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Choi JJ, Jung WS, Chang YJ, Yoo S, Kwak HJ. Effective concentration of remifentanil for successful i-gel insertion during remimazolam induction. Korean J Anesthesiol 2023; 76:235-241. [PMID: 36314044 DOI: 10.4097/kja.22606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/26/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Remifentanil can be used as adjuvants during remimazolam induction without neuromuscular blockade. We evaluated the 95% effective concentration (EC) of remifentanil effect-site concentration (Ce) for the successful insertion of an i-gel using the biased-coin up-and-down method in adult patients during remimazolam induction. METHODS Forty 19-65 year-old patients scheduled to undergo surgery using i-gel were enrolled. Anesthesia was induced using remimazolam infusion (12 mg/kg/h). Simultaneously, remifentanil was infused at a predetermined Ce. After 5 min of anesthesia induction, the i-gel was inserted. The 95% EC (EC95) of remifentanil in each patient was determined using a biased-coin up-and-down method based on a successful insertion in a preceding patient. The step size of remifentanil Ce was 0.4 ng/ml. If the insertion failed, remifentanil Ce was increased in the next patient. Following successful insertions, the corresponding concentration decreased in subsequent patients with a probability of 1/19 or was maintained with a probability of 18/19. The time from remimazolam infusion initiation to a bispectral index (BIS) < 60 (time to BIS60) and hemodynamic variables were measured and recorded. RESULTS The EC95 (95% CI) of Ce was 2.07 (1.94, 2.87) ng/ml. The overall time to BIS60 was 154.0 ± 39.9 s. No patient experienced significant hypotension or bradycardia during remimazolam induction. CONCLUSIONS The EC95 of remifentanil Ce was 2.07 (1.94, 2.87) ng/ml for successful i-gel insertion during remimazolam induction at 12 mg/kg/h without hemodynamic instability in adult patients. Future studies should measure remifentanil Ce in elderly patients or using remimazolam at various infusion doses.
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Affiliation(s)
- Jung Ju Choi
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Seungbeom Yoo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Wang B, Du L, Zhang L, Zheng J. Prewarming non-inflatable cuff laryngeal mask for mechanical ventilation: A systematic review and meta-analysis with trial sequential analysis. Medicine (Baltimore) 2022; 101:e31032. [PMID: 36316864 PMCID: PMC9622593 DOI: 10.1097/md.0000000000031032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Non-inflatable cuff laryngeal masks are generally composed of thermoplastic material. The thermoplastic nature of the non-inflatable cuff will become soft and match the laryngeal anatomy better as it reaches body temperature after intubation. This meta-analysis aims to evaluate the clinical validity of prewarming non-inflatable cuff laryngeal mask before insertion. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, Ovid Medline, CNKI, Wan Fang Database and VIP Database to find randomized controlled trials (RCTs) researching the clinical validity of prewarming non-inflatable cuff laryngeal mask. The retrieval time is up to June 2022. Articles published in the English and Chinese languages were considered. Quality assessment was conducted with the Cochrane Collaboration's tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Subgroup analyses and trial sequential analysis (TSA) were performed to control the risk of random errors. Publication bias was assessed by funnel plots and Egger's regression test. The outcomes included sealing pressure immediately after successful ventilation, the first-attempt intubation success rate and the incidence of postoperative pharyngeal pain. RESULTS Eight RCTs evaluating 683 patients were identified. Pooled results showed that compared to the control group, prewarming non-inflatable cuff laryngeal mask provided a higher sealing pressure immediately after successful ventilation (mean difference: 1.73 cm H2O; 95% confidence interval [CI]: 0.95-2.52; P < .0001; I2 = 16; high quality), higher first-attempt intubation success rate (risk ratio [RR]: 1.05; 95% CI: 1.01-1.09; P = .01; I2 = 26%; high quality, number needed to treat [NNT] = 22 [95% CI 12.5-100]) and lower incidence of postoperative pharyngeal pain (RR: 0.59, 95% CI: 0.46-0.75; P < .0001; I2 = 0; high quality, NNT = 6 [95% CI 4.17-9.09]). The results were confirmed by TSA. CONCLUSION Prewarming non-inflatable cuff laryngeal mask could provide better mechanical ventilation efficiency with higher sealing pressure, a higher first-attempt intubation success rate and a lower incidence of postoperative pharyngeal pain. TRIAL REGISTRATION NUMBER PROSPERO CRD42021245350.
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Affiliation(s)
- Bo Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianqiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Jianqiao Zheng, Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guo Xue Alley, Chengdu 610041, Sichuan, China (e-mail: )
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Sivashankari B, Engineer S, Balagopal KTS. A randomized trial to compare thenar eminence dimensions-based method with body weight method to determine I-gel size in pediatric patients. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Huh H, Cho JE, Lee SW, Kim HC. The effects of two-handed jaw thrust on i-gel™ placement in anesthetized non-paralyzed patients. Minerva Anestesiol 2021; 87:1109-1116. [PMID: 34676743 DOI: 10.23736/s0375-9393.21.15696-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND I-gelTM is a second-generation supraglottic airway device with a non-inflatable cuff. In this prospective randomized investigation, we evaluated the effects of two-handed jaw thrust technique on i-gel insertion in anesthetized non-paralyzed patients. METHODS Seventy-four adult patients were allocated to two groups (N.=37 each). In the jaw thrust group, two-handed jaw thrust technique was applied to facilitate i-gel insertion. In the control group, conventional i-gel insertion was performed. The success rate at the first attempt, air leakage pressure, insertion time, and postoperative sore throat incidence were recorded. RESULTS The success rate at the first attempt was higher in the jaw thrust group (37 [100%] vs. 31 [84%], difference of 16%, 95% confidence interval for the difference: 1 to 33%, P=0.03). The median air leakage pressure was higher in the jaw thrust group than in the control group (20 [interquartile range 13] vs. 17 [interquartile range 3] cmH<inf>2</inf>O, difference: 6, 95% confidence interval of the difference: 3 to 8, P<0.01). The mean insertion time was shorter in the jaw thrust group (27±14 vs. 41±29 seconds, difference: 14 seconds, 95% confidence interval of the difference: 3 to 24, P=0.01). The incidence of postoperative sore throat at the postoperative one hour was lower in the jaw thrust group (seven [20%] vs. 15 [41%], difference 22%, 95% confidence interval for the difference: -1 to 42%, P=0.04). CONCLUSIONS The two-handed jaw thrust technique facilitated i-gel insertion compared to the conventional technique in anesthetized non-paralyzed patients.
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Affiliation(s)
- Hyub Huh
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Kangdong, Seoul, South Korea
| | - Jang E Cho
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Suk W Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Hyun-Chang Kim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea -
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Zheng J, Du L, Wang J, Zhang L, Chen G. Prewarming i-gel laryngeal mask for mechanical ventilation: a meta-analysis of randomised control trials and trial sequential analysis. BMJ Open 2021; 11:e045461. [PMID: 34376440 PMCID: PMC8356164 DOI: 10.1136/bmjopen-2020-045461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To systematically evaluate the efficiency of prewarming i-gel laryngeal mask for mechanical ventilation by meta-analysis and trial sequential analysis. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane library, Web of Science, Ovid Medline and PubMed were searched from their inception to 31 August 2020. Only articles published in English language were considered. METHODS Randomised controlled trials (RCTs) comparing the efficiency of prewarming i-gel laryngeal mask versus keeping it at room temperature for mechanical ventilation were included. Primary outcome was sealing pressure immediately after successful ventilation. Secondary outcomes were the first-attempt insertion success rate and the incidence of postoperative pharyngeal pain. Two authors independently selected studies. Quality analysis was performed using the modified Jadad Scale. Trial sequential analysis (TSA) was used to control risk of random errors. Sensitivity analysis was done to assess the effect of a single study on the pooled estimates. Publication bias was assessed by funnel plots and Egger's regression test. RESULTS Four RCTs comprising 374 patients were included. The results of meta-analysis showed that compared with the control group, prewarming i-gel laryngeal mask provides a higher sealing pressure immediately after successful ventilation (mean difference 2.19 cm H2O; 95% CI (1.17 to 3.21); p<0.0001; high quality), with firm evidence from TSA and lower publication bias (p=0.7372). No significant difference was observed in the first-attempt insertion success rate (relative ratio (RR) 1.06; 95% CI (1.00 to 1.12); p=0.07; high quality) with lower publication bias (p=0.1378). The TSA indicating further trials are required. No significant difference was assessed in the incidence of postoperative pharyngeal pain (RR 1.0; 95% CI (0.14 to 6.90); p=1.0; high quality). CONCLUSION Prewarming i-gel laryngeal mask provides higher sealing pressure compared with keeping it at room temperature. But prewarming i-gel laryngeal mask did not increase the first-attempt insertion success rate, nor did it decrease the incidence of postoperative pharyngeal pain.
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Affiliation(s)
- Jianqiao Zheng
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
| | - Jia Wang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Lu Zhang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Guo Chen
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
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Farouk I, Abdelhamid BM, Wishahy MK, Mohamed H, Hassan MM. Efficiency of I-gel supraglottic airway device during mechanical ventilation in supine and lateral decubitus position in obese patient; prospective observational study. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1789811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Inas Farouk
- Department of Anaesthesia, Pain management and surgical ICU, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Bassant Mohamed Abdelhamid
- Department of Anaesthesia, Pain management and surgical ICU, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Hassan Mohamed
- Department of Anaesthesia, Pain management and surgical ICU, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohamed Mahmoud Hassan
- Department of Anaesthesia, Pain management and surgical ICU,National Cancer Institute, Cairo University, Cairo, Egypt
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Luthra A, Chauhan R, Jain A, Bhukal I, Mahajan S, Bala I. Comparison of Two Supraglottic Airway Devices: I-gel Airway and ProSeal Laryngeal Mask Airway Following Digital Insertion in Nonparalyzed Anesthetized Patients. Anesth Essays Res 2019; 13:669-675. [PMID: 32009713 PMCID: PMC6937903 DOI: 10.4103/aer.aer_132_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/17/2022] Open
Abstract
Aims: The study is aimed to compare the efficacy of I-gel and ProSeal laryngeal mask airway (PLMA) in nonparalysed anesthetized individuals following manufacturer-recommended digital insertion. Materials and Methods: In this prospective randomized observational study, 40 American Society of Anesthesiologists I and II patients, aged 18–65 years scheduled for elective surgical procedures were allocated either to PLMA group (Group P, n = 20) or the I-gel group (Group I, n = 20). Following digital insertion of PLMA or I-gel, the following parameters were compared: insertion time, ease of insertion, number of attempts, failed insertion, airway reaction during insertion, oropharyngeal leak (OPL) pressure, and gastric insufflation on auscultation. Fiberoptic view of both the channels of the airway devices and ease of insertion of 12 F Ryle's tube through gastric drain channel were graded. Postoperative complications were also noted. Results: First attempt and overall insertion success were similar (PLMA, 85% and 100%; I-gel 80% and 100%, respectively). Mean (standard deviation) insertion times were similar (PLMA, 27.40 [11.51] s; I-gel 25.45 [9.03] s). Mean OPL pressure was 3.5 cm H2O higher with PLMA (P < 0.012). The passage of Ryle's tube was easier through I-gel than PLMA. Grade I glottic view (full view of the vocal cords) was visible in 17 (85%) patients who were managed with I-gel whereas only 9 (45%) patients had Grade I view in the PLMA group. Conclusion: The time required for digital insertion of PLMA and I-gel in nonparalyzed anesthetized patients is similar but PLMA forms a better oropharyngeal seal. I-gel is better positioned over the laryngeal framework and esophagus. I-gel allows easier passage of Ryle's tube through its drain channel than PLMA. The incidence and severity of postoperative sore throat and hoarseness was higher with PLMA.
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Affiliation(s)
- Ankur Luthra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Jain
- Department of Anesthesiology, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab of Emirates
| | - Ishwar Bhukal
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalvi Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Garg A, Lamba NS, Ajai Chandra NS, Singhal RK, Chaudhary V. Supraglottic airway devices in short gynecological procedures: A randomized, clinical study comparing the Baska ® mask and I-Gel ® device. J Family Med Prim Care 2019; 8:1134-1137. [PMID: 31041263 PMCID: PMC6482730 DOI: 10.4103/jfmpc.jfmpc_359_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Supraglottic airway devices are used for anesthesia in elective surgical procedures circumventing the need for intubation. We investigated the efficacy and safety of Baska® mask in comparison to an I-Gel® device. Methods In this cross-sectional, observational study, we randomized 100 female patients (age 18-45 years, American Society of Anaesthesiologists grade I or II) undergoing elective short gynecological procedures into two groups, to receive ventilation with either Baska mask® (group 1, n = 50) or an I-Gel® device (group 2, n = 50). We excluded patients with obesity, short neck, and known systemic and upper airway disorders. The primary outcome was the oropharyngeal airway seal pressure, and the secondary outcomes were the ease of insertion and the complication rate. The results were analyzed using Mann-Whitney U-test and Fisher's exact test, and correlation analysis was done by Spearman's correlation test. Results A total of 56 patients underwent dilatation and curettage, whereas the remaining had hysteroscopy in the study. The airway seal pressure achieved was higher with Baska® mask than I-Gel® device (35.8 ± 10.3 and 26.9 ± 7.5 of cm H2O, respectively; P < 0.0001). The ease of insertion (P < 0.0001) was better in group 1 and the complication rates were similar in both the groups (P > 0.05). Conclusion Baska® mask offers a superior airway seal pressure with minimum complications in comparison to an I-Gel® device. Further studies with a large number of patients in different surgical settings are required to confirm our findings.
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Affiliation(s)
- Anurag Garg
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - N S Lamba
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - N S Ajai Chandra
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - R K Singhal
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - Vishal Chaudhary
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
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Dingley J, Stephenson J, Allender V, Dawson S, Williams D. Changes in hardness and resilience of i-gelTM
cuffs with temperature: a benchtop study. Anaesthesia 2018; 73:856-862. [DOI: 10.1111/anae.14300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Dingley
- Swansea University College of Medicine; Swansea UK
| | | | - V. Allender
- Food Science and Technology; Department of Healthcare and Food; Cardiff School of Sport and Health Sciences; Cardiff Metropolitan University; Cardiff UK
| | - S. Dawson
- Food Science and Technology; Department of Healthcare and Food; Cardiff School of Sport and Health Sciences; Cardiff Metropolitan University; Cardiff UK
| | - D. Williams
- Welsh Centre for Burns; ABM University Health Board; Swansea UK
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Singh A, Bhalotra AR, Anand R. A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial. Indian J Anaesth 2018; 62:858-864. [PMID: 30532321 PMCID: PMC6236799 DOI: 10.4103/ija.ija_153_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Second-generation supraglottic airway devices are widely used in current anaesthesia practice. This randomised study was undertaken to evaluate and compare laryngeal mask airway: ProSeal laryngeal mask airway (PLMA), Supreme laryngeal mask airway (SLMA) and I-gel. Methods Eighty-four adult patients undergoing elective surgery were randomly allocated to three groups: group P (PLMA), group I (I-gel) and group S (SLMA) of 28 patients each. Insertion times, number of insertion attempts, haemodynamic response to insertion, ease of insertion of airway device and gastric tube, oropharyngeal leak pressure (OLP) and pharyngolaryngeal morbidity were assessed. The primary outcome measure was the OLP after successful device insertion. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0 software using Chi-squared/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests. P < 0.05 was considered statistically significant. Results The demographic profile of patients was comparable. OLP measured after insertion, 30 minutes later and at the end of surgery differed significantly between the three groups (P < 0.001). The mean OLP was 32.64 ± 4.14 cm·H2O in group P and 29.79 ± 3.70 cm·H2O in group S. In group I, the mean OLP after insertion was 26.71 ± 3.45 cm H2O, which increased to 27.36 ± 3.22 cm H2O at 30 minutes and to 27.50 ± 3.24 cm H2O towards the end of surgery. However, these increases were not statistically significant (P = 0.641). Device insertion time was longest for group P (P = 0.001) and gastric tube insertion time was longest for group I (P = 0.001). Haemodynamic response to insertion and pharyngolaryngeal morbidity were similar with all three devices. Conclusion PLMA provides better sealing pressure but takes longer to insert. I-gel and SLMA have similar sealing pressures. I-gel insertion time is quicker.
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Affiliation(s)
- Anisha Singh
- Department of Anesthesia, Maulana Azad Medical College, New Delhi, India
| | - Anju R Bhalotra
- Department of Anesthesia, Maulana Azad Medical College, New Delhi, India
| | - Raktima Anand
- Department of Anesthesia, Maulana Azad Medical College, New Delhi, India
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Park MJ, Kwon WY, Kim K, Suh GJ, Shin J, Jo YH, Kim KS, Lee HJ, Kim J, Lee SJ, Kim JY, Cho JH. Prehospital Supraglottic Airway Was Associated With Good Neurologic Outcome in Cardiac Arrest Victims Especially Those Who Received Prolonged Cardiopulmonary Resuscitation. Acad Emerg Med 2017; 24:1464-1473. [PMID: 28898484 DOI: 10.1111/acem.13309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/13/2017] [Accepted: 09/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We performed this study to investigate the association of prehospital supraglottic airway (SGA) on neurologic outcome in cardiac arrest victims with adjustment of postresuscitation variables as well as prehospital and resuscitation variables. METHODS This study was a retrospective study based on a multicenter prospective cohort registry from December 2013 to April 2016. According to the 28-day cerebral performance categories (CPCs) scale, patients were divided into the good-outcome group (CPC 1-2) and the poor-outcome group (CPC 3-5). We compared the two groups with respect to demographic variables, prehospital and in-hospital resuscitation variables, and postresuscitation variables. RESULTS A total of 869 cardiac arrest victims who received in-progress cardiopulmonary resuscitation (CPR) were delivered to the emergency department of three hospitals, and 310 patients were admitted to the intensive care unit. The use of a prehospital SGA was independently associated with 28-day good neurologic outcome (odds ratio [OR] = 7.88; 95% confidence interval [CI] = 1.33-46.53; p = 0.023] when postresuscitation variables were adjusted, although there were no significant association with the acquisition of sustained return of spontaneous circulation (OR = 0.992; 95% CI = 0.591-1.666; p = 0.976). Furthermore, a prehospital SGA was significantly associated with good neurologic outcome, especially in patients who received prolonged CPR (low flow time > 15 minutes; OR = 3.41; 95% CI = 1.23-9.45; p = 0.018) rather than in patients with nonprolonged CPR (OR = 4.50; 95% CI = 0.75-27.13; p = 0.101). CONCLUSIONS When postresuscitation variables were adjusted, the prehospital SGA was independently associated with 28-day good neurologic outcome in cardiac arrest victims.
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Affiliation(s)
- Min Ji Park
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Woon Yong Kwon
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Kyuseok Kim
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Gil Joon Suh
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Jonghwan Shin
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - You Hwan Jo
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Kyung Su Kim
- Department of Emergency Medicine; Seoul National University College of Medicine; Seoul
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Hui Jai Lee
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - Joonghee Kim
- Department of Emergency Medicine; Seoul National University Bundang Hospital; Seongnam-si Gyeonggi-do
| | - Se Jong Lee
- Department of Emergency Medicine; Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Seoul
| | - Jeong Yeon Kim
- Department of Emergency Medicine; Seoul National University Hospital; Seoul
| | - Jun Hwi Cho
- Department of Emergency Medicine; Kangwon National University Hospital; Chuncheon-si Gangwon-do Republic of Korea
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Jung YS, Paik H, Min SH, Choo H, Seo M, Bahk JH, Seo JH. Calling the patient's own name facilitates recovery from general anaesthesia: a randomised double-blind trial. Anaesthesia 2016; 72:197-203. [DOI: 10.1111/anae.13688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Y. S. Jung
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - H. Paik
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - S.-H. Min
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - H. Choo
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - M. Seo
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-H. Bahk
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
| | - J.-H. Seo
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
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Naik L, Bhardwaj N, Sen IM, Sondekoppam RV. Intubation Success through I-Gel® and Intubating Laryngeal Mask Airway® Using Flexible Silicone Tubes: A Randomised Noninferiority Trial. Anesthesiol Res Pract 2016; 2016:7318595. [PMID: 27478436 PMCID: PMC4958418 DOI: 10.1155/2016/7318595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 05/12/2016] [Accepted: 06/01/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction. The study aims to test whether flexible silicone tubes (FST) improve performance and provide similar intubation success through I-Gel as compared to ILMA. Our trial is registered in CTRI and the registration number is "CTRI/2016/06/006997." Methods. One hundred and twenty ASA status I-II patients scheduled for elective surgical procedures needing tracheal intubation were randomised to endotracheal intubation using FST through either I-Gel or ILMA. In the ILMA group (n = 60), intubation was attempted through ILMA using FST and, in the I-Gel group (n = 60), FST was inserted through I-Gel airway. Results. Successful intubation was achieved in 36.67% (95% CI 24.48%-48.86%) on first attempt through I-Gel (n = 22/60) compared to 68.33% (95% CI 56.56%-80.1%) in ILMA (n = 41/60) (p = 0.001). The overall intubation success rate was also lower with I-Gel group [58.3% (95% CI 45.82%-70.78%); n = 35] compared to ILMA [90% (95% CI 82.41%-97.59%); n = 54] (p < 0.001). The number of attempts, ease of intubation, and time to intubation were longer with I-Gel compared to ILMA. There were no differences in the other secondary outcomes. Conclusion. The first pass success rate and overall success of FST through an I-Gel airway were inferior to those of ILMA.
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Affiliation(s)
- Latha Naik
- Department of Anaesthesia and Intensive Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Indu Mohini Sen
- Department of Anaesthesia and Intensive Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh V. Sondekoppam
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6A 5A5
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Van Zundert TC, Hendrickx JF, De Witte JL, Wong DT, Cattano D, Brimacombe JR. Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients. J Clin Anesth 2016; 31:231-7. [DOI: 10.1016/j.jclinane.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/28/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
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Hattori K, Komasawa N, Miyazaki Y, Kido H, Deguchi S, Minami T. Muscle relaxant facilitates i-gel insertion by novice doctors: A prospective randomized controlled trial. J Clin Anesth 2016; 33:218-22. [PMID: 27555168 DOI: 10.1016/j.jclinane.2016.03.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE This study aimed to determine whether muscle relaxants facilitates insertion efficacy of the i-gel supraglottic device (i-gel) by novice doctors in anesthetized patients. DESIGN Randomized clinical trial. SETTING Operating room. PATIENTS Seventy adult patients scheduled for elective surgery under general anesthesia. INTERVENTIONS Seventy adult patients were assigned to the rocuronium (MR group; 35 patients) or control group (C group; 35 patients). Anesthesia was induced with propofol and remifentanil, and 0.9mgkg(-1) rocuronium was administered in the MR group. MEASUREMENTS The number of attempts to successful insertion, sealing pressure, and subjective difficulty of insertion were compared between the groups. MAIN RESULTS The total number of insertion attempts were as follows: one (MR group, 17 cases; C group, 4 cases), two (MR group, 13 cases; C group, 14 cases), three (MR group, 4 cases; C group, 14 cases), and failure (MR group, 1 case; C group, 3 cases), which was significantly different (P<.001). Sealing pressure was significantly higher in the MR group than in the C group (MR group, 22.1±5.4 cmH2O; C group, 18.7±3.2 cmH2O, P<.001). Subjective difficulty of insertion was significantly lower in the MR group than in the C group (C group, 72.4±19.0mm; MR group, 29.4±18.3mm; P<.001). CONCLUSIONS Our randomized clinical trial suggests that muscle relaxation facilitates i-gel insertion efficacy in anesthetized patients, as assessed by successful insertion rate, sealing pressure, and subjective difficulty of insertion.
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Affiliation(s)
| | | | - Yu Miyazaki
- Department of Anesthesiology, Osaka Medical College
| | - Haruki Kido
- Department of Anesthesiology, Osaka Medical College
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Choi JJ, Kim JY, Lee D, Chang YJ, Cho NR, Kwak HJ. Male patients require higher optimal effect-site concentrations of propofol during i-gel insertion with dexmedetomidine 0.5 μg/kg. BMC Anesthesiol 2016; 16:20. [PMID: 27004426 PMCID: PMC4804608 DOI: 10.1186/s12871-016-0186-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pharmacokinetics and pharmacodynamics of an anesthetic drug may be influenced by gender. The purpose of this study was to compare effect-site half maximal effective concentrations (EC50) of propofol in male and female patients during i-gel insertion with dexmedetomidine 0.5 μg/kg without muscle relaxants. METHODS Forty patients, aged 20-46 years of ASA physical status I or II, were allocated to one of two groups by gender (20 patients per group). After the infusion of dexmedetomidine 0.5 μg/kg over 2 min, anesthesia was induced with a pre-determined effect-site concentration of propofol by target controlled infusion. Effect-site EC50 values of propofol for successful i-gel insertion were determined using the modified Dixon's up-and-down method. RESULTS Mean effect-site EC50 ± SD of propofol for successful i-gel insertion was significantly higher for men than women (5.46 ± 0.26 μg/ml vs. 3.82 ± 0.34 μg/ml, p < 0.01). The EC50 of propofol in men was approximately 40% higher than in women. Using isotonic regression with a bootstrapping approach, the estimated EC50 (95% confidence interval) of propofol was also higher in men [5.32 (4.45-6.20) μg/ml vs. 3.75 (3.05-4.43) μg/ml]. The estimated EC95 (95% confidence interval) of propofol in men and women were 5.93 (4.72-6.88) μg/ml and 4.52 (3.02-5.70) μg/ml, respectively. CONCLUSIONS During i-gel insertion with dexmedetomidine 0.5 μg/kg without muscle relaxant, male patients had higher effect-site EC50 for propofol using Schnider's model. Based on the results of this study, patient gender should be considered when determining the optimal dose of propofol during supraglottic airway insertion. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02268656. Registered August 26, 2014.
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Affiliation(s)
- Jung Ju Choi
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dongchul Lee
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Noo Ree Cho
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
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Radhika KS, Sripriya R, Ravishankar M, Hemanth Kumar VR, Jaya V, Parthasarathy S. Assessment of suitability of i-gel and laryngeal mask airway-supreme for controlled ventilation in anesthetized paralyzed patients: A prospective randomized trial. Anesth Essays Res 2016; 10:88-93. [PMID: 26957697 PMCID: PMC4767080 DOI: 10.4103/0259-1162.167849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Laryngeal mask airway supreme (LMA-S) has an inflatable cuff while i-gel has a noninflatable cuff made of thermoplastic elastomer. AIMS To study the efficacy of ventilation and the laryngeal seal pressures (LSPs) with either device. Our secondary objectives were to compare the ease of insertion, adequacy of positioning the device, hemodynamic response to device insertion, and any postoperative oropharyngeal morbidity. SETTINGS AND DESIGN A prospective, randomized, single-blinded study at Teaching Medical School in South India. MATERIALS AND METHODS Forty-two patients posted for surgery under general anesthesia were randomly divided into two groups - LMA-S and i-gel. After a standardized premedication and anesthesia induction sequence, the supra-glottic devices were introduced. Ease of insertion was assessed from the number of attempts taken to insert, insertion time, and any maneuvers required to insert the device. Position of the device was assessed by the ease of gastric catheter placement and the fibreoptic grading of laryngeal visualization. Efficacy of ventilation was determined from the LSP, peak inspiratory pressure (PIP), and end-tidal carbon dioxide (EtCO2)values. Any postoperative oropharyngeal morbidity was also recorded. STATISTICAL ANALYSIS Descriptive analysis was reported as a mean and standard deviation, median, and range of continuous variables. Demographics were analyzed using a unpaired t-test for parametric data and Chi-square test for nonparametric data. Respiratory and hemodynamic data was analyzed using one-way ANOVA to find statistical difference within and between the two groups. RESULTS LMA-S was successfully inserted in 95% of patients and i-gel in 85.5% of patients. There was a significant difference (P = 0.021) in the LSPs between the two groups (18.15 cmH2O in LMA-S and 21.28 cmH2O in the i-gel group). There was no significant difference in the PIPs, leak fraction, and the EtCO2values. CONCLUSION Both devices are suitable for positive pressure ventilation (PPV) in anesthetized paralyzed patients. However, i-gel gives a better laryngeal seal when compared to LMA-S and may be chosen preferentially for PPV.
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Affiliation(s)
| | - R Sripriya
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - M Ravishankar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - V R Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - V Jaya
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - S Parthasarathy
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Yoo JY, Lee YS, Hong SY, Park SH, Min TJ, Kim WY, Kim JH, Park YC. Flexible bronchoscopic foreign body removal through the I-gel supraglottic airway -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji-Young Yoo
- Department of Anesthesiology and Pain Medicine, Ajou Universitiy School of Medicine, Suwon, Korea
| | - Yoon-Sook Lee
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Soon-Young Hong
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sang-Hee Park
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Too-Jae Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Woon-Young Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jae-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young-Cheol Park
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Ansan, Korea
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Mishra SK, Sivaraman B, Balachander H, Naggappa M, Parida S, Bhat RR, Yuvaraj K. Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™ and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial. Anesth Essays Res 2015; 9:353-8. [PMID: 26712973 PMCID: PMC4683478 DOI: 10.4103/0259-1162.159771] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: A sustained and effective oropharyngeal sealing with supraglottic airway (SGA) is required to maintain the ventilation during laparoscopic gynecological surgery in the Trendelenburg position. This study was conducted with I-gel™ and ProSeal LMA™, two prototype SGA devices with a gastric access. Materials and Methods: We enrolled 60 American Society of Anesthesiologists physical status I and II patients and randomized to either I-gel or ProSeal LMA (PLMA) group. After induction of anesthesia using a standardized protocol, one of the SGA devices was inserted. The primary objective of this study was to compare the oropharyngeal leak (sealing) pressure of I-gel™ and ProSeal LMA™ after pneumoperitoneum and Trendelenberg position. The secondary objectives were to compare ease of insertion, cuff position as assessed by the fiberoptic view of the glottis, adequacy of ventilation and incidence of complication. Results: The baseline (before pneumoperitoneum) oropharyngeal leak pressure of I-gel was less than the PLMA (mean (standard deviation [SD]) 24 (4) vs. 29 (4) cmH2O, respectively; P < 0.001). After pneumoperitoneum, the leak airway pressure in I-gel group was significantly less than that of PLMA group (mean [SD] 27 (3) vs. 34.0 (4) cmH2O, respectively; P < 0.001). Peak airway pressure was increased after pneumoperitoneum compared to baseline in both the groups. However, end-tidal carbon dioxide was maintained within normal limits. The insertion parameters, fiberoptic view of the glottis, fiberoptic view of the drain tube, and complications were comparable between the groups. Conclusion: Both I-gel and PLMA are effective for ventilation in gynecological laparoscopic surgeries. However, PLMA provides better sealing as compared to I-gel.
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Affiliation(s)
| | - B Sivaraman
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | | | - Mahesh Naggappa
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - Satyen Parida
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - Ravindra R Bhat
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
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Gupta B, Gupta S, Hijam B, Shende P, Rewari V. Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study. J Emerg Trauma Shock 2015; 8:188-92. [PMID: 26604523 PMCID: PMC4626934 DOI: 10.4103/0974-2700.166589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD) have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature. AIMS The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation. MATERIALS AND METHODS In the study, Airway Trainer (Laerdal) manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA) and LMA Classic™ (CLMA) in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups. RESULTS The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds) as compared to CLMA (17.07 ± 3.5 seconds) and PLMA (25 + 4.78 seconds). Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%). The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA. CONCLUSION All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA.
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Affiliation(s)
- Babita Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India
| | - Surender Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India
| | - Bijaya Hijam
- Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India
| | - Pallavi Shende
- Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
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Kim EM, Kim MS, Koo BN, Lee JR, Lee YS, Lee JH. Clinical efficacy of the classic laryngeal mask airway in elderly patients: a comparison with young adult patients. Korean J Anesthesiol 2015; 68:568-74. [PMID: 26634080 PMCID: PMC4667142 DOI: 10.4097/kjae.2015.68.6.568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/10/2015] [Accepted: 07/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. Methods Fifty patients aged 65-85 years (elderly group) and 50 patients aged 20-40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study. Manipulations required during insertion, success rate, insertion time, oropharyngeal leak pressure, gastric insufflation, and intraoperative inadequate ventilation with the LMA-C were assessed. Fiberoptic evaluation was used to determine the position of the LMA-C. Results In the elderly group, the insertion success rate on the first attempt was significantly lower than that in the young group (84 vs. 96%, P = 0.02). The insertion time in the elderly group was significantly longer than that in the young group (28.5 ± 19.6 vs. 22.2 ± 6.4 seconds, P = 0.001). However, there was no difference in oropharyngeal leak pressure or fiberoptic grade between the two groups after proper placement of the LMA-C. During the surgery, inadequate ventilation events occurred more frequently in the elderly group than in the young group (31.3 vs. 4.0%, P < 0.001). Conclusions The clinical efficacy of the LMA-C in elderly patients was inferior to that in young adult patients. Therefore, further studies are required to determine the type of SGA that can provide excellent clinical efficacy in the geriatric population.
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Affiliation(s)
- Eun Mi Kim
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sub Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Moore A, Gregoire-Bertrand F, Massicotte N, Gauthier A, Lallo A, Ruel M, Todorov A, Girard F. I-gel Versus LMA-Fastrach Supraglottic Airway for Flexible Bronchoscope-Guided Tracheal Intubation Using a Parker (GlideRite) Endotracheal Tube: A Randomized Controlled Trial. Anesth Analg 2015; 121:430-6. [PMID: 26076387 DOI: 10.1213/ane.0000000000000807] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The I-gel (IG) supraglottic airway device is a reliable way to establish an airway. Its large ventilation lumen allows for easy passage of an endotracheal tube. With the use of a flexible bronchoscope, the IG offers a good visualization of the laryngeal inlet. This prospective randomized study aims to compare the success rate of flexible bronchoscope-guided tracheal intubation using either the IG or the LMA-Fastrach (FT) laryngeal masks. METHODS One hundred twenty patients requiring general anesthesia were randomized to 1 of the 2 study groups: IG or FT. After anesthesia induction, the assigned laryngeal mask was inserted to obtain adequate ventilation. We then proceeded to a flexible bronchoscope-guided intubation through the supraglottic device. Tracheal intubation and laryngeal mask insertion success rates were noted, as well as the time required for these manipulations. The view of the laryngeal inlet was graded for each intubation attempt. RESULTS Sixty patients were assigned to each study group. The intubation success rates were similar between the IG and the FT groups (100 % vs 95.0 % at first attempt; P = 0.12). The times required for tracheal intubation were significantly lower in the IG group (30 ± 11 seconds vs 50 ± 21 seconds; P < 0.0001). Glottic visualization was better in the IG group, with a significantly higher percentage of grade 1 visualization (63.3% vs 3.3%; P < 0.0001) and a lower percentage of grade 3 visualization (1.7% vs 60.0%; P < 0.0001), than that in the FT group. CONCLUSIONS The use of the IG supraglottic airway device as a conduit for flexible bronchoscope-guided tracheal intubation results in a success rate equivalent to the use of the LMA-FT. However, the IG allows for shorter intubation times and a better visualization of the glottic opening compared with the LMA-FT.
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Affiliation(s)
- Alex Moore
- From the *Departement d'anesthesiologie, Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, Montreal, Canada; and †Department of Psychiatry, Washington University Medical Center, St. Louis, Missouri
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Miyazaki Y, Komasawa N, Matsunami S, Kusaka Y, Minami T. Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial. J Anesth 2015; 29:654-9. [PMID: 25910889 DOI: 10.1007/s00540-015-2016-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study investigated the hypothesis that the efficacy of insertion of the supraglottic device i-gel(®) (i-gel) can be improved by laryngoscopy and can provide better sealing pressure in anesthetized patients by novice doctors. METHODS Eighty-four adult patients were assigned to the laryngoscopy group (L group, 42 patients) or control group (i.e., conventional blind insertion; C group, 42 patients). Anesthesia was induced with propofol and remifentanil, and rocuronium 0.6-0.9 mg/kg was administered. The number of attempts until successful insertion, sealing pressure, vital sign changes upon insertion, and subjective difficulty of insertion by novice doctors were compared between the groups. RESULTS The total number of insertion attempts was one (L group 36 cases, C group 23 cases), two (L group 6 cases, C group 18 cases), and three (L group 0 case, C group 1 case), with significant differences between groups (P = 0.007). The sealing pressure was significantly higher in the L group than in the C group (L group 22.3 ± 2.6 cmH2O, C group 19.5 ± 2.7 cmH2O, P < 0.001). Vital sign changes (heart rate and blood pressure) did not differ between the two groups. The subjective difficulty of insertion was significantly lower in the L group than in the C group (L group 26.8 ± 11.8 mm, C group 47.0 ± 15.1 mm, P < 0.001). The incidence of postoperative pharyngeal pain was significantly lower in the L group than in the C group (P < 0.001), while the incidence of hoarseness did not differ between the two groups (P = 1.00). CONCLUSION Our results suggest that laryngoscopy facilitates i-gel insertion by novice doctors, as reflected in the rate of successful insertions, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.
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Affiliation(s)
- Yu Miyazaki
- Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan
| | - Nobuyasu Komasawa
- Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan.
| | - Sayuri Matsunami
- Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan
| | - Yusuke Kusaka
- Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Daigaku-machi 2-7, Takatsuki, Osaka, 569-8686, Japan
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Sastre JA, López T, Garzón JC. [Blind tracheal intubation through two supraglottic devices: i-gel versus Fastrach intubating laryngeal mask airway (ILMA)]. ACTA ACUST UNITED AC 2015; 59:71-6. [PMID: 22480552 DOI: 10.1016/j.redar.2012.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/06/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of supraglottic devices as a means of rescue in patients difficult to intubate or ventilate has increased in the field of anaesthetics and in emergency medicine. This study is designed to evaluate the success rate of blind intubations using two supraglottic devices, the Fastrach ILMA and the i-gel mask. PATIENTS AND METHODS A total of 80 patients (40 per group) were included. After positioning them a leak test was performed, the glottis view was checked with a fibrobronchoscope, and an attempt was made to introduce an endotracheal tube through the device, and the procedure was repeated. Adequate ventilation was evaluated, as well as the grade of fibrobronchoscope view, the success of the intubation, and the complications observed after their use. RESULTS There were no differences in the incidence of adequate ventilation with either device. The glottis view (Brimacombe scale) was better with i-gel (77.78% versus 68.42%) at the second attempt, but not on the first. A higher percentage of intubations were achieved with the Fastrach ILMA (70% versus 40%; P=.013). The incidence of throat pain was similar with both devices, but post-operative dysphonia was more frequent with i-gel (20% versus 0; P=.0053). CONCLUSIONS Both devices were equally effective in achieving adequate ventilation; however, the Fastrach ILMA enabled a higher number of intubations to be made than i-gel and with a lower incidence of post-operative dysphonia.
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Affiliation(s)
- J A Sastre
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Ekinci O, Abitagaoglu S, Turan G, Sivrikaya Z, Bosna G, Özgultekin A. The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation. Saudi Med J 2015; 36:432-6. [PMID: 25828279 PMCID: PMC4404476 DOI: 10.15537/smj.2015.4.10050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups. METHODS Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpaşa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded. RESULTS The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar. CONCLUSION Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.
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Affiliation(s)
- Osman Ekinci
- Department of Anesthesiology and Reanimation, Haydarpasa Numune Teaching and Research Hospital, Istanbul, Turkey. E-mail.
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Kim HC, Park HP. A reply. Anaesthesia 2015; 70:365. [DOI: 10.1111/anae.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. C. Kim
- Seoul National University Hospital; Seoul South Korea
| | - H. P. Park
- Seoul National University Hospital; Seoul South Korea
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Komasawa N, Nishihara I, Tatsumi S, Minami T. Does prewarming the i-gel supraglottic airway device fit the larynx better compared to keeping it at room temperature for non-paralysed, sedated patients: a randomised controlled trial. BMJ Open 2015; 5:e006653. [PMID: 25586372 PMCID: PMC4298088 DOI: 10.1136/bmjopen-2014-006653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to test the hypothesis that the i-gel supraglottic airway device would fit the larynx and provide better sealing pressure if prewarmed to 42°C relative to the device kept at room temperature in non-paralysed, sedated patients. METHODS A total of 74 adult patients were assigned to the warm (i-gel prewarmed to 42°C; W group; 37 patients) or the control (i-gel kept at room temperature; C group; 37 patients) groups. Anaesthesia was induced with propofol and fentanyl. The i-gel was prewarmed to 42°C for 30 min before insertion in the W group, but kept at room temperature (approximately 23°C) for the C group. The number of attempts made until successful insertion and sealing pressure were compared between the two groups. RESULTS Insertion was successful with one attempt in 35 cases each for the W and C groups. Two attempts were needed in two cases for the W group and one case for the C group. There was one failed attempt in the C group, but none in the W group. None of the differences between the two groups were significant (p=0.51). Sealing pressure was slightly, but not significantly, higher in the W group than in the C group (W group 22.6±6.1 cm H2O; C group 20.7±6.1 cm H2O; p=0.15). CONCLUSIONS Prewarming of the i-gel to 42°C did not increase the success rate of insertion, nor did it significantly increase sealing pressure in anaesthetised, non-paralysed patients. Our data suggest that we can keep the i-gel at room temperature for emergency airway management for non-paralysed, sedated patients. TRIAL REGISTRATION NUMBER University Medical Information Network, Japan 000012287.
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Affiliation(s)
- Nobuyasu Komasawa
- Department of Anaesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Isao Nishihara
- Department of Anaesthesiology, Hokusetsu General Hospital, Takatsuki, Osaka, Japan
| | - Shinichi Tatsumi
- Department of Anaesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Toshiaki Minami
- Department of Anaesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
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Komasawa N, Nishihara I, Tatsumi S, Minami T. Prewarming of the i-gel facilitates successful insertion and ventilation efficacy with muscle relaxation: a randomized study. J Clin Anesth 2014; 26:663-7. [DOI: 10.1016/j.jclinane.2014.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Kapoor S, Jethava DD, Gupta P, Jethava D, Kumar A. Comparison of supraglottic devices i-gel(®) and LMA Fastrach(®) as conduit for endotracheal intubation. Indian J Anaesth 2014; 58:397-402. [PMID: 25197106 PMCID: PMC4155283 DOI: 10.4103/0019-5049.138969] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: i-gel®, a recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA Fastrach® frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel® and LMA Fastrach® was evaluated. The complications if any were also studied. Methods: A total of 100 patients undergoing elective surgery under general anaesthesia were randomised in two groups comprising of 50 patients each to tracheal intubation using either i-gel (I group) or LMA Fastrach (F group). After induction of anaesthesia SAD was inserted and on achieving adequate ventilation with the device, blind tracheal intubation was attempted through the SAD. Success at first-attempt and overall tracheal intubation success rates were evaluated, and tracheal intubation time was measured. Data were analysed using IBM SPSS Statistics 20.0 software (Statistical Package for Social Sciences by International Business Machines Corporation). P < 0.05 was considered as statistically significant. Results: There was no difference in the incidence of adequate ventilation with either of the SAD. The success rate of tracheal intubation in first attempt was 66% in Group I and 74% in Group F, while overall success rate of tracheal intubation was 82% in Group I when compared to 96% in Group F. Time taken for successful tracheal intubation through LMA Fastrach was lesser (20.96 s) when compared to i-gel (24.04 s). Complication rates were statistically similar in both the groups. Conclusion: i-gel® is a better device for rescue ventilation due to its quick insertion but an inferior intubating device in comparison to LMA Fastrach®.
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Affiliation(s)
- Sameer Kapoor
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi University of Medical Science and Technology, Sitapura, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi University of Medical Science and Technology, Sitapura, Jaipur, Rajasthan, India
| | - Priyamvada Gupta
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi University of Medical Science and Technology, Sitapura, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi University of Medical Science and Technology, Sitapura, Jaipur, Rajasthan, India
| | - Alok Kumar
- Department of Anesthesiology, Critical Care and Pain Management, Mahatma Gandhi University of Medical Science and Technology, Sitapura, Jaipur, Rajasthan, India
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Joly N, Poulin LP, Tanoubi I, Drolet P, Donati F, St-Pierre P. Randomized prospective trial comparing two supraglottic airway devices: i-gel™ and LMA-Supreme™ in paralyzed patients. Can J Anaesth 2014; 61:794-800. [DOI: 10.1007/s12630-014-0198-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
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Taxak S, Vashisht K, Kaur KP, Ahlawat G, Bhardwaj M. A study to evaluate fibreoptic-guided intubation through the i-gel™. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Taxak
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS Haryana, India
| | - K Vashisht
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS Haryana, India
| | - KP Kaur
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS Haryana, India
| | - G Ahlawat
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS Haryana, India
| | - M Bhardwaj
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS Haryana, India
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de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel®vs laryngeal mask airway in adults. Anaesthesia 2014; 69:1151-62. [DOI: 10.1111/anae.12772] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. de Montblanc
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - L. Ruscio
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - J. X. Mazoit
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - D. Benhamou
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
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Hashimoto Y, Asai T, Arai T, Okuda Y. Effect of cricoid pressure on placement of the I-gel™ : a randomised study. Anaesthesia 2014; 69:878-82. [PMID: 24866121 DOI: 10.1111/anae.12731] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2014] [Indexed: 11/30/2022]
Abstract
We studied 40 adult patients to see if cricoid pressure affected placement of the I-gel(™). In a randomised crossover design, the i-gel was placed with and without cricoid pressure, and we compared the success rate of adequate ventilation through the i-gel, time to placement and the rate of optimal position of the device between the two circumstances. Cricoid pressure significantly decreased the success rate of adequate ventilation through the i-gel (40 vs 34 patients) (p = 0.041, 95% CI for difference 4-26%), and significantly decreased the rate of the optimal position (39 vs 17 patients) (p < 0.001). The time to achieve adequate ventilation was significantly longer (p < 0.001) with cricoid pressure than without (median difference 8 s; 95% CI for median difference 3-12 s). Cricoid pressure significantly decreases the success rate of ventilation through the i-gel, but the success rate of ventilation through the i-gel is reasonably high.
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Affiliation(s)
- Y Hashimoto
- Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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Saran S, Mishra SK, Badhe AS, Vasudevan A, Elakkumanan LB, Mishra G. Comparison of i-gel supraglottic airway and LMA-ProSeal™ in pediatric patients under controlled ventilation. J Anaesthesiol Clin Pharmacol 2014; 30:195-8. [PMID: 24803756 PMCID: PMC4009638 DOI: 10.4103/0970-9185.130013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND i-gel™ and the ProSeal™ laryngeal mask airway (PLMA) are two supraglottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of i-gel compared with PLMA for airway maintenance in pediatric patients under general anesthesia with controlled ventilation. MATERIALS AND METHODS A total of 60 American Society of Anesthesiologists physical status 1 and 2 patients were included in the study and randomized to either i-gel or PLMA group. After induction of anesthesia using a standardized protocol for all the patients, one of supraglottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion and fiber-optic scoring of the glottis were noted. Airway parameters such as end-tidal carbon dioxide (EtCO2), peak airway pressures and leak airway pressures were noted. Patients were observed for any complications in the first 12 h of the post-operative period. RESULTS Both groups were comparable in terms of ease of insertion, number of attempts and other insertion parameters. Ease of gastric tube insertion, EtCO2, airway pressures (peak and leak airway pressure) and fiber-optic view of the glottis were comparable in both groups. There were no clinically significant complications in the first 12 h of the post-operative period. CONCLUSION i-gel is as effective as PLMA in pediatric patients under controlled ventilation.
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Affiliation(s)
- Sai Saran
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Sandeep Kumar Mishra
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Ashok Shankar Badhe
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Arumugam Vasudevan
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Lenin Babu Elakkumanan
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
| | - Gayatri Mishra
- Departments of Anaesthesiology & Critical Care, Jawaharlal Institute of Post-Graduate Medical Education and Research, Gorimedu, Puducherry, India
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Kim HC, Yoo DH, Kim HJ, Jeon YT, Hwang JW, Park HP. A prospective randomised comparison of two insertion methods for i-gel placement in anaesthetised paralysed patients: standard vs. rotational technique. Anaesthesia 2014; 69:729-34. [PMID: 24773470 DOI: 10.1111/anae.12680] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 11/30/2022]
Abstract
In this prospective randomised study, we compared two techniques for i-gel(™) insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. In the rotation group (n = 90), the i-gel was rotated 90° anticlockwise in the mouth and re-rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs. 87 (97%; p = 0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs. 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cm H2O vs. 27.1 (9.4) cm H2O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs. 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.
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Affiliation(s)
- H C Kim
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Das A, Majumdar S, Mukherjee A, Mitra T, Kundu R, Hajra BK, Mukherjee D, Das B. i-gel™ in Ambulatory Surgery: A Comparison with LMA-ProSeal™ in Paralyzed Anaesthetized Patients. J Clin Diagn Res 2014; 8:80-4. [PMID: 24783088 PMCID: PMC4003694 DOI: 10.7860/jcdr/2014/7890.4113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Supraglottic devices have mostly eliminated the need of hemodynamically stressful routine endotracheal intubation for ambulatory surgeries. We aimed to compare hemodynamics- like blood pressure (BP) and heart rate (HR) alterations caused by stress response due to i-gel™ and LMA-ProSeal™ usage in Day care surgeries. Secondary outcomes included ease of insertion, time and number of attempts for the placement of devices. MATERIALS AND METHODS From April 2008 to July 2009, Sixty adult ASA I-II patients of either sex, aged 20-30, were randomly allocated into two groups (Group i-gel (n=30) receiving i-gel and Group PLMA (n=30) receiving LMA-ProSeal for airway maintenance) undergoing day care surgical procedures under general anaesthesia (GA).The ease of insertion and time taken for placement of device, postoperative complications were assessed. Haemodynamic parameters (HR, BP) were noted. It was a prospective, double blinded, and randomized controlled study. Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (+ SD). p <0.05 was considered statistically significant. RESULTS Demographically both the groups were similar. i-gel was more easily inserted than LMA-ProSeal (90% vs. 83.33% respectively). i-gel insertion time was shorter than PLMA (14.9 vs. 20.0 sec respectively) and was statistically significant. Hemodynamics (HR, BP) were less altered in i-gel than PLMA and the results were statistically significant (p <0.05). CONCLUSION i-Gel; a relatively newer and cheap supraglottic device; insertion is easier and quicker as well as hemodynamically less stressful when compared with LMA-ProSeal in a day care setting.
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Affiliation(s)
- Anjan Das
- Assitant Professor, Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Saikat Majumdar
- Assitant Professor, Department of Anaesthesiology, NRS Medical College, Kolkata, India
| | - Anindya Mukherjee
- R.M.O. Cum Clinical Tutor, Department of Anaesthesiology, NRS Medical College, Kolkata, India
| | - Tapobrata Mitra
- R.M.O. Cum Clinical Tutor, Department of Anaesthesiology, Bangur Institute of Neurology, Kolkata, India
| | - Ratul Kundu
- R.M.O. Cum Clinical Tutor, Department of Anaesthesiology, I.P.G.M.E.R, Kolkata, India
| | - Bimal Kumar Hajra
- Associate Professor, Department of Anaesthesiology, NRS Medical College, Kolkata, India
| | - Dipankar Mukherjee
- Associate Professor, Department of Anaesthesiology, NRS Medical College, Kolkata, India
| | - Bibhukalyani Das
- Professor and Ex- HOD, Department of Anaesthesiology, NRS Medical College, Kolkata, India
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Alexiev V, Ochana A, Abdelrahman D, Coyne J, McDonnell JG, O'Toole DP, Neligan P, Laffey JG. Comparison of the Baska(®) mask with the single-use laryngeal mask airway in low-risk female patients undergoing ambulatory surgery. Anaesthesia 2013; 68:1026-32. [PMID: 23855898 DOI: 10.1111/anae.12356] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2013] [Indexed: 11/30/2022]
Abstract
We compared the Baska(®) mask with the single-use classic laryngeal mask airway (cLMA) in 150 females at low risk for difficult tracheal intubation in a randomised, controlled clinical trial. We found that median (IQR [range]) seal pressure was significantly higher with the Baska mask compared with the cLMA (40 (34-40 [16-40]) vs 22 (18-25 [14-40]) cmH2O, respectively, p < 0.001), indicating a better seal. In contrast, the first time success rate for insertion of the Baska mask was lower than that seen with the cLMA (52/71 (73%) vs 77/99 (98%), respectively, p < 0.001). There were no differences in overall device insertion success rates (78/79 (99%) vs 68/71 (96%), respectively, p = 0.54). The Baska mask proved more difficult to insert, requiring more insertion attempts, taking longer to insert and had higher median (IQR [range]) insertion difficulty scores (1.6 (0.8-2.2 [0.1-5.6]) vs 0.5 (0.3-1.4 [0.1-4.0]), respectively, p < 0.001). There was also an increased rate of minor blood staining of the Baska mask after removal, but there were no differences in other complication rates, such as laryngospasm, or in the severity of throat discomfort. In conclusion, in clinical situations where the seal with the glottic aperture takes priority over ease of insertion, the Baska mask may provide a useful alternative to the cLMA.
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Affiliation(s)
- V Alexiev
- Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Ireland
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Theiler L, Gutzmann M, Kleine-Brueggeney M, Urwyler N, Kaempfen B, Greif R. i-gel™ supraglottic airway in clinical practice: a prospective observational multicentre study. Br J Anaesth 2012; 109:990-5. [PMID: 22956643 DOI: 10.1093/bja/aes309] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The i-gel™ supraglottic airway device has been studied in randomized controlled studies, but it has not been evaluated in a large prospective patient cohort. Therefore, we performed this prospective multicentre observational study to evaluate success rates, airway leak pressure, risk factors for i-gel failure, and adverse events. METHODS With Ethics Committee approval and waiver of patients' consent, data about anaesthesia providers, patient characteristics, and the performance of the i-gel were recorded in five independent hospitals in Switzerland over a period of 24 months. We analysed success rates, leak pressures, adverse events, and risk factors for failure. RESULTS Data from 2049 i-gel uses were analysed. Patients' mean age was 47 (range 6-91) yr. The primary i-gel success rate without changing size was 93%; the overall success rate was 96%. Insertion was deemed very easy or easy in 92%. The mean airway leak pressure was 26 (8) cm H(2)O. The mean anaesthesia time was 67 (42) min. Risk factors associated with i-gel failure were males (P<0.001), impaired mandibular subluxation (P=0.01), poor dentition (P=0.02), and older age (P<0.01). Adverse events recorded were laryngeal spasms (n=25, 1.2%), blood stained airway devices (n=79, 3.9%), transient nerve damage (n=2, 0.1%), one case of transient vasovagal asystole, and one glottic haematoma. CONCLUSIONS The i-gel is a reliable supraglottic airway device failing in <5% and providing high airway leak pressures. Males, impaired mandibular subluxation, poor dentition, and older age are risk factors associated with primary device failure. Serious adverse events are rare.
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Affiliation(s)
- L Theiler
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Gautier Bldg, Room 415, 1011 N.W. 15th Street, Miami, FL 33136, USA.
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Das B, Mitra S, Samanta A, Vijay BS. Comparison of i-gel™ supraglottic device with classic laryngeal mask airway in anesthetized paralyzed children undergoing elective surgery. Anesth Essays Res 2012; 6:180-3. [PMID: 25885613 PMCID: PMC4173459 DOI: 10.4103/0259-1162.108305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT The newest variation of the i-gel supraglottic airway is a pediatric version. AIMS This study was designed to investigate the usefulness of the size 2 i-gel compared with the classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children. SETTINGS AND DESIGN A prospective, randomized, single-blinded study was conducted in tertiary care teaching hospital. SUBJECT AND METHODS Sixty ASA grade I-II patients undergoing lower abdominal, inguinal, and orthopedic surgery were included in this prospective study. The patients were randomly assigned to i-gel and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. STATISTICAL ANALYSIS USED Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. RESULTS There were no differences in the demographic and hemodynamic data among the two groups. The airway leak pressure of the i-gel group (26.1 ± 2.4 cm H2O) was significantly higher than that of the cLMA group (22.64 ± 2.2 cm H2O). The success rates for first attempt of insertion were similar among the two devices. There were no differences in the incidence of postoperative airway morbidity among the two groups. CONCLUSIONS Hemodynamic parameters, ease of insertion, and postoperative complications were comparable between the i-gel and cLMA groups, but airway sealing pressure was significantly higher in i-gel group.
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Affiliation(s)
- Bikramjit Das
- Department of Anaesthesiology, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Subhro Mitra
- Department of Anaesthesiology, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Arijit Samanta
- Department of Anaesthesiology, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Bhavani S. Vijay
- Department of Anaesthesiology, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
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Singh J, Yadav MK, Marahatta SB, Shrestha BL. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients. Indian J Anaesth 2012; 56:348-52. [PMID: 23087456 PMCID: PMC3469912 DOI: 10.4103/0019-5049.100815] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. METHODS Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. RESULTS Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000). Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H(2)0; P=0.00). Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7%) successes and 2/24(8.3%) failure and for cLMA, 19/24 (79.16%) successes and 5/24 (16.7%) failure in the first attempt. CONCLUSION The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.
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Affiliation(s)
- Jeevan Singh
- Department of Anaesthesia, Dhulikhel Hospital, Kathmandu University School of Medical Sciences (KUSMS) Post Box Number: 11008, Dhulikhel, Kavre, Nepal
| | - Manohar Kumar Yadav
- Sushma Koirala Memorial Hospital for Plastic and Reconstructive Surgery, Shankhu, Kathmandu, Nepal
| | - Sujan Babu Marahatta
- Department of Community Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences (KUSMS) Post Box Number: 11008, Dhulikhel, Kavre, Nepal
| | - Bikash Lal Shrestha
- Department of ENT, Dhulikhel Hospital, Kathmandu University School of Medical Sciences (KUSMS) Post Box Number: 11008, Dhulikhel, Kavre, Nepal
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Alexiev V, Salim A, Kevin LG, Laffey JG. An observational study of the Baska® mask: a novel supraglottic airway. Anaesthesia 2012; 67:640-5. [PMID: 22563956 DOI: 10.1111/j.1365-2044.2012.07140.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Baska mask is a novel supraglottic airway device. We conducted an initial observational study to assess this device in 30 low-risk female patients. All Baska masks were inserted by a single investigator. The overall success rate for device insertion was 96.7% (95% CI 82.8-99.9%), while the success rate for the first insertion attempt was 76.7% (95% CI 57.7-90.1%). The device was easy to insert, with a mean (SD) difficulty score of 0.9 (1.6) on a 10-cm scale. The mean (SD) airway leak pressure was 35.7 (13.3) cmH(2) O. The incidence of throat pain, dysphonia and dysphagia was low. We conclude that the Baska mask demonstrates a level of utility as an alternative supraglottic airway that is worthy of further clinical study.
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Affiliation(s)
- V Alexiev
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Ireland
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Lee JR, Kim MS, Kim JT, Byon HJ, Park YH, Kim HS, Kim CS. A randomised trial comparing the i-gel (TM) with the LMA Classic (TM) in children. Anaesthesia 2012; 67:606-11. [PMID: 22352745 DOI: 10.1111/j.1365-2044.2012.07072.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We performed a prospective, randomised trial comparing the i-gel(TM) with the LMA Classic(TM) in children undergoing general anaesthesia. Ninety-nine healthy patients were randomly assigned to either the i-gel or the LMA Classic. The outcomes measured were airway leak pressure, ease of insertion, time taken for insertion, fibreoptic examination and complications. Median (IQR [range]) time to successful device placement was shorter with the i-gel (17.0 (13.8-20.0 [10.0-20.0]) s) compared with the LMA Classic (21.0 (17.5-25.0 [15.0-70.0]) s, p = 0.002). There was no significant difference in oropharyngeal leak pressure between the two devices. A good fibreoptic view of the glottis was obtained in 74% of the i-gel group and in 43% of the LMA Classic group (p < 0.001). There were no significant complications. In conclusion, the i-gel provided a similar leak pressure, but a shorter insertion time and improved glottic view compared with the LMA Classic in children.
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Affiliation(s)
- J-R Lee
- Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Ragazzi R, Finessi L, Farinelli I, Alvisi R, Volta CA. LMA Supreme™vs i-gel™- a comparison of insertion success in novices. Anaesthesia 2012; 67:384-8. [DOI: 10.1111/j.1365-2044.2011.07002.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eschertzhuber S, Brimacombe J, Kaufmann M, Keller C, Tiefenthaler W. Directly measured mucosal pressures produced by the i-gel™ and Laryngeal Mask Airway Supreme™ in paralysed anaesthetised patients. Anaesthesia 2012; 67:407-10. [PMID: 22324968 DOI: 10.1111/j.1365-2044.2011.07024.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The i-gel™ and LMA Supreme™ are extraglottic airway devices with non-inflatable and inflatable cuffs, respectively. We hypothesised that directly measured mucosal pressures would differ between these devices in anesthetised paralysed patients. Thirty patients were randomly allocated to receive one of these two devices. Four pressure sensors were attached to all airway devices used to measure mucosal pressure at the base of the tongue, the distal oropharynx, the hypopharynx and the pyriform fossa. At these four places, median (IQR [range]) i-gel mucosal pressures were 8.0 (2.7-10.7 [0-26.7]), 5.0 (2.7-7 [1.0-37.3]), 9.3 (2.7-13.3 [0-22.7] and 8.0 (2.7-10.7 [0-25.3]) cmH(2)O, respectively, and for the LMA Supreme, these were 5.0 (0.5-8.0 [0-33]), 4.0 (1.3-9.3 [0-24]), 10.7 (4-17.3 [0-26.7]) and 8.0 (0-10.7 [0-36]) cmH(2)O, respectively. Mucosal pressures were low and similar for both devices. The LMA Supreme mucosal pressures were higher in the hypopharynx than in the distal oropharynx (p = 0.04) and base of the tongue (p = 0.011). There were no pressure differences between the locations for the i-gel.
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Affiliation(s)
- S Eschertzhuber
- Department of Anesthesia and Intensive Care Medicine, Medical University Innsbruck, Austria
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Tracheal intubation through the I-gel™ supraglottic airway versus the LMA Fastrach™: a randomized controlled trial. Anesth Analg 2011; 114:152-6. [PMID: 22075016 DOI: 10.1213/ane.0b013e318236f438] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The i-gel™ is a supraglottic airway device not requiring inflation of a cuff for lung ventilation. Its design allows for unobstructed passage of a tracheal tube and previous studies have demonstrated a favorable alignment with the glottic inlet. In this prospective randomized study, we compared the success rate of blind tracheal intubation using the i-gel and the laryngeal mask airway (LMA) Fastrach™. METHODS One hundred sixty patients requiring general anesthesia and airway management were randomized to tracheal intubation using the i-gel or the LMA Fastrach. After induction of general anesthesia, the allocated device was inserted and adequate lung ventilation was confirmed. Blind tracheal intubation was then attempted. First attempt and overall tracheal intubation success rates were evaluated and tracheal intubation times were measured. RESULTS Eighty patients were recruited in each study group. Successful tracheal intubation was obtained on the first attempt in 69% of patients with the i-gel and 74% of patients with the LMA Fastrach (95% confidence interval [CI] of difference, -9% to 19%, P = 0.60). The overall intubation success rate was lower using the i-gel than it was using the LMA Fastrach (73% vs 91%, 95% CI of difference, 7% to 31%, P < 0.0001). CONCLUSIONS On first attempts, successful blind tracheal intubation was obtained at comparable rates using the i-gel and the LMA Fastrach. However, when the first attempt was unsuccessful, subsequent attempts through the i-gel did not significantly increase tracheal intubation success rate. The LMA Fastrach yielded a higher overall intubation success rate.
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Theiler L, Kleine-Brueggeney M, Urwyler N, Graf T, Luyet C, Greif R. Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway. Br J Anaesth 2011; 107:243-50. [PMID: 21652615 DOI: 10.1093/bja/aer102] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). METHODS With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). RESULTS Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. CONCLUSIONS Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel™.
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Affiliation(s)
- L Theiler
- Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, and University of Bern, Switzerland
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Weber U, Oguz R, Potura LA, Kimberger O, Kober A, Tschernko E. Comparison of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery. Anaesthesia 2011; 66:481-7. [DOI: 10.1111/j.1365-2044.2011.06682.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chew EEF, Hashim NHM, Wang CY. Randomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients. Anaesth Intensive Care 2011; 38:1018-22. [PMID: 21226431 DOI: 10.1177/0310057x1003800609] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared the performance of the LMA Supreme (SLMA) with the I-Gel during anaesthesia in spontaneously breathing adult patients. Ninety patients with American Society of Anesthesiologists physical status I or II were studied in a prospective randomised controlled study. Our primary outcome measure was oropharyngeal leak pressure. We also compared the overall insertion success rate, ease of insertion, adequacy of ventilation and incidence of complications. The mean (SD), oropharyngeal leak pressure for the SLMA was 25.6 (5.1) cmH2O, which was greater than for the I-Gel 20.7 (5.9) cmH2O (P = 0.0001). The first attempt and overall insertion success rates were similar between the two groups (SLMA 97.8 and 97.8%; I-Gel 93.3 and 100%, P = 0.132). The SLMA was rated easier to insert than the I-Gel (P = 0.011), but the time taken for insertion (P = 0.433) was similar. The incidence of complications was low in both groups. The grade of fibreoptic view was better with the I-Gel than the SLMA (P = 0.001). We conclude that in adults with normal airways, the SLMA is easier to insert and provides a higher oropharyngeal leak pressure, but fibreoptic views are better with the i-gel.
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Affiliation(s)
- E E F Chew
- Department of Anaesthesia, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Russo SG, Moerer O, Nickel EA, Goetze B, Timmermann A, Quintel M. [Extraglottic airway devices in the intensive care unit]. Anaesthesist 2010; 59:555-63. [PMID: 20502847 DOI: 10.1007/s00101-010-1728-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extraglottic airway devices (EGA) are not only used in routine anaesthesia practice, they also have a distinct value for in-hospital and out-of-hospital difficult airway management. In the environment of the intensive care unit (ICU) EGA are not used on a regular basis. However, expertise and knowledge regarding EGA coming from the operating theatre or the out-of-hospital setting may also be of value for the ICU setting. This review presents the potential indications for EGA on the ICU for the management of difficult airway situations as well as during percutaneous tracheotomy. Furthermore, the possible advantages of EGA during postoperative recovery from anaesthesia as well as termination of controlled ventilation for intensive care patients are discussed.
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Affiliation(s)
- S G Russo
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Deutschland.
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