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The omphalocele is an abdominal wall defect at the base of the umbilical cord, with the worldwide prevalence of 2.6 per 10,000 births. Omphalocele contains herniated abdominal organs and is classified in small and giant based on the size of the defect. Omphalocele is associated with several syndromes or structural anomalies. We reported a case of giant omphalocele of 6 cm with right lung agenesis with tracheal and right bronchial hypoplasia. Laryngeal mask stabilized the newborn allowing endotracheal intubation. Due to serious malformations, the newborn died after few hours of life for cardio-respiratory arrest. Early and accurate prenatal diagnosis allows a better intervention strategies in delivery room, improving the chances of survival and reducing complications for infants with omphalocele., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The cornerstone of treatment for respiratory distress syndrome in preterm infants is surfactant administration, traditionally performed through an invasive procedure involving tracheal intubation and mechanical ventilation. Consequently, there has been a growing interest in exploring less invasive methods of surfactant delivery to mitigate the associated risks. Currently, several techniques are under evaluation, including intratracheal instillation using a thin catheter, aerosolized or nebulized administration, and guided administration by supraglottic airway devices. One such method is surfactant administration through laryngeal or supraglottic airway, which involves placing a laryngeal mask without the need for laryngoscopy and administering surfactant through the device. The simplicity of laryngeal mask insertion could potentially streamline the surfactant delivery process, eliminating the necessity for advanced skills. This narrative review aimed to assess the current evidence in the literature regarding the benefits and risks associated with surfactant administration through a laryngeal supraglottic airway., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Supraglottic airways (SGAs) are used during general anesthesia (GA) due to comfort. Certain complications are possible, such as gastric distension. The incidence of pulmonary aspiration of regurgitated gastric contents was found to be 0.02%. A difference in the incidence of gastric regurgitation was not identified between the use of SGAs and endotracheal intubation. We report a case of gastric distension and atelectasis in a patient in whom an I-gel® was used for GA., Case: A 63-year-old female patient underwent triple arthrodesis on her ankle under GA using an SGA (I-gel® size 3). After surgery, she suffered from nausea and abdominal bloating. A chest radiograph revealed that a large amount of air in her stomach had caused gastric distention, which resulted in left hemidiaphragm elevation and atelectasis., Conclusions: This case illustrates that the use of I-gel® in prolonged surgeries may result in malposition of the SGA and gastric insufflation and atelectasis.

For preterm infants with respiratory distress syndrome, delivery of surfactant via brief intubation (INtubate, SURfactant, Extubate; InSurE) has been the standard technique of surfactant administration. However, this method requires intubation and positive pressure ventilation. It is thought that even the short exposure to positive pressure inflations may be enough to initiate the cascade of events that lead to lung injury in the smallest neonates. In an effort to avoid tracheal intubation and positive pressure ventilation, several alternative and less invasive techniques of exogenous surfactant administration have been developed over the years. These have been investigated in clinical studies, including randomized clinical trials, and have demonstrated advantages such as a decrease in the need for mechanical ventilation and incidence of bronchopulmonary dysplasia. These newer techniques of surfactant delivery also have the benefit of being easier to perform. Surfactant delivery via pharyngeal instillation, laryngeal mask, aerosolization, and placement of a thin catheter are being actively pursued in research. We present a contemporary review of surfactant administration for respiratory distress syndrome via these alternative methods in the hope of guiding physicians in their choices for surfactant application in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

To determine the effects of peak inspiratory pressure (PIP)-guided intracuff pressure (ICP) modulation of laryngeal mask airway (LMA) Supreme™ during laparoscopic cholecystectomy. Totally 120 patients were randomly divided using computer-generated numbers into a control group (n = 60; ICP, 60 cmH2O) and a PIP group (n = 60), in which ICP was increased with 5 cmH2O each time from PIP level until no air leaks from the oropharynx. PIP, ICP, cuff volume (CV), oropharyngeal leak pressure (OLP) and leak fraction (LF) were recorded before and after pneumoperitoneum establishment. Postoperative pharyngolaryngeal complications (sore throat, dysphagia, pharyngeal hematoma, and dysphonia) were also recorded. Demographic data were similar in the two groups. The CV and ICP before and after pneumoperitoneum were significantly lower in the PIP group (CV: 15.6 ± 2.3 mL and 21.0 ± 2.6 mL; ICP: 14.3 ± 2.9 cmH2O and 20.5 ± 3.4 cmH2O) than in the control group (CV: 33.0 ± 2.8 mL and 32.8 ± 1.9 mL; ICP: 60.0 ± 0.1 cmH2O and 60.0 ± 0.1 cmH2O) (P < 0.05). Although OLP was lower in the PIP group (P < 0.05), the LF was similar in the two groups (P > 0.05). There were fewer postoperative pharyngolaryngeal complications in the PIP group (P < 0.05). Compared with a fixed ICP of 60 cmH2O, PIP-guided ICP modulation during LMA Supreme™ use provided effective airway sealing at a lower CV and ICP, and produced fewer postoperative pharyngolaryngeal complications in patients undergoing laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Intratracheal tumors account for approximately 0.2 % of respiratory tumors, including primary and secondary tumors. Secondary tumors of the upper trachea are most commonly derived from advanced thyroid cancer. Surgical resection is currently the general curative modality for thyroid cancer with tracheal invasion. Patients with tracheal tumors invading and protruding into the lumen may have reduced oxygen reserve capacity, leading to a shorter safe window for general anesthesia induction. Establishing an appropriate artificial airway is essential to ensure intraoperative safety for these patients. Here, we report a case of tracheal tumor caused by differentiated papillary thyroid carcinoma invading the upper segment of the trachea and the non-conventional approach used for intraoperative airway management without traditional endotracheal intubation. A 59-year-old female presented with bilateral neck masses and hemoptysis. The CT scan revealed suspicious malignant thyroid nodules, and tracheoscopy showed an approximately 50 % obstruction of the tracheal lumen. The patient's physical examination and biochemical examination showed no significant abnormalities. Based on imaging studies and pre-anesthetic assessment, a multidisciplinary team decided against performing endotracheal intubation in the patient due to the risk of tumor bleeding during the procedure. Instead, they opted for a modified endotracheal tube and the insertion of a laryngeal mask airway (LMA). The anesthesia induction and maintenance proceeded smoothly, with stable intraoperative hemodynamics. The tumor was successfully resected and tracheal anastomosis was performed without any complications. The strategy adroitly evades the risk of bleeding and dislodgement due to tumor contact during the intubation process. In this case report, the anesthetic highlight is the employment of a reverse insertion technique for endotracheal intubation, facilitated by a sterile suction catheter and complemented by an innovative modification to the tracheal tube. For patients with thyroid cancer invading the upper segment of the trachea, and in whom rapid induction anesthesia is anticipated not to cause tumor collapse, the use of laryngeal mask airway combined with modified tracheal tube mechanical ventilation is both safe and feasible. • Tracheal tumors pose challenges for ventilation while avoiding bleeding and dissemination risks. • Supraglottic airway devices (LMAs) are safe alternatives for ventilation in tracheal tumor cases. • Innovative techniques like reverse insertion and retrograde suction catheter insertion minimize risks during intubation. • Our case presents a rare occurrence of differentiated papillary thyroid carcinoma invading the trachea, resulting in an endogenous tracheal tumor. [ABSTRACT FROM AUTHOR]

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 The laryngeal mask airway (LMAⓇ) ProtectorTM (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff PilotTM technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring. Case We report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case. Conclusions This case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff PilotTM technology is not a panacea for potential cranial nerve injury after airway manipulation.

BACKGROUND: Laryngeal mask airway is a supraglottic airway device with an inflatable cuffforming a low-pressure seal around the laryngeal inlet and permitting ventilation. Thei-gel is a novel supraglottic airway device made of thermoplastic elastomer which is soft,gel-like and transparent. Unlike conventional LMA, it does not have an inflatable cuff.The present study was undertaken to compare the performance oftwo supraglottic airway devices classic laryngeal mask airway and i-gel in anesthetized,paralyzed adult patients posted for elective surgeries under general anesthesia. METHODS : One hundred patients, scheduled for various elective surgical procedures undergeneralanesthesia belonging to ASA class I and II were included in the study and wererandomly divided into two groups with 50 patients in each group. In Group 1 (n=50), I gelsupraglottic airway device was used and Group 2 (n=50) classic laryngeal maskairway was used. Both the devices were compared concerning the ease of insertion, the number of insertion attempts, time of insertion, airway leak pressure, hemodynamic changes, intraoperative and postoperative complications. RESULTS : There was no statistically significant difference between the devices concerning ease of insertion and the number of attempts of insertion. The mean airway leak pressurewith igel was significantly higher as compared with c-LMA 26.38±2.76 and19.7±2.10 cm H2O, respectively. The mean time of insertion for i-gel was17.12±3.42 secs which was significantly shorter compared to c-LMA with a meaninsertion time of 25.62±5.28 secs. There were no statistically significantdifferences in hemodynamic changes and the postoperative complications between thedevices CONCLUSION : Both i-gel and c-LMA are easy to insert and provide an effective airway during positive pressure ventilation, with i-gel providing a better airway sealing pressure as compared to c-LMA

Abstract Background Obstetric dfficult airway is a leading cause of maternal morbidity and mortality. The laryngeal mask airway (LMA) is often used as a rescue airway device after failed intubation, however, little is known about predictors of difficult LMA insertion, particularly in obstetrics. Since Mallampati scores of III/IV has been associated with difficult tracheal intubation, our present study aims to investigate if Mallampati score (MP) could predict airway outcomes for LMA use in obstetrics. Methods This prospective cohort study was performed at a single-center: Quanzhou Women’s and Children’s Hospital, Fujian Province, China. Five hundred and eighty-four parturients undergoing elective cesarean section under general anesthesia were recruited. The primary outcome was time to effective ventilation, and secondary outcomes included first attempt insertion success, seal pressure, ventilation and hemodynamic parameters, occurrence of clinical aspiration, and maternal and fetal outcomes. Results The parturients were classified into two groups based on MP of III/IV (High MP: 61) versus I/II (Low MP: 523). BMI was higher in the High MP group than in the Low MP group (mean (SD) 29.3 (7.0) vs 26.8 (3.1), p

Abstract Background Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. Methods A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. Discussion Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur. Trial registration ClinicalTrials.gov. Identifier: NCT03133572. Registered April 28, 2017.

Background and Aims: The use of newer supraglottic devices has been extended to laparoscopic procedures. We conducted this study to compare and evaluate the efficacy of these two devices in pediatric laparoscopic surgeries. Material and Methods: Eighty children, 2–8 years of age, scheduled for elective short laparoscopic procedures were randomly allocated to the I-gel or endotracheal tube (ETT) group. Standard anesthesia protocol was followed for inhalational induction. I-gel or ETT was inserted according to the manufacturer's recommendations. Ventilation was set with tidal volume 10 ml/kg and a respiratory rate of 16/min. Carboperitoneum was achieved up to an intra-abdominal pressure of 12 mmHg. Statistical Analysis: The primary outcome variable was adequacy of ventilation (peak airway pressure, end-tidal CO2, minute ventilation, and SPO2). These variables were recorded after securing airway, after carboperitoneum and desufflation of the peritoneal cavity. The oropharyngeal leak pressures were also noted. Statistical analysis was done using SPSS software version 17.0. P

Background and Aims: Newly developed supraglottic airway devices (SGAs) are designed to be used both for ventilation and as conduits for endotracheal intubation with standard endotracheal tubes (ETTs). We compared the efficacy of the Ambu AuraGain (AAG) and the newly developed intubating laryngeal tube suction disposable (ILTS-D) as conduits for blind and fiber-optically guided endotracheal intubation in an airway mannequin. Material and Methods: This is a prospective, randomized, crossover study in an airway mannequin, with two arms: blind ETT insertion by medical students and fiber-optically guided ETT insertion by anesthesiologists. The primary outcome variable was the time to achieve an effective airway through an ETT using AAG and ILTS-D as conduits. Secondary outcome variables were the time to achieve effective supraglottic ventilation and successful exchange with an ETT, and the success rates for blind endotracheal intubation and fiber-optically guided intubation techniques for both SGAs. Results: Forty participants were recruited to each group. All participants were able to insert both devices successfully on the first attempt. For blind intubation, the success rate for establishing a definitive airway with an ETT using the SGA as a conduit was significantly higher with ILTS-D (82.5%) compared with AAG (20.0%) (P < 0.001). None of the participants were able to successfully complete the exchange of the SGA for the ETT with the AAG. In the fiber optic guided intubation group, the rate of successful exchange was significantly higher with ILTS-D (84.6%) compared with AAG (61.5%) (P = 0.041). Conclusion: The ILTS-D successfully performs in an airway mannequin with higher success rate and shorter time for blindly establishing an airway with an ETT using the SGA as a conduit, compared with AAG. Further clinical trials are warranted.

Aim. The aim of the study was to assess the effectiveness of selected methods of alternative airway management by nursing staff. Material and methods. A prospective, pilot observational study was conducted on a group of 51 nurses undergoing specialization training or with specialty. Each nurse managed the airway with a laryngeal mask (LMA-Laryngeal Mask) and a laryngeal tube (LT-D-Laryngeal Tube) on a BT-CSIE trainer, and then carried out one minute ventilation using a bag valve mask, according to possessed knowledge and skills. The obtained parameters (time, pressure on the incisors, head tilt, ventilation quality) were recorded using a dedicated tablet. Statistical analysis was performed using the IBMSPSS Statistics 20 package. Results. No statistically significant differences were observed between the trials to open the airway using LMA and LT-D. Higher efficiency of LMA airway opening was demonstrated in the first trial and the average tidal volume during ventilation in relation to LT-D (LMA 547.84ml vs. LT-D 522.63ml). In addition, there was a significant difference in pressure on the incisors (LMA 6.82N vs. LT-D 4.12N). Conclusions. The effectiveness of LMA and LT-D insertion was assessed at a high level, with no significant differences between them. Variables: age, seniority, education level and type of specialization did not significantly differentiate the results obtained. [ABSTRACT FROM AUTHOR]

Background and Aims: The Laryngeal Mask Airway (LMA) Protector™ is one of the latest introduced supraglottic airway devices. It provides access and functional separation of the respiratory and digestive tracts. Compared to the LMA Supreme™, it has two digestive ports, one to provide suction in the pharyngeal region and one for gastric tube insertion. High oropharyngeal leak pressure is a marker for safe ventilation when using LMA devices. We hypothesized that oropharyngeal leak pressure of the LMA Protector™ is 5 cm H2O higher than the oropharyngeal leak pressure of the LMA Supreme™ at various cuff volumes. Secondary outcome measures were ease of insertion of both masks, fiberoptic confirmation of correct positioning, failures of insertion, presence of blood staining, sore throat, presence of air leak and insertion time. Material and Methods: American Society of Anesthesiologists (ASA) I-III patients aged >18 years, scheduled for elective minor ambulatory surgery under general anesthesia with a LMA were included. Patients were randomized in the LMA Protector™ or LMA Supreme™ group based on a computer-generated random sequence table. After general anesthesia induction, oropharyngeal leak pressures were measured. Results: Oropharyngeal leak pressures were significantly higher (P < 0.0001) for LMA Protector™ compared to LMA Supreme™ at different cuff volumes and a cuff pressure of 65 cm H2O. Insertion time was significantly higher for the LMA Protector™ (29 sec) [interquartile range (IQR) 23, 35] compared to the LMA Supreme™ (19 sec) (IQR 16, 22) (P < 0.0001). There were no statistically significant differences in ease of insertion (number of attempts for succesful positioning), failures of insertion, presence of blood staining, sore throat or presence of air leak. Conclusion: Oropharyngeal leak pressures were consistently higher (>5 cm H2O) for LMA Protector™ compared to LMA Supreme™. LMA Protector™, therefore, allows effective ventilation at higher airway pressures than LMA Supreme™. Trial Registration: http://clinicaltrials.gov.NCT03462550. [ABSTRACT FROM AUTHOR]

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.

Published reports of uvular necrosis are uncommon and it is possibly an under-reported complication of oropharyngeal manipulation. Uvular necrosis is thought to develop due to ischaemia secondary to mechanical compression of the uvula from oropharyngeal devices. Patients typically present with symptoms of a sore throat within 48 hours postoperatively. It is unclear whether there are any preventable factors, or any specific management strategies that might reduce this complication. Treatment is most commonly conservative management, including observation and simple analgesia. We present 13 cases of uvular injury that were reported to a web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand. While the postoperative findings varied, sore throat was the most frequent symptom. Most of the cases resolved spontaneously; the remainder with supportive treatment only. The findings suggest that patients who sustain a uvular injury can be reassured, but they should be advised to seek review early if sore throat persists or any difficulty with breathing develops. [ABSTRACT FROM AUTHOR]

Introduction: Due to the high sensitivity, eye surgeries should have the least irritating reactions after anesthesia. On the other hand, due to the fact that the laryngeal mask is less irritated, using this device is always a good choice in cataract surgery. Postoperative stimulation the present study was designed to compare the two methods of using Lubricant gel, lidocaine gel during laryngeal mask airway (LMA) on hemodynamic symptoms and anesthesia reactions in patients undergoing cataract surgery. Materials and Methods: This randomized double-blind clinical trial study was performed on 120 patients undergoing cataract surgery. Patients were randomly divided into 60 equal groups of lidocaine gel and lubricant gel. Systolic and diastolic blood pressure, heart rate and arterial oxygen saturation before and immediately after induction 5 minutes after surgery 15 minutes after surgery, 30 minutes after surgery and were calculated in recovery. Episodes of cough, sore throat, nausea and vomiting in recovery, 2, 6, 12 and 24 hours after surgery were also recorded in the ophthalmology department. Results: The findings of the present study indicated that the groups were not significantly different in terms of demographic characteristics. There was no significant difference between cough, nausea and heart rate and oxygen saturation rate of arterial blood 30 minutes after surgery and recovery in the airway of the laryngeal mask after its exit, but in sore throat and saturation of arterial blood hemoglobin there is a significant difference. The intensity of sore throat in the lidocaine group decreased and the oxygen saturation of arterial blood increased in the 15 minutes after surgery in the lidocaine group. Conclusion: The results showed that in general, the use of lidocaine could be effective in reducing the severity of sore throat after surgery compared to lubricant, although no significant difference was observed between other variables; it is recommended in future studies in surgery and Caesar with more facilitators for LMA. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the efficacies of four anesthetic induction drugs (thiopental, propofol, midazolam-thiopental, and etomidate-propofol) on cardiovascular response during laryngeal mask airway (LMA) placement in eye surgery. Materials and Methods: The present clinical trial study included 128 patients who were candidates for ophthalmic surgery in four groups. Patients in the first group were given a combination of midazolam (0.04 mg/kg) with thiopental (2.5 mg/kg) (Group T + M). We administered propofol alone (2.5 mg/kg) to patients in the second group (Group P). The third group received a combination of etomidate (0.1 mg/kg) with propofol (1 mg/kg) (ET + P group) and patients in the fourth group received thiopental drug (5 mg/kg) alone (Group T). Then, the stability of patients' hemodynamic parameters before anesthesia was evaluated and compared immediately after anesthesia, 1, 3, and 5 min after LMA placement. Results: There was no significant difference between the four groups in changes in oxygen saturation level (P > 0.05). Furthermore, the difference between decreased systolic blood pressure and diastolic blood pressure over time was not significant in 5 min in both Groups T + M and T (P > 0.05). In addition, the stability of these two groups was higher than the other two groups (P < 0.05) and the most unstable group was Group P. The changes pulse rate in the P group were significant (P < 0.05). Conclusion: According to the results of the current study, thiopental and Midazolam can be used as an effective induction compound to facilitate LMA insertion with higher hemodynamic stability compared to propofol alone, propofol and etomidate, and thiopental alone.

Abstract 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

Objectives: This study aimed to compare the effcacy of surfactant administration by laryngeal mask airway (LMA) and endotracheal intubation in the management of respiratory distress syndrome (RDS) in preterm infants. Materials and Methods: In a prospective interventional study in NICU at Al-Zahra hospital, 50 premature infants with gestational age of 33-37 weeks and birth weight of 1800 g or more who needed surfactant replacement therapy for RDS were randomly allocated to 2 groups. Twenty-fve neonates in ETT group received surfactant by endotracheal intubation and the LMA were used for the administration of surfactant in 25 neonates (LMA group). Results: The mean gestational age in LMA group was 32.88±1.32 and it was 33.76±2.12 weeks in ETT group (P=0.15). The mean RDS score was not statistically different 2 two groups, 7.68±0.80 vs. 7.24±1.17 (P=0.79). Mechanical ventilation was needed for 1 neonate in the LMA group and 3 infants in the ETT group (P=0.16). After surfactant administration, the mean FiO 2 requirements to maintain oxygen saturation between% 88 to 92% showed a statistically signifcant decrease in both groups. The needed FiO2s were 0.60±0.12 and 0.57±0.12 before surfactant therapy and decreased to 0.42±0.15 and 0.36±0.10 after surfactant administration in LMA and ETT groups, respectively (P

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.

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.

The AIRWAYS-2 cluster randomised controlled trial compared the i-gel supraglottic airway device (SGA) with tracheal intubation (TI) as the first advanced airway management (AAM) strategy used by Emergency Medical Service clinicians (paramedics) treating adult patients with non-traumatic out-of-hospital cardiac arrest (OHCA). It showed no difference between the two groups in the primary outcome of modified Rankin Scale (mRS) score at 30 days/hospital discharge. This paper reports outcomes to 6 months. Paramedics from four ambulance services in England were randomised 1:1 to use an i-gel SGA (759 paramedics) or TI (764 paramedics) as their initial approach to AAM. Adults who had a non-traumatic OHCA and were attended by a participating paramedic were enrolled automatically under a waiver of consent. Survivors were invited to complete questionnaires at three and six months after OHCA. Outcomes were analysed using regression methods. 767/9296 (8.3%) enrolled patients survived to 30 days/hospital discharge and 317/767 survivors (41.3%) consented and were followed-up to six months. No significant differences were found between the two treatment groups in the primary outcome measure (mRS score: 3 months: odds ratio (OR) for good recovery (i-gel/TI, OR) 0.89, 95% CI 0.69–1.14; 6 months OR 0.91, 95% CI 0.71–1.16). EQ-5D-5L scores were also similar between groups and sensitivity analyses did not alter the findings. There were no statistically significant differences between the TI and i-gel groups at three and six months. We therefore conclude that the initially reported finding of no significant difference between groups at 30 days/hospital discharge was sustained when the period of follow-up was extended to six months. [ABSTRACT FROM AUTHOR]

Aim: The appropriate anesthetic technique to be used in cases of proximal hypospadias in children is a subject of debate. Local or regional anesthesia as well as intubation can be used. In this study, it was aimed to evaluate retrospectively the different anesthesia and surgery techniques used and their perioperative outcomes in the cases of proximal hypospadias consulting our hospital. Materials and Methods: The hospital files of 30 cases operated on for proximal hypospadias were scanned retrospectively to evaluate the different methods of anesthesia and repair surgery implemented. The patients operated under general anesthesia were grouped on the basis of the airway equipment used for anesthesia as Laryngeal mask airway (Group 1) and endotracheal intubation (Group 2). Routine penile block implementation, effectiveness of anesthesia, side effects, hemodynamic changes and complications in all patients were recorded. Results: A total of 56 sessions of operations on 28 patients were carried out. In 26 of the session’s laryngeal mask and in 30 sessions endotracheal intubation were used. When the data of Group 1 and Group 2 were compared, the groups did not differ significantly with respect to age, anesthesia methods and duration, hypospadias repair methods, duration and sessions, intraoperative parameters, hospital stay and complications (all p>0.05). The two groups differed on the ASA physical status classification values with Group 2 values being significantly higher (p<0.05). Conclusion: Effectiveness of anesthesia by using LMA or endotracheal intubation were perioperatively equivalent during repair of proximal hypospadias with different methods of surgery. [ABSTRACT FROM AUTHOR]

Introduction: Cataract surgery is a short operation and in this type of operation, a laryngeal mask can be used instead of a tracheal tube, which has less complications. However, withdrawal reactions from anesthesia and the persistence of hemodynamic instabilities due to the sensitivity of eye surgery are still being studied. The aim of this study was to compare the effect of lubricant gel and normal saline during laryngeal airway mask on hemodynamic stability and reactive symptoms of withdrawal from anesthesia was performed in patients undergoing cataract surgery. Methods and Materials: This randomized double-blind clinical trial study was performed on 120 patients undergoing cataract surgery. Patients were randomly divided into two equal groups of normal saline and lubricant gel. Systolic and diastolic blood pressure, heart rate and arterial blood oxygen saturation were measured before and immediately after induction, 5, 15 and 30 minutes after surgery, and in recovery. Also, episodes of cough, sore throat, nausea and vomiting were recorded in recovery, 1, 6, 12 and 24 hours after surgery in the ophthalmology ward. Results: The findings of the present study showed that the study groups did not differ significantly in terms of demographic characteristics. There was no significant difference between the number of coughs and nausea and heart rate in the airway of the laryngeal mask after its extraction. However, there was a significant difference between the two groups in terms of arterial blood oxygen saturation at 15 and 30 minutes after surgery and in recovery. So that the rate of oxygen saturation of arterial blood in 15 (P = 0.049)) and 30 minutes after surgery (P = 0.008) and in recovery (P = 0.007) of was increased in the normal saline group. Conclusion: The results of this study showed that the use of lidocaine gel to facilitate airway implantation has no effect on cough, postoperative sore throat. It is suggested that in future studies to investigate this issue in surgery with more facilitators for LMA. [ABSTRACT FROM AUTHOR]

Providing a secure airway management during general anesthesia could be problematic in some medical cases, especially when there is a risk of regurgitation and aspiration of the gastric content due to increased intragastric pressure. The current study aimed to test the applicability of two types of LMA in several animal species and to compare its effectiveness to the endotracheal intubation method in securing sealed airway respiration as an alternative to using endotracheal tubes. The study was conducted in dogs (n=33), cats (n=9), swine (n=9), rabbits (n=5), sheep (n=7) and roe deer (n=1). One or both types of laryngeal masks were used for each animal species: LMA Classic™-cLMA and LMA ProSeal?-PLMA. The assessment of each laryngeal mask was performed by determining the insertion technique, the possibilities of first-attempt insertion and malposition, the compliance with various animal species, ventilation time, cuff pressure, and sealing capacity. The highest LMA size compatility in dogs (23,87±14,30 kg) was size-3 in six and size-4 in forteen subjects; In swine (43,22±12,32 kg), size-4; In rabbits (3,84±0,36 kg) size-1; and in sheep (48,29±4,65 kg) size-3 and size-4. Ventilation time was highest in swine and roe deer (121,11±42,85 min and 300,00 min, respectively) and lowest in cat (28,33±16,96 min). First-attempt LMA insertion success was lowest in rabbits (60%), and highest in sheep and roe deer (100%). Malposition was with highest rate in rabbits (40%) and lowest in cat, sheep and roe deer (0%). Gastric reflux was most frequently observed in sheep (71,4%) and roe deer (100%). The usage of LMA in the veterinary anesthetic practice significantly improves airway management in animals during general anesthesia. The inflated LMA cuff does not prevent its disposition. Therefore, both the drain and respiratory tubes must be fixed. The usage of LMA in rabbits was associated with higher incidence of malposition and other complications. Our findings suggest that LMA designed for humans can be used for airway management in veterinary medicine. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 < 16 points indicated "satisfactory" and "unsatisfactory" responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from "satisfactory" and "unsatisfactory" responses. The primary outcome involved the determination of the median effective dose (ED50) of 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. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to investigate if a laryngeal mask could improve respiratory condition during radiofrequency catheter ablation (RFCA). Methods: Twenty-four consecutive patients who underwent RFCA for atrial fibrillation were divided into two groups (Facemask group; n = 10, Laryngeal mask group; n = 14). All patients were completely sedated under intravenous anesthesia and fitted with artificial respirators during the RFCA. The capnography waveforms and their differential coefficients were analyzed to evaluate the changes of end-tidal CO2 (ETCO2) values, respiratory intervals, expiratory durations, and inspiratory durations. Results: During the RFCA, ETCO2 values of the laryngeal mask group were higher than those of the facemask group (36.0 vs. 29.2 mmHg, p = 0.005). The respiratory interval was significantly longer in the laryngeal mask group than those in the facemask group (4.28 s vs.5.25 s, p < 0.001). In both expiratory and inspiratory phases, the mean of the maximum and minimum values of CO2 was significantly higher when using a laryngeal mask than when using a facemask. The inspiratory-expiratory ratio of the laryngeal mask group was significantly larger than that of the facemask group (1.59 vs. 1.27, p < 0.001). The total procedure duration, fluoroscopic duration and the ablation energy were significantly lower in the laryngeal mask group than in the facemask group. The ETCO2 value is the most influential parameter on the fluoroscopic duration during the RFCA procedure (β = − 0.477, p = 0.029). Conclusions: The use of a laryngeal mask could stabilize respiration during intravenous anesthesia, which could improve the efficiency of RFCA. [ABSTRACT FROM AUTHOR]

This study represents the design and implementation of a portable medical device that provides cuff pressure measurement for the tracheal tube and laryngeal mask. The developed device is a portable medical device for monitoring the air pressure in the pilot balloon used in operating rooms and intensive care units. The cuff pressure values measured in the tracheal tube or laryngeal mask can be transferred simultaneously to the display and memory card on the device. It gives an audible warning when the air pressure inside the cuff pilot balloon is outside the allowable range of pressure values. The device was developed using an embedded microcontroller based system board and barometric pressure-gauge. Pressure measurements were tested on infant and child phantoms in-vitro and statistical analysis was performed with the actual data obtained. [ABSTRACT FROM AUTHOR]

Abstract The endoscopic net forceps with the support of a laryngeal mask airway are a dependable choice for retrieving a round metallic object from an airway.

Background: The use of laryngeal mask airway (LMA) for infants is increasing. But, there is not sufficient research on the anesthetic drugs used for infants whose airway is supported with laryngeal mask airway. This study aimed to compare the respiratory complications of propofol and isoflurane in these infants. Methods: Ninety 6- to 24-months old infants undergoing inguinal herniorrhaphy under general anesthesia with laryngeal mask airway were randomly allocated into two groups of 45. The first group received propofol and the second received isoflurane as maintenance of anesthesia. Peripheral capillary oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2) and mean arterial blood pressure (MAP) were recorded every 5 minutes. In addition, for each patient MAP, SpO2, respiratory complication, nausea and vomiting were recorded every 15 minutes in the recovery room. Findings: Patients receiving propofol had significantly lower ETCO2, heart rate and MAP (P < 0.01 for all). SPO2 was lower at 15th, 25th, 30th minutes of the surgery and on admission, 15th and 45th minute of recovery in patients receiving isoflurane; but the differences were not statistically significant. Conclusion: Regarding the results, propofol is probably a better choice for maintenance of general anesthesia with laryngeal mask airway in infants.

The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts.

Background: There is growing use of laryngeal mask airway (LMA) as an alternative for endotracheal intubation, in maintaining airway in patients undergoing general anesthesia. However, there are not sufficient studies to compare advantages and side effects between laryngeal mask airway and endotracheal intubation in neonates. Methods: A total of 88 neonates undergoing inguinal herniorrhaphy were allocated to two groups of 44. In one group, the airway was maintained through laryngeal mask airway, and through endotracheal intubation in the other. Peripheral capillary oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), heart rate, mean arterial blood pressure and recovery time were recorded and compared between the two groups. Respiratory complications including decreased O2 saturation, laryngospasm, bronchospasm, tube displacement and removal were recorded and compared, too. Findings: Mean arterial blood pressure and heart rate were not significantly different between the two groups. SpO2 was significantly lower and ETCO2 was significantly higher in laryngeal mask airway group (P < 0.05). Recovery time and respiratory complications were significantly higher in laryngeal mask airway group, too (P < 0.05). Conclusion: Our findings support the use of endotracheal intubation versus laryngeal mask airway in neonates.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire., (Copyright © 2023 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Current guidelines for neonatal resuscitation suggest the use of a laryngeal mask when ventilation with both facemask and endotracheal tube has failed in newborns weighing >2000 g or delivered ≥ 34 weeks of gestation age. Paediatric I-gel ® is one of the latest supraglottic airway management devices suitable for children and newborns. I-gel ® use was effective in guaranteeing adequate ventilation in patients with anatomic abnormalities in case of respiratory impairment or during surgical procedures after the induction of anaesthesia., Objective: The purpose of our review was to evaluate the use and efficacy of I-gel ® in case of complicated intubations., Methods: In July 2023, two authors of this paper independently conducted searches of the MEDLINE, Web of Science, and Scopus databases without imposing any time constraints or other restrictions. Three case reports were included, each describing the use of I-gel ® device in difficult intubations in newborns with anatomical abnormalities., Results: No difficulties were reported in the insertion of the device, which was placed even by inexperienced clinicians., Conclusion: The data collected highlighted the possibility of using I-gel ® not only as a rescue device after attempted and failed endotracheal placement but also as a first choice in selected patients. Studies on larger cohorts would be needed. Further research involving larger patient cohorts of multicentre NICUs is necessary to confirm the use of laryngeal masks in neonates weighing less than 2000 grams., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objectives/hypothesis: To evaluate whether endotracheal intubations are superior to the use of laryngeal masks in the airway management for adenoidectomies in pediatric patients in terms of safety and duration of surgery.Study Design: Retrospective case series.Methods: A retrospective analysis of 1,500 adenoidectomies in children using laryngeal mask or endotracheal intubation for intraoperative ventilation between 2009 and 2017. Data collected included complications, duration of surgery, and duration of induction and emergence from anesthesia.Results: The use of laryngeal masks did not accelerate the time needed for induction and emergence of anesthesia although significantly increasing the duration of surgery itself. There also were significantly more complications during and after anesthesia when using a laryngeal mask. In 10% of the children, the laryngeal mask had to be replaced by an endotracheal tube intraoperatively.Conclusions: There is no reason to recommend the use of a laryngeal mask as the first choice of airway management regarding adenoidectomies in children.Level Of Evidence: 3 Laryngoscope, 129:E383-E388, 2019. [ABSTRACT FROM AUTHOR]

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

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Background and Aims: Newly developed supraglottic airway devices (SGAs) are designed to be used both for ventilation and as conduits for endotracheal intubation with standard endotracheal tubes (ETTs). We compared the efficacy of the Ambu AuraGain (AAG) and the newly developed intubating laryngeal tube suction disposable (ILTS-D) as conduits for blind and fiber-optically guided endotracheal intubation in an airway mannequin. Material and Methods: This is a prospective, randomized, crossover study in an airway mannequin, with two arms: blind ETT insertion by medical students and fiber-optically guided ETT insertion by anesthesiologists. The primary outcome variable was the time to achieve an effective airway through an ETT using AAG and ILTS-D as conduits. Secondary outcome variables were the time to achieve effective supraglottic ventilation and successful exchange with an ETT, and the success rates for blind endotracheal intubation and fiber-optically guided intubation techniques for both SGAs. Results: Forty participants were recruited to each group. All participants were able to insert both devices successfully on the first attempt. For blind intubation, the success rate for establishing a definitive airway with an ETT using the SGA as a conduit was significantly higher with ILTS-D (82.5%) compared with AAG (20.0%) (P < 0.001). None of the participants were able to successfully complete the exchange of the SGA for the ETT with the AAG. In the fiber optic guided intubation group, the rate of successful exchange was significantly higher with ILTS-D (84.6%) compared with AAG (61.5%) (P = 0.041). Conclusion: The ILTS-D successfully performs in an airway mannequin with higher success rate and shorter time for blindly establishing an airway with an ETT using the SGA as a conduit, compared with AAG. Further clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of chewing gum after hysteroscopic surgery on sore throat related to laryngeal mask insertion. Methods Ninety patients undergoing hysteroscopic surgery were randomly divided into experimental group (group G) and control group (group C) with 45 patients in each group. All patients were under general anesthesia with laryngeal mask insertion. After sugery, Ramsay scores were evaluated to determine patients’ awareness recovering from general anesthesia. When the patients came to sense with Ramsay scores of 2-3 (T0), we recorded a visual analogue scale (VAS) score for sore throat with or without swallowing, and then patients in group G chewed gum for 10 minutes while patients in group C did not. VAS scores for sore throat with or without swallowing were recorded at 2 ( T2)、6 (T6) and 24 hours (T24) after sugery. Results The overall incidence of VAS score for sore throat >3 within 24 h after surgery was significantly lower in group G (15.56%, 7/45) than in group C (35.56%, 16/45) (P=0.026). With the exception of T0 point, VAS scores for sore throat of group G were significantly lower than that of group C whether swallowed or not at the remaining points after the operation (P<0.05). Patients’ satisfaction score was significantly higher in group G (8.87±1.08) than in group C (7.16±1.15) (P<0.001). Conclusions Chewing gum after short-time gynecological operation can alleviate the sore throat caused by laryngeal mask in general anesthesia. [ABSTRACT FROM AUTHOR]