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Introduction: Laryngeal mask airway (LMA) use in neonatal resuscitation is limited despite existing evidence and recommendations. This survey investigated the knowledge and experience of healthcare providers on the use of the LMA and explored barriers and solutions for implementation. Methods: This online, cross-sectional survey on LMA in neonatal resuscitation involved healthcare professionals of the Union of European Neonatal and Perinatal Societies (UENPS). Results: A total of 858 healthcare professionals from 42 countries participated in the survey. Only 6% took part in an LMA-specific course. Some delivery rooms were not equipped with LMA (26.1%). LMA was mainly considered after the failure of a face mask (FM) or endotracheal tube (ET), while the first choice was limited to neonates with upper airway malformations. LMA and FM were considered easier to position but less effective than ET, while LMA was considered less invasive than ET but more invasive than FM. Participants felt less competent and experienced with LMA than FM and ET. The lack of confidence in LMA was perceived as the main barrier to its implementation in neonatal resuscitation. More training, supervision, and device availability in delivery wards were suggested as possible actions to overcome those barriers. Conclusion: Our survey confirms previous findings on limited knowledge, experience, and confidence with LMA, which is usually considered an option after the failure of FM/ET. Our findings highlight the need for increasing the availability of LMA in delivery wards. Moreover, increasing LMA training and having an LMA expert supervisor during clinical practice may improve the implementation of LMA use in neonatal clinical practice. [ABSTRACT FROM AUTHOR]

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.

Abstract Background One of the most often used bedside surgical techniques in critical care units (ICUs) for critically ill individuals who need prolonged mechanical ventilation is percutaneous dilatational tracheostomy (PDT). Numerous difficulties may arise from puncturing the esophagus or making a false passage during surgery. Objectives To compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) during PDT guided by ultrasonography (US) or bronchoscopy. Methods Our study was a prospective cohort of 120 patients admitted to the Critical Care Department at Kasr Alainy Hospital and Damanhur Medical National Institute between March 2020 and November 2021. Hemodynamics, arterial blood gasses, complications, and outcomes of the patients were recorded. Results The studied patients were divided into the ETT and LMA groups (60 patients in each group). Then, each group was subdivided into two subgroups (ETT-US, ETT-Bronch, LMA-US, and LMA-Bronch; 30 patients in each subgroup) according to the guiding procedure used for puncturing the trachea: US-guided or bronchoscopy-guided. Regarding HR, there was no statistically significant difference between the two groups or four subgroups before, during, and after the procedure. In addition, there was no statistically significant difference between the two studied groups regarding MAP before the procedure. However, during and after the procedure, MAP was significantly higher in the ETT group. There was no discernible change in oxygen saturation or PaO2 before, during, or after the procedure. However, there was no discernible difference in PaCO2 levels before and after the procedure; it was much greater in the ETT group and ETT-Bronch subgroup during the process. Furthermore, there was no statistically significant variation in the number of punctures between the two groups or the four subgroups. The length of the process varied significantly across the two major groups and the four evaluated subgroups. The LMA group had the shortest procedure duration (5.05 ± 1.28 min), the LMA-Bronch subgroup (4.79 ± 1.42 min), and the LMA-US subgroup (5.31 ± 1.10 min), while the ETT had the longest procedure duration group (5.86 ± 1.11 min), the ETT-Bronch subgroup (6.09 ± 1.23 min), and ETT-US (5.63 ± 0.94 min). Regarding complications, there was no considerable difference between the two groups or four subgroups except aerophagia. Aerophagia was considerably more common in the LMA group (7 candidates) and was not observed in the ETT group. Conclusions Our study concluded that the laryngeal mask airway improves ventilation during percutaneous dilatation tracheostomy, especially when used with ultrasound, and thus can be used for candidates with traumatic brain injury and brain edema.

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.

Background: The use of laryngeal masks (LM) has increased widely today, both in anesthesia and in emergency cases. LM are available as reusable and disposable. Although reuse of disposable LM is not recommended, they are reused again after decontamination with different methods in anesthesia units in some countries. The reprocessing of single-use LM was therefore investigated. The hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are pathogens that can pass into saliva. It is known that the HBV is more resistant to decontamination methods as compared to HCV and HIV.Objectives: In this study, it was aimed to investigate the effectiveness of different decontamination methods on disposable and reusable LM and to evaluate the reusability of disposable LM after they were treated with simulated saliva samples containing HBV DNA.Study design and setting: The observational study was carried out in Medical Microbiology Department of Erciyes University Medicine Faculty between March 2016 and Mach 2018. Method: Simulated saliva samples were prepared, and plasma samples of patients with plasma HBVDNA levels of 10IU/mL were inoculated into these samples. HBV DNA levels in saliva samples were investigated by the real-time PCR (Qiagen, Germany). Reusable and disposable LMs were placed into HBV DNA-positive simulated saliva samples. The LM were kept in saliva at 37°C for 1 hour, then dried for 24 hours at room temperature. After cleaning in the automatic washer, different decontamination methods were applied to the LMs. Decontamination methods applied to reusable and disposable LM were thermal disinfection 1 minute at 90°C (A600), thermal disinfection 5 minutes at 90°C (A3000), thermal disinfection (A600) + hydrogen peroxide gas plasma sterilization, thermal disinfection (A600) + ethylene oxide sterilization, and disinfection with high-level disinfectant with 2% peracetic acid without cleaning in the automatic washer. Also, thermal disinfection (A3000) +5 minutes steam sterilization at 134°C was implemented only to reusable LM. At least three LM were used for each group. Control samples were also used. After the decontamination procedures, the LM were kept in phosphate buffer (PBS) solution for 1 hour at 37°C with shaking. The presence of HBV DNA was investigated by the real-time PCR by taking samples from PBS. The polyethylene glycol procedure was used for saliva and nucleic acid isolation. After the decontamination procedures, the functioning control of the LM was controlled.Results: The HBV DNA level in the simulated saliva samples was 100,000 IU/mL (lg 5). No HBV DNA was detected in reusable and disposable LM after A600 thermal disinfection + ethylene oxide and A600 thermal disinfection + hydrogen peroxide. No HBV DNA was detected in reusable LM after A3000 thermal disinfection+ steam sterilization. However, HBV DNA was detected in LM after A600 or A3000 thermal disinfection alone and disinfection with peracetic acid.While no deformation was observed in reusable LM after reprocessing, deformation was observed in disposable LM.Conclusion: Reuse with high-level disinfection, which is frequently applied to disposable LM, is an incorrect and dangerous practice, therefore disposable LM should not be reused. Reusable LM can be reused after being reprocessing with thermal disinfection + steam or thermal disinfection + hydrogen peroxide low temperature sterilization after effective cleaning.

OBJECTIVES: Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners. METHODS: This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration. RESULTS: The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794). CONCLUSION: Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i.

Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, single-blinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student’s t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™.

Supraglottic airway devices such as laryngeal masks and i-gels are useful for airway management. The i-gel is a relatively new device that replaces the air-inflated cuff of the laryngeal mask with a gel-filled cuff. It remains unclear which device is more effective for neonatal resuscitation. We aimed to evaluate the dependence of successful airway management in neonatal simulators on the device type and providers' backgrounds. Ninety-one healthcare providers performed four attempts at airway management using a laryngeal mask and i-gel in two types of neonatal manikins. The dependence of successful insertions within 16.7 s (75th percentile of all successful insertions) on the device type and providers' specialty, years of healthcare service, and completion of the neonatal resuscitation training course was assessed. Successful insertion (p = 0.001) and insertion time (p = 0.003) were associated with using the i-gel vs. laryngeal mask. The providers' backgrounds were not associated with the outcome. Using the i-gel was associated with more successful airway management than laryngeal masks using neonatal manikins. Considering the limited effect of the provider's specialty and experience, using the i-gel as the first-choice device in neonatal resuscitation may be advantageous. Prospective studies are warranted to compare these devices in the clinical setting. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners. METHODS: This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration. RESULTS: The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794). CONCLUSION: Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i. [ABSTRACT FROM AUTHOR]

Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, singleblinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student's t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™. [ABSTRACT FROM AUTHOR]

Background: Epinephrine (adrenaline) is currently the only cardiac agent recommended during neonatal resuscitation. The inability to predict which newborns are at risk of requiring resuscitative efforts at birth has prevented the collection of large, high-quality human data. Summary: Information on the optimal dosage and route of epinephrine administration is extrapolated from neonatal animal studies and human adult and pediatric studies. Adult resuscitation guidelines have previously recommended vasopressin use; however, neonatal studies needed to create guidelines are lacking. A review of the literature demonstrates conflicting results regarding epinephrine efficacy through various routes of access as well as vasopressin during asystolic cardiac arrest in animal models. Vasopressin appears to improve hemodynamic and post-resuscitation outcomes compared to epinephrine in asystolic cardiac arrest animal models. Key Messages: The current neonatal resuscitation guidelines recommend epinephrine be primarily given via the intravenous or intraosseous route, with the endotracheal route as an alternative if these routes are not feasible or unsuccessful. The intravenous or intraosseous dose ranges between 0.01 and 0.03 mg/kg, which should be repeated every 3–5 min during chest compressions. However, the optimal dosing and route of administration of epinephrine remain unknown. There is evidence from adult and pediatric studies that vasopressin might be an alternative to epinephrine; however, the neonatal data are scarce. [ABSTRACT FROM AUTHOR]

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The laryngeal mask airway (LMA) is commonly used for airway management. Cuff hyperinflation has been associated with complications, poor ventilation and increased risk of gastric insufflation. This study was designed to determine the best cuff inflation method of AuraOnce™ LMA during bronchoscopy and EBUS (Endobronquial Ultrasound Bronchoscopy) procedure. We designed a Randomized controlled, doble-blind, clinical trial to compare the efficacy and safety of three cuff inflation methods of AuraOnce™ LMA. 210 consenting patients scheduled for EBUS procedure under general anesthesia, using AuraOnce™ LMA were randomized into three groups depending on cuff insufflation: residual volume (RV), half of the maximum volume (MV), unchanged volume (NV). Parameters regarding intracuff pressure (IP), airway leak pressure (OLP), leakage volume (LV) were assessed, as well as postoperative complications (PC). 201 (95.7%) patients completed the study. Mean IP differed between groups (MV: 59.4 ± 32.4 cm H2O; RV: 75.1 ± 21.1 cm H2O; NV: 83.1 ± 25.5 cmH20; P < 0.01). The incidence of IP > 60 cmH2O was lower in the MV group compared to the other two (MV: 20/65(30.8%); RV:47/69 (68.1%); NV 48/67 (71.6%); p < 0.01). The insertion success rate was 89,6% (180/201) at first attempt, with no difference between groups (p = 0.38). No difference between groups was found either for OLP (p = 0.53), LV (p = 0.26) and PC (p = 0.16). When a cuff manometer is not available, a partial inflation of AuraOnce™ LMA cuff using MV method allows to control intracuff pressure, with no significant changes of OLP and LV compared to RV and NV insufflation method. Registration clinical trial: NCT04769791. [ABSTRACT FROM AUTHOR]

Abstract Background To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. Methods Children aged 3–7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators. Results The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P 0.05). Conclusion Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn’t encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management. Trial registration The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).

Yan Zhang,1,&ast; Wenjun Meng,2,&ast; Chengwen Hu,1 Meirong Dong,1 Youqun Chu,1 Fang Kang,2 Juan Li,2 Xia Chen1 1Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China; 2Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xia Chen; Juan Li, Department of Nursing; Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China, Email ChenXiaahslyy@163.com; huamuzi1999@126.comBackground: Sore throat is a common complication after general anesthesia. Oral care solutions have been used to reduce the incidence of oral complications or ventilator-associated pneumonia, but their effect on postoperative sore throat (POST) is unclear. This study aims to investigate whether oral care solution can alleviate POST in patients undergoing i-gel laryngeal mask general anesthesia.Methods: A total of 120 patients who were scheduled for elective surgery under laryngeal mask general anesthesia were enrolled. The patients were randomly assigned to an experimental group (oral care solution) and a control group (0.9% saline) and gargled for 1 min with 10mL of oral care solution or saline 5 min before anesthesia induction. The primary outcomes were the overall incidence of sore throat within 24 h and incidence at 20 min, 1 h, 6 h, 24 h after removal of i-gel. The secondary outcomes were the severity of sore throat at the four time points and incidence of hoarseness, cough within 24 h after removal of i-gel.Results: A total of 111 patients were included in the analysis. The overall incidence of sore throat within 24 h in the experimental group was significantly lower than that in the control group, as was the incidence at four time points (P< 0.05). The VAS scores at the four time points in the experimental group were significantly lower than those in the control group (P< 0.05), and the results of repeated measurement analysis of variance showed that time effect and intergroup effect were statistically significant (P< 0.001). No differences were found between the groups in the incidence of hoarseness and cough.Conclusion: Gargling with oral care solution before anesthesia induction can significantly reduce the incidence and severity of POST in patients undergoing i-gel laryngeal mask general anesthesia.Keywords: oral care solution, laryngeal mask, general anesthesia, postoperative sore throat

To observe the effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation on patients undergoing ureteroscopic holmium laser lithotripsy. One hundred and twenty patients who underwent ureteroscopic holmium laser lithotripsy in our hospital were selected and randomly divided into nasopharyngeal airway group (research group) and laryngeal mask group (control group). These patients, respectively, received intravenous anesthesia under nasopharyngeal airway and laryngeal mask-assisted ventilation. The following evaluation indexes were compared and analyzed between the two groups, including anesthetic effect, hemodynamics, stress response, postoperative recovery, adverse reactions, etc. There were no significant differences in Visual Analog Scale, hemodynamics, and stress response between the two groups at each time point (P > 0.05). There were no significant differences in residence time and postoperative recovery time between the two groups (P > 0.05). The difference in airway establishment time between the two groups was statistically significant (P < 0.05), and cases with blood in the research group was significantly lower than those in the control group (P < 0.05). Patient satisfaction in research group was significantly higher than those in the control group (P < 0.05). The clinical effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation in ureteroscopic holmium laser lithotripsy is significant, which helps to stabilize patients’ hemodynamics, reduce their stress response and adverse reactions, and improve the satisfaction rate of patient.

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training.

A laryngeal mask is one of the most widely used airway management devices. The SingularityTM Air is a second-generation laryngeal mask whose shaft angle can be adjusted after insertion. Since the device's performance has been assessed on mannequins only, this study aimed to evaluate SingularityTM Air's effectiveness in the clinical setting. The prospective single-center cohort study included 100 adults undergoing elective surgery under general anesthesia and suitable for airway securing with a laryngeal mask. The primary endpoint was the oropharyngeal leak pressure, and the secondary endpoints were the ease of insertion and the patient's comfort. Laryngeal mask insertion was successful in 97%, and mechanical ventilation was possible in 96% of patients. After insertion, the median (IQR) oropharyngeal leak pressure was 25 (18–25) cm H2O, which remained stable at 25 (25–25) cm H2O after 20 min. The median (IQR) time for successful manual bag ventilation was 42 (34–50) seconds. Nineteen patients complained of side effects (e.g., sore throat, difficulty swallowing), but none persisted. The SingularityTM Air performed well in a clinical setting, and its oropharyngeal leak pressure was comparable to that of other masks reported in the literature. The time for successful manual ventilation was slightly longer, and patients reported more temporary side effects. [ABSTRACT FROM AUTHOR]

Background: To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery. Methods: Children aged 3–7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators. Results: The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05). Conclusion: Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management. Trial registration: The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. (https://www.chictr.org.cn. Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023). [ABSTRACT FROM AUTHOR]

Airway-related articles have featured heavily in the British Journal of Anaesthesia since it was founded in 1923. In the 100 years thereafter, 1102 airway-related articles have been published in the journal, written by 2955 unique authors from 55 different countries. In this editorial, we highlight some of the major publications in airway management and their impact on the specialty. Summaries of the most cited articles are contained within online supplementary material as well as links to all airway-related articles for readers who wish to delve deeper into this body of work. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the level of training, awareness, experience, and confidence of neonatal practice providers in the use of laryngeal mask (LM), and to identify the barriers in its implementation in the neonatal population. Study Design Descriptive observational study utilizing an anonymous online questionnaire among healthcare providers at the Oklahoma Children's Hospital who routinely respond to newborn deliveries and have been trained in the Neonatal Resuscitation Program (NRP). Participants included physicians, trainees, nurse practitioners, nurses, and respiratory therapists. Results Ninety-five participants completed the survey (27.5% response rate). The sample consisted of 77 NRP providers (81%), 11 instructors (12%), and 7 instructor mentors (7%). Among 72 respondents who had undergone LM training, 51 (54%) had hands-on manikin practice, 4 (4%) watched the American Academy of Pediatrics (AAP) NRP educational video, and 17 (18%) did both. Nurses (39 out of 46) were more likely to have completed LM training than were physicians (31 out of 47). With only 11 (12%) participants having ever placed a LM in a newly born infant, the median confidence for LM placement during neonatal resuscitation was 37 on a 0 to 100 scale. Frequently reported barriers for LM use in neonates were limited experience (81%), insufficient training (59%), preference for endotracheal tube (57%), and lack of awareness (56%). Conclusion While the majority of the neonatal practice providers were trained in LM placement, only a few had ever placed one in a live newborn, with a low degree of confidence overall. Future practice improvement should incorporate ongoing interdisciplinary LM education, availability of LM in the labor and delivery units, and promotion of awareness of LM as an alternative airway. Key Points LM is underutilized as an alternative airway. Insufficient experience and training limit LM use. Providers confidence with LM placement is low. [ABSTRACT FROM AUTHOR]

Background and Aim: Supraglottic airway devices are increasingly being used for airway management. I-gel is being widely used even for pediatric patients. Although the weight-based selection of the size of the device seems to be the standard technique, this method may not be possible in all patients. The aim of the study was to compare the standard weight-based method with the thenar eminence dimension-based method for I-gel selection. Material and Methods: A prospective randomized study was conducted on 74 pediatric patients of either sex, aged between 6 months and 15 years, belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III and who were posted for various surgical procedures under general anesthesia. The study population was divided into two groups of 37 patients each. I-gel was inserted based on weight in group A patients and based on thenar eminence size in group B patients. Parameters like first attempt success rate, ease of insertion, and complications were compared between the two groups using Student's t-test and Chi-square test. Results: The demographic values between the groups were comparable. The first attempt success rate was 97.4% in group A and 91.7% in group B (P = 0.358). Insertion of I-gel was unsuccessful in two patients in group B. Two patients of group B had blood staining of the device. None of the patients had complications related to insertion. Conclusion: The thenar eminence dimension can be used instead of weight while choosing the size of I-gel in pediatric patients. None of the patients had complications related to device insertion. [ABSTRACT FROM AUTHOR]

Abstract Background Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has received extensive attention for its utility in tubeless anesthesia. Still, the effects of its carbon dioxide accumulation on emergence from anesthesia have not been reported. This randomized controlled trial aimed at exploring the impact of THRIVE combined with laryngeal mask (LM) on the quality of emergence in patients undergoing microlaryngeal surgery. Methods After research ethics board approval, 40 eligible patients receiving elective microlaryngeal vocal cord polypectomy were randomly allocated 1:1 to two groups, THRIVE + LM group: intraoperative apneic oxygenation using THRIVE followed by mechanical ventilation through a laryngeal mask in the post-anesthesia care unit (PACU), or MV + ETT group: mechanically ventilated through an endotracheal tube for both intraoperative and post-anesthesia periods. The primary outcome was duration of PACU stay. Other parameters reflecting quality of emergence and carbon dioxide accumulation were also recorded. Results Duration of PACU stay (22.4 ± 6.4 vs. 28.9 ± 8.8 min, p = 0.011) was shorter in the THRIVE + LM group. The incidence of cough (2/20, 10% vs. 19/20, 95%, P

As an important supraglottic airway tool,laryngeal mask airway(LMA) has been used more and more widely in clinic. In addition to being used in gynaecological and pediatric small-scale elective surgery, it has also been used in elderly patients' surgery, obese patients' auxiliary ventilation, thoracic surgery, and even emergency airway management. There are different ventilation modes of anesthesia machine during general anesthesia operation, but there is no conclusion on which mode to choose when using LMA. For different patients, different operations and different types of LMA, anesthesiologists can choose a relatively suitable ventilator mode and adjust respiratory parameters to reduce lung injury during mechanical ventilation, so that patients can obtain the best prognosis.

Supraglottic airway devices such as laryngeal masks and i-gels are useful for airway management. The i-gel is a relatively new device that replaces the air-inflated cuff of the laryngeal mask with a gel-filled cuff. It remains unclear which device is more effective for neonatal resuscitation. We aimed to evaluate the dependence of successful airway management in neonatal simulators on the device type and providers’ backgrounds. Ninety-one healthcare providers performed four attempts at airway management using a laryngeal mask and i-gel in two types of neonatal manikins. The dependence of successful insertions within 16.7 s (75th percentile of all successful insertions) on the device type and providers’ specialty, years of healthcare service, and completion of the neonatal resuscitation training course was assessed. Successful insertion (p = 0.001) and insertion time (p = 0.003) were associated with using the i-gel vs. laryngeal mask. The providers’ backgrounds were not associated with the outcome. Using the i-gel was associated with more successful airway management than laryngeal masks using neonatal manikins. Considering the limited effect of the provider’s specialty and experience, using the i-gel as the first-choice device in neonatal resuscitation may be advantageous. Prospective studies are warranted to compare these devices in the clinical setting.

Background: Training is required to achieve proficiency in airway management. Simulators are of utmost importance not only for the purpose of training novices, but also for evaluating newer airway devices and techniques. Growing evidence supports inadequate anatomic airway reproduction in adult and pediatric manikins. Methods: We conducted an observational study comparing 17 radiological anatomic airway measurements obtained via the computed tomography of three commercially available manikins with the same measurements obtained from a population of newborns/infant (range: 0–3 months) undergoing magnetic resonance imaging for diagnostic purposes. According to the reference (mean and standard deviation (SD) of the pediatric population), each manikin measurement was defined as adequate, partially adequate or inadequate (difference between means: ≤±1, 1.0–1.96 or >1.96 SD, respectively). The primary outcome was the number of measurements with an adequate reproduction of airways. Results: We included 27 pediatric patients (21 ± 19 days, 48% males, 46.6 ± 3.5 cm, 2.7 ± 0.5 Kg and 12.6 ± 2.9 kg/m2). All manikins had n = 11/17 measurements with inadequate airway anatomic reproduction. The three measurements with more adequate reproduction were the height of the soft palate, retropalatal airspace volume and tongue volume (adequate in two manikins, and partially adequate in the remaining one). Conclusions: In three manikins commonly used for training in pediatric airways, static dimensions do not seem anatomically correct in relation to those of pediatric patients. Such inaccuracies may introduce biases in airway device development as well as in training. [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility and safety of using diaphragmatic ultrasound to guide timing of laryngeal mask extraction during anaesthesia for laparoscopic inguinal hernia surgery in children. Methods A total of 140 children undergoing laparoscopic inguinal hernia repair surgery were selected, and the children were randomly divided into two groups : the group with laryngeal mask extraction guided by diaphragmatic ultrasound (Group D) and the group with laryngeal mask extraction guided by awake (group A). The two groups were instructed on the timing of laryngeal mask extraction according to different ways, and the incidence of adverse events, such as difficulty in pulling out, cough, laryngospasm, bronchospasm, and pharyngeal pain, were compared between the two groups during and after the extraction, the analysis compared the incidence and management of peripheral oxygen desaturation between the two groups. Results The rates of difficulty in pullout and laryngospasm in group D were both lower than those in group A, and the number of cases of adverse events in group D was lower than that in group A, the difference was statistically significant. The incidence of oxygen desaturation after removal of the laryngeal mask was lower in group D than in group A, and the difference was statistically significant. The time from the end of surgery to removal of the laryngeal mask and the steward awakening score up to 4 points in group D were shorter than those in group A, and the differences were statistically significant. Conclusion During awakening from anaesthesia for laparoscopic inguinal hernia surgery in children, monitoring the rate of change in diaphragmatic thickness with ultrasound can lead to better guidance in the extraction of laryngeal mask with a lower incidence of adverse effects and greater safety. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Sciences / Sağlık Bilimleri Dergisi is the property of Erciyes Universitesi Saglik Bilimleri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Background and Aims: A variety of extraglottic airway devices (EADs) are available. Main concerns with EADs are protection against aspiration and ability to ventilate patients with high airway pressures. Baska mask meets these criteria and is the only third-generation device available for clinical use. Methods: After institutional ethics committee approval and informed consent were obtained, this prospective study was performed in 100 adult patients undergoing surface surgeries at a tertiary referral centre. The primary outcome was the success rate of insertion, while the secondary outcomes were the sealing pressure, stability of the device and the perioperative complications of Baska mask. We then compared it with other currently used EADs. Results: The first attempt at insertion and overall success rates, showed values of 81% and 98%, respectively. Insertion was quick (median 12; interquartile range [IQR] 9-15 s). The mask sealing pressure, was 35 cmH2O (median [IQR 20-50 cmH2O]). Also, the mask remained stable in 95% of patients intraoperatively. Sore throat and dysphagia were seen in 37% and 24% of patients, respectively. No patient had laryngospasm or desaturation at any time. It compared favourably well with other EADs, while achieving higher sealing pressures. Conclusion: We found that the Baska mask performs well with excellent first attempt at insertion and overall success rates, higher sealing pressures and minimal complications compared to currently used EADs in clinical anaesthesia. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: to assess the efficacy of inhalation anesthesia with laryngeal mask in extremely premature infants with low or extremely low birthweight and somatic comorbidities during the surgery of retinopathy of prematurity (ROP) in the active phase of the disease. Materials and methods. 477 infants of 25 to 32 weeks’ gestational age were treated by delimiting retinal laser photocoagulation. Inductive anesthesia with Sevoflurane (BAXTER HEALTHCARE Corp, USA) was followed by placing a laryngeal mask. The delimiting retinal laser photocoagulation was performed using laser devices with an adapter on a binocular forehead ophthalmoscope Supra (Quantel Medical, France) and LachtaMylon (Lasermedservis, Russia,). After the surgery, the recovery from sedation and return of consciousness took 7 to 10 minutes. Results. An inhalation of Sevoflurane with the adoption of a laryngeal mask airway significantly decreases complications of anesthesia in premature infants with comorbidities and reduces the length of hospital stay. The quick clearance of Sevoflurane makes it possible to begin feeding the infant one hour after the surgery. Conclusion. Inhalation anesthesia with Sevoflurane is a method ensuring that preterm infants receive adequate anesthesia in the treatment of retinopathy of prematurity in its active phase.

Abstract Background Endotracheal intubation in rabbits is challenging and supraglottic airway devices, such as laryngeal masks (LMA), represent an alternative as they are easy to insert, and do not stimulate the larynx requiring therefore a lighter plane of anaesthesia for their insertion and positioning than the endotracheal tubes. We investigated whether, compared to an endotracheal tube, the LMA can reduce the negative effects of general anaesthetics on some cardiovascular and respiratory parameters routinely monitored in rabbits anaesthetized for elective gonadectomy. The records of 21 adult mixed breed pet rabbits were collected retrospectively. Rabbits were divided in two groups based on the type of airway device used. A laryngeal mask secured the airway in group LMA (n = 11), and in group ETT (n = 10) an endotracheal tube was used. The amount of propofol used before successful insertion of the airway device was recorded. A pitot-based spirometer was connected and ventilatory variables were measured immediately after insertion. Pulse rate, non-invasive arterial blood pressure, haemoglobin oxygen saturation, respiratory rate, end-tidal carbon dioxide and volatile anaesthetic consumption were also monitored during the surgical procedure; extubation time was noted as well. Results The use of LMA required significantly less propofol (0.8 to 4 mg/kg) for insertion than the ETT (1.2 to 5.6 mg/kg), and the difference was statistically significant (P

Background and Aim: Supraglottic airway devices are increasingly being used for airway management. I-gel is being widely used even for pediatric patients. Although the weight-based selection of the size of the device seems to be the standard technique, this method may not be possible in all patients. The aim of the study was to compare the standard weight-based method with the thenar eminence dimension-based method for I-gel selection. Material and Methods: A prospective randomized study was conducted on 74 pediatric patients of either sex, aged between 6 months and 15 years, belonging to American Society of Anesthesiologists (ASA) physical status I, II, and III and who were posted for various surgical procedures under general anesthesia. The study population was divided into two groups of 37 patients each. I-gel was inserted based on weight in group A patients and based on thenar eminence size in group B patients. Parameters like first attempt success rate, ease of insertion, and complications were compared between the two groups using Student's t-test and Chi-square test. Results: The demographic values between the groups were comparable. The first attempt success rate was 97.4% in group A and 91.7% in group B (P = 0.358). Insertion of I-gel was unsuccessful in two patients in group B. Two patients of group B had blood staining of the device. None of the patients had complications related to insertion. Conclusion: The thenar eminence dimension can be used instead of weight while choosing the size of I-gel in pediatric patients. None of the patients had complications related to device insertion.

Background and Aims: Oropharyngeal leak pressure (OLP) of LMA Protector is reported to be higher compared to other second generation supraglottic devices (SGDs) indicating better seal with patient's airway and hence enhanced safety. To ascertain its benefit in patients undergoing surgeries where head and neck position other than neutral is required, we conducted a prospective randomized study to compare OLP of LMA Protector with LMA-ProSeal (PLMA) with head and neck in neutral, extension, flexion, and rotation position. Methods: 80 American Society of Anesthesiologists (ASA) I-II patients aged more than 18 years undergoing elective surgery under general anaesthesia were recruited. Patients were randomized in the LMA Protector or PLMA group. After induction of anaesthesia, OLP was measured in both the groups in different head and neck position. The insertion characteristics of both SGDs were also recorded and compared. Results: The OLP of LMA Protector and PLMA was found to be comparable in neutral head position (p = 0.08). There was no significant difference in OLP of both devices in extension, flexion, or head rotation. In both the study groups, head extension position led to significant decrease in OLP compared to supine position. With the flexion and rotation positioning of head and neck, significant increase in OLP in each group was noted. Conclusion: The OLP of LMA Protector and PLMA are comparable in different head and neck position. With both the devices, there was significant decrease in OLP with extension whereas significant increase was noted in flexion and rotation of head and neck.

Background and Aims: Supraglottic devices are preformed or flexible, and the insertion characteristics of the two types may be different. This study aims to compare the insertion characteristics of Ambu AuraGain (AAG), preformed) and LMA ProSeal (PLMA), flexible, requires an introducer tool for placement. Methods: Forty American Society of Anesthesiologists (ASA) physical status I/II patients of either sex between 18 and 60 years with no anticipated airway difficulty were randomly allocated to either group AAG or PLMA (n = 20 each). Pregnant females, known case of chronic respiratory disorders and gastroesophageal reflux were excluded. After induction of anaesthesia and muscle relaxation, appropriately sized AAG or PLMA was inserted. Time for successful insertion (primary outcome), ease of device insertion and gastric drain insertion, first attempt success rate (secondary outcomes) were recorded. Statistical analysis was done using SPSS version 20.0. Quantitative parameters were compared using Student's t-test, and qualitative parameters were compared using Chi-square test. A P value of

To compare efficacy of spontaneous breathing with pressure support and volume-controlled mandatory ventilation during combined general anesthesia using desflurane and without muscle relaxants.Subjects and Methods. 100 patients were included in the study. All underwent low-traumatic operations on the lower limbs under general combined anesthesia using supraglottic air devices without muscle relaxants. Immediately prior to the induction of anesthesia, patients were randomly divided into two groups: Group 1 (VCV) where a mandatory volume control mode was used (n = 50) and Group 2 (PSV) where a pressure support mode was used (n = 50). The following parameters were assessed: hemodynamics, gas exchange, depth of anesthesia before induction, during and after the end of general anesthesia; arterial blood gas composition one hour after induction of anesthesia; indicators of pressure in the respiratory tract during mechanical ventilation, as well as time parameters of awakening.Results. In patients of Group 2 (PSV), according to the analysis of arterial blood gases, a higher level of PaO2 (p = 0.006), Horowitz index (p = 0.005), and carbon dioxide level (p

Abstract Background To assess the effectiveness and safety of laryngeal mask anesthesia (LMA) in thoracoscopic pulmonary wedge resection based on patient‐reported outcomes (PROs). Methods This randomized controlled trial included 107 patients who underwent thoracoscopic pulmonary wedge resection between June 2017 and December 2021 for pulmonary nodule or pulmonary bullae. In one group, LMA was applied for general anesthesia, and in the other group, endotracheal intubation (ETT) was used. Results A total of 107 patients were included in the study. The symptom assessment based on PROs showed that the incidence of pharyngodynia, trachyphonia, and cough were lower in the LMA group, while the postoperative gastrointestinal reaction did not significantly differ between the two groups. The pain score and global satisfaction score were significantly better in the LMA group. The satisfaction degree of anesthesia and the surgical field did not significantly differ between the two groups. The anesthesia recovery time, indwelling days of chest catheter, and postoperative hospital stay of the LMA group were all shorter, while the operation time, intraoperative blood loss and lowest intraoperative oxygen saturation did not significantly differ between the two groups. The highest intraoperative partial pressure of CO2 was significantly higher in the LMA group. The artery blood gas analysis after the operation did not significantly differ between the two groups. Conclusion Compared with ETT, the application of LMA may demonstrate promising advantages in airway management for thoracoscopic pulmonary wedge resection. Registration No. of clinical trial (ChiCTR2000034905).

Background: Airway management with supraglottic airway devices (SGA) in life-threatening emergencies in children is increasingly being used. Different specifications of laryngeal masks (LM) and the laryngeal tube (LT) are commonly used devices for this purpose. We present a literature review and interdisciplinary consensus statement of different societies on the use of SGA in pediatric emergency medicine. Material and methods: Literature review in the PubMed database and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine. Levels and consensus finding within the group of authors. Results: The evidence for successful applications of the various types of LM is significantly higher than for LT application. Reported smaller series of successful applications of LT are currently limited to selected research groups and centers. Especially for children below 10 kg body weight there currently exists insufficient evidence for the successful application of the LT and therefore its routine use cannot be recommended. SGAs used for emergencies should have a gastric drainage possibility. Discussion: Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children currently only the LM can be recommended for alternative (i.e., non-intubation) emergency airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1½, 2, 2½, 3) for out of hospital use and in hospital emergency use and all users should regularly be trained in its application. [ABSTRACT FROM AUTHOR]

Background: Respiratory support during the patient's anesthesia is done in different ways, such as endotracheal intubation and laryngeal mask. Endotracheal intubation is inevitably used for respiratory support in general anesthesia patients. The use of alternative methods for respiratory support during the process of general anesthesia is one of the most significant ways to control anesthesia complications. The laryngeal mask is placed around the larynx to allow spontaneous and controlled ventilation. Both of the respiratory support methods can cause complications. The purpose of this study is to compare the side effects of sore throat and hoarseness caused by two methods in surgical patients. Methods: This study was conducted in the period from September to November 2022 on patients who were referred and underwent surgery at Baqiyatallah Hospital. The study is a cohort study that was conducted retrospectively on 60 patients who underwent any surgery with two methods of anesthesia by ETI and LMA. In order to evaluate hoarseness, the standard Voice Handicap Index (VHI-10) questionnaire was used. In order to evaluate the complication of sore throat caused by the respiratory support method, a 4-point pain checklist was used for 24 hours and 14 days after the surgery. Results: The findings of our study showed that the average amount of sore throat 24 hours after surgery in the LMA and ETI groups was 2.13 and 2.2, respectively, and these values 14 days later were 1.17 and 1.07, respectively. The average level of hoarseness in the 24 hours after surgery in LMA and ETI groups was 2.66 and 3.13, respectively. The statistical comparison of the severity of side effects between the two groups showed that in the LMA method, the amount of sore throat and hoarseness is less than the ETI method, although this reduction does not have a significant difference. Conclusion: The results of this study showed that the rate of complications of sore throat and hoarseness in the laryngeal mask group is reduced compared to the endotracheal intubation group, although this difference is not significant. [ABSTRACT FROM AUTHOR]

Background and Aims: Supraglottic devices are preformed or flexible, and the insertion characteristics of the two types may be different. This study aims to compare the insertion characteristics of Ambu AuraGain (AAG), preformed) and LMA ProSeal (PLMA), flexible, requires an introducer tool for placement. Methods: Forty American Society of Anesthesiologists (ASA) physical status I/II patients of either sex between 18 and 60 years with no anticipated airway difficulty were randomly allocated to either group AAG or PLMA (n = 20 each). Pregnant females, known case of chronic respiratory disorders and gastroesophageal reflux were excluded. After induction of anaesthesia and muscle relaxation, appropriately sized AAG or PLMA was inserted. Time for successful insertion (primary outcome), ease of device insertion and gastric drain insertion, first attempt success rate (secondary outcomes) were recorded. Statistical analysis was done using SPSS version 20.0. Quantitative parameters were compared using Student's t-test, and qualitative parameters were compared using Chi-square test. A P value of <0.05 was considered significant. Results: Time taken for successful insertion of PLMA was 22.94 ± 6.12 s and for AAG was 24.32 ± 4.96 s, (P = 0.458). Device insertion was significantly easy in PLMA group (P < 0.002). First attempt success rate was achieved in 17 (94.4%) cases in PLMA group compared to 15 (78.9%) cases in AAG group (P = 0.168). Ease of drain tube insertion was comparable among the groups (P = 0.298). The haemodynamic variables were also comparable. Conclusion: PLMA is easier to insert as compared to AAG, but the insertion time and first attempt success rate are similar. The preformed curvature in AAG does not provide any added advantage over the non-preformed PLMA. [ABSTRACT FROM AUTHOR]

As an important supraglottic airway tool, laryngeal mask airway (LMA) has been used more and more widely in clinic. In addition to being used in gynaecological and pediatric small-scale elective surgery, it has also been used in elderly patients' surgery, obese patients' auxiliary ventilation, thoracic surgery, and even emergency airway management. There are different ventilation modes of anesthesia machine during general anesthesia operation, but there is no conclusion on which mode to choose when using LMA. For different patients, different operations and different types of LMA, anesthesiologists can choose a relatively suitable ventilator mode and adjust respiratory parameters to reduce lung injury during mechanical ventilation, so that patients can obtain the best prognosis. [ABSTRACT FROM AUTHOR]

Background: Since 2005, the Neonatal Resuscitation Program (NRP) has recommended the laryngeal mask (LM) as an alternative airway when positive-pressure ventilation (PPV) is unsuccessful and intubation is unsuccessful or unfeasible. There is a paucity of literature regarding LM use in high-resource countries; however, anecdotal information and recent studies suggest low implementation.Purpose: This article increases awareness of LM safety and efficacy, provides guidance for determining nursing scope of practice, and includes suggestions for developing a training program.Methods: Methods include considering NRP customers' questions, recent systematic reviews of the literature, how NRP recommendations are developed, how to determine nursing scope of practice, and how to develop a training program.Findings/results: Recent studies support the NRP recommendation to use the LM as a rescue airway when PPV fails and intubation is not feasible. The LM provides more effective PPV than face-mask ventilation. The LM may be effective as the initial PPV device for infants of at least 34 weeks' gestation. To use the LM, nurses may require training, which may include a simulation-based curriculum.Implications For Practice: Nurses can increase their awareness of the advantages of LM use, determine their scope of practice, and develop a training program. When face-mask ventilation is unsuccessful and intubation is unfeasible, LM insertion will likely increase the newborn's heart rate and avoid intubation.Implications For Research: Future research should determine training requirements, efficacy of the LM as the initial PPV device in high-resource settings, and LM use during complex resuscitation and in preterm newborns. [ABSTRACT FROM AUTHOR]

To address the problem of lack of clinical evidence for airway devices introduced to the market, the Difficult Airway Society (UK) developed an approach (termed ADEPT; Airway Device Evaluation Project Team) to standardise the model for device evaluation. Under this framework we assessed the LMA Protector, a second generation laryngeal mask airway. A total of 111 sequential adult patients were recruited and the LMA Protector inserted after induction of general anaesthesia. Effective insertion was confirmed by resistance to further distal movement, manual ventilation, and listening for gas leakage at the mouth. The breathing circuit was connected to the airway channel and airway patency confirmed with manual test ventilation at 20 cm H20 (water) pressure for 3 s. Data was collected in relation to the time for placement, intraoperative performance and postoperative performance of the airway device. Additionally, investigators rated the ease of insertion and adequacy of lung ventilation on a 5-point scale. The median (interquartile range [range]) time taken to insertion of the device was 31 (26–40[14–780]) s with the ability to ventilate after device insertion 100 (95% CI 96.7- 100)%. Secondary endpoints included one or more manoeuvres 60.3 (95% CI 50.6—69.5)% cases requiring to assist insertion; a median ease of insertion score of 4 (2–5[3–5]), and a median adequacy of ventilation score of 5 (5–5[4–5]). However, the first time insertion rate failure was 9.9% (95% CI 5.1—17.0%). There were no episodes of patient harm recorded, particularly desaturation. The LMA Protector appears suitable for clinical use, but an accompanying article discusses our reflections on the ADEPT approach to studying airway devices from a strategic perspective. [ABSTRACT FROM AUTHOR]

BackgroundPrevious research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia.MethodsWe included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit.ResultsA total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups.ConclusionThe LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.

Objective: Circumcision is the excision and removal of skin part that covers glans penis which is called as prepicium, Dorsal penile nevre block (DPNB) is used alone or in combination with general anesthesia for circumcision. Application of a laryngeal mask (LMA) is preferred especially in pediatric age group because it requiresless anesthetic substance, it doesn’t trigger laryngeal reflexes. Our aim was to compare DPNB application under sedation and LMA application for management of anesthesia in circumcision surgery. Material and Methods: The thousand and ten patients who had DPNB under sedation and LMA were compared with regards to duration of surgery, duration of anesthesia, duration of recovery, need for postoperative analgesia, complications, and season of surgery. Results: Duration of surgery, anesthesia, and recovery were significantly shorter in DPNB application under sedation compared with LMA application (p

Background. Induction of general anesthesia may cause hemodynamic instability. Remifentanil is often prescribed to suppress the hemodynamic response to anesthesia. The aim of this study was to investigate the effect of remifentanil on hemodynamic response to induction of anesthesia with propofol fentanyl or propofol ketamine and laryngeal mask airway (LMA) insertion. Methods. This double-blind randomized clinical trial study was performed on 44 candidates for cataract surgery in Feyz Hospital, Isfahan, Iran from March to June 2020. Patients were randomly assigned into two groups using random allocation software. The first group received 1 mcg/kg fentanyl and the second group received 0.5 mg/kg ketamine. Also, both groups received 1 mg/kg propofol and 0.5 mcg/kg remifentanil intravenously. Hemodynamic parameters were measured and recorded at study times, and the results were analyzed statistically. Results. The mean age (P=0.199), weight (P=0.050), height (P=0.9), and frequency distribution of gender (0.763) and American Society of Anesthesiologists (ASA) score (0.069) were not significantly different between the two groups. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in fentanyl group were significantly lower than the ketamine group immediately before LMA insertion, as well as 1, 3, and 5 minutes after LMA insertion (P 0.050). Conclusion. Intravenous administration of remifentanil in induction of anesthesia with propofol-ketamine and propofol-fentanyl reduced changes in hemodynamic responses to LMA insertion. This hemodynamic stability was increased by adding remifentanil to the propofol-ketamine combination. Practical Implications. Remifentanil is associated with weakening of hemodynamic responses to LMA insertion in induction of anesthesia with propofol and ketamine or propofol and fentanyl; this effect can be associated with safety in cardiac patients.

PurposeTo analyze the relationship between eccentric downward eye movement/eccentric downward eye-positioning (EDEM/EDEP) encountered in patients undergoing ophthalmic surgeries and its return to a centralized position under general anesthesia (GA) with the depth of anesthesia (DOA).MethodsPatients undergoing ophthalmic surgeries (6 months-12 years) under sevoflurane anesthesia without non-depolarizing muscle relaxant (NDMR) who witnessed a sudden tonic EDEM/EDEP were both retrospectively (R-group) and prospectively (P-group) enrolled (ambispective study). R-group included data-points after induction (AI) till the time surgery lasted while P-group compiled data both during induction (DI) and AI. DOA in terms of MAC (minimum alveolar concentration) at the time of EDEM/EDEP and centralization of eyeball and their timings were noted and compared for both AI and DI data-points. Also, vertical eccentric eye positions were scored and correlated with MAC.ResultsAI data included 22 (14R+8P) events and their mean MAC of EDEM/EDEP and centralization were 1.60 ± 0.25 and 1.18 ± 0.17 respectively (p = 0.000). DI data included 62 (P) cases and its mean MAC of EDEM/EDEP and centralization was 2.19 ± 0.43 and 1.39 ± 0.26 respectively (p = 0.000). Median (IQR) eye positions during down-positioning in 84 events was −3 (−3.9 to −2.5). It was preceded by an eccentric upward drift of eyes in 10/22 (6R+4P) AI cases. A strong negative correlation was seen between DOA and eccentric eye positions (r = −0.77, p = 0.000).ConclusionsTonic down-rolling of eyes is not uncommon in children seen without NDMR with higher depths of sevoflurane anesthesia compared to point of centralization and fluctuations in DOA should be avoided to circumvent inadvertent complications during ocular surgery.