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Sugiura T, Urushibata R, Fukaya S, Shioda T, Fukuoka T, Iwata O. Dependence of Successful Airway Management in Neonatal Simulation Manikins on the Type of Supraglottic Airway Device and Providers' Backgrounds. CHILDREN (BASEL, SWITZERLAND) 2024; 11:530. [PMID: 38790524 PMCID: PMC11119467 DOI: 10.3390/children11050530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024]
Abstract
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.
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Affiliation(s)
- Takahiro Sugiura
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan;
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka 422-8527, Japan; (R.U.); (T.S.); (T.F.)
| | - Rei Urushibata
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka 422-8527, Japan; (R.U.); (T.S.); (T.F.)
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Satoko Fukaya
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan;
| | - Tsutomu Shioda
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka 422-8527, Japan; (R.U.); (T.S.); (T.F.)
| | - Tetsuya Fukuoka
- Department of Pediatrics and Neonatology, Shizuoka Saiseikai General Hospital, Shizuoka 422-8527, Japan; (R.U.); (T.S.); (T.F.)
| | - Osuke Iwata
- Department of Pediatrics and Neonatology, Toyohashi Municipal Hospital, 50 Aza Hakken Nishi, Aotake-cho, Toyohashi 441-8570, Japan;
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya 467-8601, Japan;
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Oshika H, Koyama Y, Taguri M, Maruyama K, Hirabayashi G, Yamada SM, Kohno M, Andoh T. Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study. Medicine (Baltimore) 2018; 97:e11190. [PMID: 29924038 PMCID: PMC6023683 DOI: 10.1097/md.0000000000011190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. METHODS The authors compared airway rescue performances of the 3 devices-the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. RESULTS The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5-89.5) s, 29.9 (17.1-79.8) s, and 46.7 (21.9-211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. CONCLUSIONS Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.
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Affiliation(s)
- Hiroyuki Oshika
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Yukihide Koyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masataka Taguri
- Department of Biostatics, Yokohama City University Graduate School of Medicine, Yokohama
| | - Koichi Maruyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Go Hirabayashi
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Shoko Merrit Yamada
- Department of Neurosurgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masashi Kohno
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
- Department of Anesthesia, Tomei Atsugi Hospital, Atsugi, Japan
| | - Tomio Andoh
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
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Tracy MB, Priyadarshi A, Goel D, Lowe K, Huvanandana J, Hinder M. How do different brands of size 1 laryngeal mask airway compare with face mask ventilation in a dedicated laryngeal mask airway teaching manikin? Arch Dis Child Fetal Neonatal Ed 2018; 103:F271-F276. [PMID: 28802261 DOI: 10.1136/archdischild-2017-312766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND International neonatal resuscitation guidelines recommend the use of laryngeal mask airway (LMA) with newborn infants (≥34 weeks' gestation or >2 kg weight) when bag-mask ventilation (BMV) or tracheal intubation is unsuccessful. Previous publications do not allow broad LMA device comparison. OBJECTIVE To compare delivered ventilation of seven brands of size 1 LMA devices with two brands of face mask using self-inflating bag (SIB). DESIGN 40 experienced neonatal staff provided inflation cycles using SIB with positive end expiratory pressure (PEEP) (5 cmH2O) to a specialised newborn/infant training manikin randomised for each LMA and face mask. All subjects received prior education in LMA insertion and BMV. RESULTS 12 415 recorded inflations for LMAs and face masks were analysed. Leak detected was lowest with i-gel brand, with a mean of 5.7% compared with face mask (triangular 42.7, round 35.7) and other LMAs (45.5-65.4) (p<0.001). Peak inspiratory pressure was higher with i-gel, with a mean of 28.9 cmH2O compared with face mask (triangular 22.8, round 25.8) and other LMAs (14.3-22.0) (p<0.001). PEEP was higher with i-gel, with a mean of 5.1 cmH2O compared with face mask (triangular 3.0, round 3.6) and other LMAs (0.6-2.6) (p<0.001). In contrast to other LMAs examined, i-gel had no insertion failures and all users found i-gel easy to use. CONCLUSION This study has shown dramatic performance differences in delivered ventilation, mask leak and ease of use among seven different brands of LMA tested in a manikin model. This coupled with no partial or complete insertion failures and ease of use suggests i-gel LMA may have an expanded role with newborn resuscitation as a primary resuscitation device.
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Affiliation(s)
- Mark Brian Tracy
- Westmead Hospital, Neonatal Intensive Care Westmead, Westmead, New South Wales, Australia.,Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
| | - Archana Priyadarshi
- Westmead Hospital, Neonatal Intensive Care Westmead, Westmead, New South Wales, Australia.,Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
| | - Dimple Goel
- Westmead Hospital, Neonatal Intensive Care Westmead, Westmead, New South Wales, Australia.,Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
| | - Krista Lowe
- Westmead Hospital, Neonatal Intensive Care Westmead, Westmead, New South Wales, Australia
| | - Jacqueline Huvanandana
- Faculty of Engineering and Information Technologies, BMET Institute, Sydney University, Sydney, New South Wales, Australia
| | - Murray Hinder
- Westmead Hospital, Neonatal Intensive Care Westmead, Westmead, New South Wales, Australia.,Faculty of Engineering and Information Technologies, BMET Institute, Sydney University, Sydney, New South Wales, Australia
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Neonatal airway simulators, how good are they? A comparative study of physical and functional fidelity. J Perinatol 2016; 36:151-6. [PMID: 26583944 DOI: 10.1038/jp.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/29/2015] [Accepted: 10/01/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Proficiency in airway management is critical for neonatal health-care professionals. Simulation is a proven method to improve airway management skills. Skills transfer from simulation to the real life requires simulators with appropriate physical and functional fidelity. STUDY DESIGN A cohort of neonatal health-care professionals evaluated eight different neonatal airway simulators for physical and functional fidelity. RESULT Twenty-seven subjects completed 151 simulator evaluations. Significant differences were found between the simulators evaluated (P<0.001). The manikins with the highest fidelity scores were the SimNewB, Newborn Anne and Premature Anne (Laerdal Medical). The task trainers with the highest fidelity scores were the Neonatal Intubation Trainer (Laerdal Medical) and the Newborn Airway Trainer (Syndaver Labs). CONCLUSION Simulator fidelity is an important aspect of simulation training, but is rarely evaluated. The results of this study can aid in choosing the best simulators for training and research, and provide feedback to the industry to guide future simulator development.
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Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 2015; 25:334-45. [PMID: 25585975 DOI: 10.1111/pan.12614] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/26/2022]
Abstract
Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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Performance of size 1 I-gel compared with size 1 ProSeal laryngeal mask in anesthetized infants and neonates. ScientificWorldJournal 2015; 2015:426186. [PMID: 25793219 PMCID: PMC4352429 DOI: 10.1155/2015/426186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/21/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose. The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA. Methods. Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications. Results. There were no significant differences in terms of airway leak pressure between the I-gel (27.44 ± 5.67) and ProSeal LMA (23.52 ± 8.15) (P = 0.054). The insertion time for the I-gel was shorter (12.6 ± 2.19 s) than for the ProSeal LMA (24.2 ± 6.059 s) (P = 0.0001). Insertion success and conditions were similar in groups. We encountered few complications. Conclusion. Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.gov NCT01704118.
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Schmölzer GM, Agarwal M, Kamlin COF, Davis PG. Supraglottic airway devices during neonatal resuscitation: An historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation 2013; 84:722-30. [DOI: 10.1016/j.resuscitation.2012.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/09/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
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The ProSeal Laryngeal Mask Airway is more effective than the LMA-Classic in pediatric anesthesia: a meta-analysis. J Clin Anesth 2012; 24:639-46. [DOI: 10.1016/j.jclinane.2012.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 04/19/2012] [Accepted: 04/29/2012] [Indexed: 11/22/2022]
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Trevisanuto D, Parotto M, Doglioni N, Ori C, Zanardo V, Micaglio M. The Supreme Laryngeal Mask Airway™ (LMA): A new neonatal supraglottic device: Comparison with Classic and ProSeal LMA in a manikin. Resuscitation 2012; 83:97-100. [DOI: 10.1016/j.resuscitation.2011.07.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/13/2011] [Accepted: 07/20/2011] [Indexed: 11/30/2022]
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Zanardo V, Legarizzi S, Giustardi A, Micaglio M, Trevisanuto D. Breastfeeding success after laryngeal mask airway resuscitation. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903177136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In 1988, when the Laryngeal Mask Airway-Classic (Intavent Orthofix, Maidenhead, UK), was introduced there were only two choices of airway management: tracheal tube or facemask. The supraglottic airway, as we now understand the term, did not exist. Yet, 20 years later, we are faced with an ever increasing choice of supraglottic airway devices (SAD). For many SADs, with the exception of the LMA-Classic and LMA-Proseal (Intavent Orthofix, Maidenhead, UK), there is a lack of high quality data of efficacy. The best evidence requires a randomized controlled trial comparing a new device against an established alternative, properly powered to detect clinically relevant differences in clinically important outcomes. Such studies in children are very rare. Safety data is even harder to establish particularly for rare events such as aspiration. Therefore, most safety data comes from extended use rather than high quality evidence which inevitably biases against newer devices. For reason of these factors, claims of efficacy and particularly safety must be interpreted cautiously. This narrative review aims to present the evidence surrounding the use of currently available pediatric SADs in routine anesthetic practice.
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Affiliation(s)
- Michelle C White
- Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Marlborough Street, Bristol, UK.
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Scheller B, Schalk R, Byhahn C, Peter N, L’Allemand N, Kessler P, Meininger D. Laryngeal tube suction II for difficult airway management in neonates and small infants. Resuscitation 2009; 80:805-10. [DOI: 10.1016/j.resuscitation.2009.03.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 02/28/2009] [Accepted: 03/03/2009] [Indexed: 11/26/2022]
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Raupp P, McCutcheon C. Neonatal resuscitation--an analysis of the transatlantic divide. Resuscitation 2007; 75:345-9. [PMID: 17583409 DOI: 10.1016/j.resuscitation.2007.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 04/20/2007] [Accepted: 05/01/2007] [Indexed: 11/16/2022]
Abstract
AIM To highlight the main differences between the current editions of the Newborn Life Support (NLS; Resuscitation Council, UK) and the Neonatal Resuscitation Program (NRP; American Academy of Pediatrics and American Heart Association), and to analyse differences between the evidence underlying NLS and NRP. MATERIAL AND METHODS We undertook a detailed comparison of recommendations and references, based on the NLS and the NRP provider course manuals issued in 2006. Literature on neonatal resuscitation, published in 2005 and thereafter, was searched, focusing on controversies between NLS and NRP. RESULTS A multitude of important differences between NLS and NRP have been reaffirmed in their current editions, leading to conflicting messages regarding many aspects of resuscitation. An incongruent selection of evidence appears to be a major factor accounting for this divergence. CONCLUSION To avoid confusion among health care providers and to support the credibility of both NLS and NRP, an intensified dialogue and a more congruent evidence base between NRP and NLS is required. Mutual recognition of equivalency appears unrealistic until substantial progress in this direction has been achieved.
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Affiliation(s)
- Peter Raupp
- Department of Neonatology, Al Corniche Hospital, Abu Dhabi, United Arab Emirates.
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In this issue. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2006.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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