. Conclusions Laryngeal mask and COPA-airway are a new concept of airway management. Compared with a face mask and a conventional duct, LMA and COPA-airway provide greater tightness between the upper respiratory tract and anesthesia apparatus, allow you to safely manage anesthesia "at a distance" reduce the release of gaseous anesthetics to the environment. [ABSTRACT FROM AUTHOR]

Objectives Airway management during adenoidectomy is traditionally performed through endotracheal intubation (ETT). Laryngeal mask airway (LMA) may be less stimulating to the airway and allow for shorter overall operating room time. Previous studies report LMA use during adenotonsillectomy with conversion rates to ETT of up to 17%. There has been no prior evaluation of LMA use during adenoidectomy alone. In this study, we attempt to identify the rate and contributing factors of LMA failure during adenoidectomy. Methods All pediatric patients undergoing adenoidectomy between January 1, 2016 and June 30, 2017 were reviewed. Demographic and clinical data were collected and analysed to determine the need for conversion to ETT and the occurrence of any complications. Results Our study revealed 139 pediatric patients who underwent adenoidectomy during the study period. 110 patients had adenoidectomy performed with LMA and 27 patients had ETT. Two patients (1.8%) required conversion to ETT because of difficulty with ventilation when the mouth gag was in place. There were no complications. Mean operating room time was 20 min less in the LMA group (P < 0.05). Conclusions The use of an LMA in adenoidectomy may be a safe and effective alternative to ETT. More study is required to determine overall complication rates. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at evaluating the use of LMA for resuscitation in the delivery room among newborn infants whom positive pressure ventilation (PPV) by bag and mask had failed. Materials and methods: This is a single center, prospective, unblinded, randomized clinical trial of LMA ventilation versus ETT on neonates during resuscitation upon delivery at Ain Shams Maternity Hospital during the period between January 2012 and January 2015. The Study included 80 newborns delivered in the Maternity hospital, Ain Shams University with gestational age of 34 weeks or more who needed neonatal resuscitation in the delivery room which was performed according to the current guidelines for neonatal resuscitation by the American Academy of Pediatrics. Results: In Our Study, there was significant correlation between the LMA and the ETT as both of them succeeded to achieve adequate ventilation of the resuscitated infants. Both groups showed statistical significant improvement between their Oxygen saturation at 1 minute & at 5 minutes. The ETT showed more improvement as the mean difference between 1 & 5 minutes was -27.4±3.07 compared to - 26.5±3.4 among the LMA, but with insignificant difference between both groups. Comparison between Apgar score at 1 & 5 minutes in both groups is apparent, which showed statistical significant improvement in the 2 groups. However, the ETT group showed more improvement (although non-significant) as the mean difference between 1 & 5 minutes was -5.02±0.9 compared to -4.6±0.7 among the LMA group. Conclusion: The Laryngeal Mask Airway can be used as an efficient and successful alternative to endotracheal intubation in newborns > 2000 Gms who require neonatal resuscitation. [ABSTRACT FROM AUTHOR]

Introduction: Laryngeal Mask Airway(LMA) insertion requires a certain depth of anaesthesia to blunt the airway reflexes. Propofol alone causes undesirable hemodynamics effects and suboptimal LMA insertion condition. So this study was designed to compare the hemodynamics and insertion conditions when Ketamine or Fentanyl was combined with Propofol for induction. Methods: In this study, sixty ASA PSI(American Society of Anesthesiologists Physical Status) patients undergoing various surgical procedures under LMA were assigned to three groups; Group K, Group F and Group S who received 0.5 mg/kg of Ketamine, 1 μg/kg Fentanyl and Normal saline respectively before receiving Propofol 2.5 mg/kg after which LMA insertion was done. Arterial blood pressure and heart rate were measured at various intervals. LMA insertion conditions were graded under different parameters to calculate LMA insertion summation score. Result: Significant difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was seen between Gr K and Gr S after successful LMA insertion and after 2 mins of insertion. Significant difference in SBP was seen in between Group K and Group F (p=0.01) after successful LMA insertion. The median summed score describing the LMA insertion condition was significantly better in Ketamine [7.0 (6.0-7.5)] and Fentanyl [7.0 (6.0-7.0)J in comparison to Saline [ 8.5 (8.0-11.0)] Conclusion: During LMA insertion, adding Ketamine to Propofol provides stable hemodynamics in comparison to using Propofol. Addition of either Ketamine or Fentanyl to Propofol provides equally good conditions during LMA insertion than using Propofol alone. [ABSTRACT FROM AUTHOR]

Background: The sniffing position (neck flexion by head elevation and head extension) is commonly used for insertion of a laryngeal mask airway. However, the appropriate degrees of head elevation and head extension are unclear. In the present study, the success rate of ProSeal™ laryngeal mask airway (LMA ProSeal) insertion using two degrees of head elevation was evaluated. Methods: This prospective randomized, controlled study included 80 adult patients aged 18 to 90 years. In the 3 cm (n =40) and 6 cm (n =40) groups, the LMA ProSeal was inserted while the head was elevated 3 cm and 6 cm, respectively, using a pillow of the corresponding height. The success rate, and incidence of blood staining on cuff, sore throat and hoarseness were assessed. The alignments of laryngeal and oral axes were also evaluated. Results: The first attempt success rate was higher in the 3 cm than the 6 cm group (87 % vs. 60 %, P = 0.014). In 86 % of patients in the 6 cm group and 50 % of patients in the 3 cm group in whom the second attempt failed, the third insertion attempt was successful by using a pillow height of the opposite group. The alignments of the two axes were not different between the two groups (P> 0.05). Conclusions: The first attempt success rate of ProSeal laryngeal mask insertion was higher with 3 cm than 6 cm head elevation in adult patients. [ABSTRACT FROM AUTHOR]

Introduction: The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.Methods: 150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.Results: Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.Conclusion: The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Many recent studies have shown the use of Laryngeal Mask Airway (LMA) inAdenotonsillectomy but not in Dacryocystorhinostomy (DCR) surgery in paediatric age group. So, this study was carried out to evaluate the safety of LMA use in Pediatric External Dacryocystorhinostomy performed under General Anaesthesia. MATERIAL AND METHOD:This retrospective study was carried out by collecting the data of 96 children with American Society of Anesthesiologists (ASA) physical status 1 from Lumbini Eye Institute (Memorandum of Understanding with UCMS), Bhairahawa, Nepal from September 2008 to June 2014 to find out any significant cardiorespiratory complications associated with the use of LMA. RESULTS: This study foundno significant cardio-respiratory complications during insertion and after removal ofLMA. Though airway obstruction and laryngospasm had occurred in few children, it was easily managed by bag and mask ventilation. Time taken to shift the patients from Operation Theatre to Post Anaesthesia Care Unit (PACU) was also less, average 13 minutes. CONCLUSION: This study showed that LMA can safely be used in children undergoing External Dacryocystorhinostomy under general anesthesia with the use of intermittent suctioning and without any interruption in surgery. [ABSTRACT FROM AUTHOR]