Tracheal Intubation Laryngeal Mask Airways Publications (4761)
Tracheal Intubation Laryngeal Mask Airways Publications
Hence, this study was designed to compare the effectiveness of ILMA technique with FOB to accomplish endotracheal intubation in patients undergoing cervical discectomy.
Sixty patients of age group 20-60 years, of American Society of Anesthesiologists status I or II, were enrolled in this prospective and randomized study. They were allocated to one of the two groups, ILMA group and FOB group. The patients were intubated orally using either equipment, after dexmedetomidine premedication and induction of general anesthesia. Chi-square and Fisher exact tests were used to find the significance of study parameters on a categorical scale. Paired samples t-test and Student's t-test were used to find the significance of study parameters on a continuous scale. Significance was assessed at 5% level of significance.
Bronchoscopy was a faster method of securing airway as compared with ILMA (38.13 ± 11.52 vs. 29.83 ± 13.75 s). Tracheal intubation was successful in all 60 patients (100%), belonging to both groups.
ILMA and FOB were comparable with regards to ease of intubation in terms of time, the number of attempts and hemodynamic stability.
The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices.
With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anaesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p<0.05).
Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once.
None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices.
This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG).
This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points.
Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO 2 (pCO 2 ), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group.
In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG.
Primary outcome was success rate of tracheal intubation through the device, while secondary outcomes were times required for device insertion and tracheal tube placement, fibreoptic scores and the incidence of perioperative complications and postoperative complaints. The success rates showed no statistical difference between devices (i-gel 100%, CTrach 97.5%, ILMA 95%). Insertion time was shortest for the i-gel (12.4 s) compared with ILMA (19.3 s) and CTrach (24.4 s). Intubation time was shorter in the i-gel group (29.4 s) in comparison with the CTrach (39.8 s, p<0.05) and sILMA (51.9 s, p<0.001) groups. Best fibreoptic scores were observed also in the i-gel group. In total, 24 patients (20%) presented with difficult laryngoscopy. The i-gel showed significantly shorter times for insertion and fibreoptic intubation than the other two devices in this group. No difference was observed in the incidence of postoperative complaints. The i-gel is a suitable alternative to the sILMA and CTrach for fibrescope-guided tracheal intubation. Shorter insertion and intubation times with the i-gel may provide advantage in case of difficult oxygenation.
Eighty-five adult patients with at least 3 difficult airway predictors or difficult airway management history were included.
The i-gel device was inserted in spontaneous ventilation under oropharyngeal local anesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anesthesia was induced to introduce the endotracheal tube guided by fiberoptic bronchoscope.
We recorded the i-gel insertion time (tgel), intubation time (tint), and O2 saturation in pulse oximetry in different moments: basal (t0), after 3 minutes of preoxygenation with a face mask at 100% fraction of inspired O2 (t1), after i-gel mask insertion (t2), and after intubation (t3). Adverse events during the procedure were also recorded, and patient discomfort was questioned.
All patients were successfully intubated. O2 saturation in pulse oximetry values were (mean±SD): 96.9±1.22 (t0), 99.0±0.85 (t1), 96.2±2.37 (t2), and 96.0±2.54 (t3). tgel and tint were 38.0±7.76 seconds and 36.5±5.55 seconds (mean±SD), respectively. No serious adverse events were recorded, and no patient suffered airway damage. Visual analogue scale for patient discomfort was 2 (interquartile range, 1-3).
i-gel insertion in spontaneously breathing patients avoids the "cannot ventilate" scenario. The subsequent fiberoptic-guided intubation through the i-gel is a safe and effective technique. More studies might be necessary to confirm the results presented, but we consider that the technique described is an adequate alternative to classic orotracheal intubation with fiberoptic bronchoscope in spontaneous ventilation for certain patients with predicted difficult airway.
A total of 50 adult patients with Cormack-Lehane grade ≥3 and general anesthesia with tracheal intubation were randomly assigned to either the laryngeal mask airway (LMA) or WNJ groups. The primary outcome was the percentage of patients with SpO2 values lower than 94 % during intubation. The proportion of successful intubations, total time of intubation, and associated complications were also recorded. The percentage of patients with SpO2 values lower than 94 % during intubation was significantly higher in the LMA group (25 % in the LMA vs. 0 % in the WNJ, P = 0.01). Although there were no statistically significant differences in the total success rates of intubation, the first-attempt success rate was significantly higher in the WNJ group (100 vs. 79.2 %, P = 0.02). The total time required for intubation with the WNJ was shorter than that of the LMA (73.4 vs. 99.5 s, P < 0.001), although the duration of fibre-optic intubation was similar. The incidence of complications was similar between the two groups. SJOV-assisted FOB using the WNJ improved oxygenation and successful tracheal intubation in the management of difficult airways. This technique can be used as an alternative approach to improve success and minimize hypoxia during difficult airway management.
Randomized clinical trials comparing ventilation strategies for infants younger than 33 weeks' gestational age within 24 hours of birth who had not been intubated.
Data were independently extracted by 2 reviewers and synthesized with Bayesian random-effects network meta-analyses.
A composite of death or BPD at 36 weeks' postmenstrual age was the primary outcome. Death, BPD, severe intraventricular hemorrhage, and air leak by discharge were the main secondary outcomes.
Among 5598 infants involved in 30 trials, the incidence of the primary outcome was 33% (1665 of 4987; including 505 deaths and 1160 cases of BPD). The secondary outcomes ranged from 6% (314 of 5587) for air leak to 26% (1160 of 4455) for BPD . Compared with mechanical ventilation, LISA had a lower odds of the primary outcome (odds ratio [OR], 0.49; 95% credible interval [CrI], 0.30-0.79; absolute risk difference [RD], 164 fewer per 1000 infants; 57-253 fewer per 1000 infants; moderate quality of evidence), BPD(OR, 0.53; 95% CrI, 0.27-0.96; absolute RD, 133 fewer per 1000 infants; 95% CrI, 9-234 fewer per 1000 infants; moderate-quality), and severe intraventricular hemorrhage (OR, 0.44; 95% CrI, 0.19-0.99; absolute RD, 58 fewer per 1000 births; 95% CrI, 1-86 fewer per 1000 births; moderate-quality). Compared with nasal CPAP alone, LISA had a lower odds of the primary outcome (OR, 0.58; 95% CrI, 0.35-0.93; absolute RD, 112 fewer per 1000 births; 95% CrI, 16-190 fewer per 1000 births; moderate quality), and air leak (OR, 0.24; 95% CrI, 0.05-0.96; absolute RD, 47 fewer per 1000 births; 95% CrI, 2-59 fewer per 1000 births; very low quality). Ranking probabilities indicated that LISA was the best strategy with a surface under the cumulative ranking curve of 0.85 to 0.94, but this finding was not robust for death when limited to higher-quality evidence.
Among preterm infants, the use of LISA was associated with the lowest likelihood of the composite outcome of death or BPD at 36 weeks' postmenstrual age. These findings were limited by the overall low quality of evidence and lack of robustness in higher-quality trials.
Conventional tracheal intubation was impossible because the patient had a difficult airway, and the procedure could cause severe cyanosis and respiratory distress. An LMA was inserted to maintain ventilation and anesthesia and to facilitate intubation. Retrograde intubation and a catheter mount were used to convert the LMA into a conventional endotracheal tube without difficulty. Airway management for patients with TOF and cleft palate deformity is not clear. Retrograde intubation permits replacing an LMA with an endotracheal tube. This method enables maintaining the airway until the LMA is exchanged with an endotracheal tube. This technique seems useful to facilitate difficult airway intubation in pediatric patients with TOF and cleft palate deformity.
The allocated LMA was inserted by the same anaesthetist; bispectral index (BIS) was between 40% and 60%.
There was no statistical difference among the groups regarding the ease of insertion and insertion time as primary outcomes; the incidence of repositioning during placement was significantly higher in the LMA Classic group than that in other groups (p<0.05) and the rates of bloodstain on the device as well as oropharyngeal mucosal oedema were higher in the LMA Fastrach group than those in other groups (p<0.05) as secondary outcomes.
We suggest that LMA Classic, LMA Supreme and LMA Fastrach had similar effectiveness regarding efficiency and airway safety. However, LMA Supreme seems to be more advantageous as it is more appropriate for fewer oropharyngeal complications and there was no repositioning.