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Arican S, Pekcan S, Hacibeyoglu G, Yusifov M, Yuce S, Uzun ST. The place of ultrasonography in confirming the position of the laryngeal mask airway in pediatric patients: an observational study. Braz J Anesthesiol 2021; 71:523-529. [PMID: 34537123 PMCID: PMC9373655 DOI: 10.1016/j.bjane.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background and objectives Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging. Methods A prospective observational study was conducted on 82 patients aged 3–15 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope. Results The average age of the patients was 6.27 ± 4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (p < 0.001; r = 0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (OR = 2.961; p = 0.046; 95% Cl 2.850–30.745). Conclusion The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective.
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Affiliation(s)
- Sule Arican
- University of Necmettin Erbakan, Medical Faculty, Department of Anaesthesiology, Konya, Turkey.
| | - Sevgi Pekcan
- University of Necmettin Erbakan, Medical Faculty, Department of Pediatric Chest Diseases, Konya, Turkey
| | - Gulcin Hacibeyoglu
- University of Necmettin Erbakan, Medical Faculty, Department of Anaesthesiology, Konya, Turkey
| | - Merve Yusifov
- University of Necmettin Erbakan, Medical Faculty, Department of Anaesthesiology, Konya, Turkey
| | - Sait Yuce
- University of Necmettin Erbakan, Medical Faculty, Department of Anaesthesiology, Konya, Turkey
| | - Sema Tuncer Uzun
- University of Necmettin Erbakan, Medical Faculty, Department of Anaesthesiology, Konya, Turkey
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Mihara T, Asakura A, Owada G, Yokoi A, Ka K, Goto T. A network meta-analysis of the clinical properties of various types of supraglottic airway device in children. Anaesthesia 2017; 72:1251-1264. [PMID: 28737223 DOI: 10.1111/anae.13970] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 01/02/2023]
Abstract
We conducted both conventional pairwise and Bayesian network meta-analyses to compare the clinical properties of supraglottic airway devices in children. We searched six databases for randomised clinical trials. Our primary end-points were oropharyngeal leak pressure, risk of insertion failure at first attempt, and blood staining risk. The risk of device failure, defined as the abandonment of the supraglottic airway device and replacement with a tracheal tube or another device, was also analysed. Sixty-five randomised clinical trials with 5823 participants were identified, involving 16 types of supraglottic airway device. Network meta-analysis showed that the i-gel™, Cobra perilaryngeal airway™ and Proseal laryngeal mask airway (LMA® -Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the LMA® -Classic, with mean differences (95% credible interval, CrI) of 3.6 (1.9-5.8), 4.6 (1.7-7.6) and 3.4 (2.0-4.8) cmH2 O, respectively. The i-gel was the only device that significantly reduced the risk of blood staining of the device compared with the LMA-Classic, with an odds ratio (95%CrI) of 0.46 (0.22-0.90). The risk (95%CI) of device failure with the LMA-Classic, LMA® -Unique and LMA-Proseal was 0.36% (0.14-0.92%), 0.49% (0.13-1.8%) and 0.50% (0.23-1.1%), respectively, whereas the risk (95%CI) of the i-gel and PRO-Breathe was higher, at 3.4% (2.5-4.7%) and 6.0% (2.8-12.5%), respectively. The risk, expressed as odds ratio (95%CrI), of insertion failure at first attempt, was higher in patients weighing < 10 kg at 5.1 (1.6-20.1). We conclude that the LMA-Proseal may be the best supraglottic airway device for children as it has a high oropharyngeal leak pressure and a low risk of insertion. Although the i-gel has a high oropharyngeal leak pressure and low risk of blood staining of the device, the risk of device failure should be evaluated before its routine use can be recommended.
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Affiliation(s)
- T Mihara
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan.,Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - A Asakura
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - G Owada
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - A Yokoi
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan
| | - K Ka
- Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan
| | - T Goto
- Department of Anaesthesiology and Critical Care Medicine, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 2015; 25:334-45. [PMID: 25585975 DOI: 10.1111/pan.12614] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/26/2022]
Abstract
Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA
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Arslan Zİ, Balcı C, Oysu DA, Yılmaz M, Gürbüz N, Ilce Z. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial. Balkan Med J 2013; 30:90-3. [PMID: 25207076 DOI: 10.5152/balkanmedj.2012.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/07/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. STUDY DESIGN Randomized clinical trial. MATERIAL AND METHODS Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. RESULTS There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01). CONCLUSION As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.
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Affiliation(s)
- Zehra İpek Arslan
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Canan Balcı
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Duygu Akalın Oysu
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Mehmet Yılmaz
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Necla Gürbüz
- Clinic of Pediatric Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Zekeriya Ilce
- Clinic of Pediatric Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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Mitra S, Das B, Jamil SN. Comparison of Size 2.5 i-gel™ with Proseal LMA™ in Anaesthetised, Paralyzed Children Undergoing Elective Surgery. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:453-7. [PMID: 23112965 PMCID: PMC3482775 DOI: 10.4103/1947-2714.101983] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The newest variation of i-gel is its pediatric version. This novel supraglottic airway device has the added advantage of a drain tube. In this study, we compared the effectiveness of size 2.5 i-gel with size 2.5 ProSeal LMA. AIMS This study was designed to investigate the usefulness of the size 2.5 i-gel compared with the ProSeal laryngeal mask airway (PLMA) of the same size in anesthetized, paralyzed children. MATERIALS AND METHODS Sixty ASA grade I - II patients undergoing elective surgery were included in this prospective study and were randomly assigned to the i-gel and PLMA groups (30 patients in each group). A size 2.5 supraglottic airway was inserted according to the assigned group. We assessed the ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications. RESULTS There were no differences in the demographic and hemodynamic data, success rates for the first attempt of insertion, or postoperative airway morbidity among the two groups. The airway leak pressure of the i-gel group (27.12 ± 1.69 cm H(2)O) was significantly higher than that of the PLMA group (22.75 ± 1.46 cm H(2)O). CONCLUSION Hemodynamic parameters, ease of insertion and postoperative complications were comparable between the i-gel and PLMA, but the nairway sealing pressure was significantly higher in the i-gel group.
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Affiliation(s)
- Subhro Mitra
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, A.M.U., Aligarh, India
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Das B, Mitra S, Jamil SN, Varshney RK. Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery. Saudi J Anaesth 2012; 6:224-8. [PMID: 23162394 PMCID: PMC3498659 DOI: 10.4103/1658-354x.101212] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [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 ProSeal laryngeal mask airway (PLMA) and 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 a tertiary care teaching hospital. METHODS Ninety ASA grade I-II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA 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. RESULTS There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH(2)O) was significantly higher than that of the PLMA group (22.73±1.2 cmH(2)O) and the cLMA group (23.63±2.3 cmH(2)O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups. CONCLUSIONS Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.
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Affiliation(s)
- Bikramjit Das
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Subhro Mitra
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shahin N. Jamil
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rohit K. Varshney
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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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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Bibliography. Opbstetric and gynecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2012; 25:389-92. [PMID: 22552532 DOI: 10.1097/aco.0b013e328354632f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goyal R, Shukla RN, Kumar G. Comparison of size 2 i-gel supraglottic airway with LMA-ProSeal™ and LMA-Classic™ in spontaneously breathing children undergoing elective surgery. Paediatr Anaesth 2012; 22:355-9. [PMID: 22151106 DOI: 10.1111/j.1460-9592.2011.03757.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We compared size 2 i-gel(®) (Intersurgical Inc.), a relatively new supraglottic airway device for use in spontaneously breathing anesthesized children with two different types of laryngeal mask airway-ProSeal™ laryngeal mask airway (PLMA) and Classic™ laryngeal mask airway (cLMA) for the ease of insertion, oropharyngeal sealing pressures (OSPs), and air leak. The hemodynamic effects on insertion of device and postoperative adverse effects were also noted. METHODS A randomized prospective study was planned in 120 children aged 2-5 years, weighing 10-20 kg, ASA physical status I-II scheduled for routine elective surgeries of <1-h duration. They were randomly divided in three groups (i-gel, PLMA, and cLMA) of 40 each, and a standard protocol for anesthesia was followed. RESULTS The age, weight, height, and type of surgery were similar in all groups. Success rate for first attempt was 95% for the i-gel group and 90% for the two laryngeal mask airway groups. Insertion was found to be easy in the majority of cases in all groups, and there was no change in blood pressure, heart rate, or oxygen saturation on insertion. The OSP was 26 ± 2.6, 23 ± 1.2, and 22 ± 2.3 cm H(2)O for i-gel, PLMA, and cLMA, respectively. The difference between the i-gel and both laryngeal mask airway groups was statistically significant (P < 0.01). There were no clinically important complications in the postoperative period. CONCLUSION Pediatric size 2 i-gel is easy to insert and provides higher OSP compared with same size PLMA and cLMA in spontaneously breathing children undergoing elective surgery. It may be a safe alternative to laryngeal mask airways in day care surgeries.
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Affiliation(s)
- Rakhee Goyal
- Department of Anesthesia and Critical Care, Armed Forces Medical College, Pune, India.
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Jagannathan N, Sohn LE, Sawardekar A, Gordon J, Langen KE, Anderson K. A randomised comparison of the LMA Supreme™ and LMA ProSeal™ in children. Anaesthesia 2012; 67:632-9. [DOI: 10.1111/j.1365-2044.2012.07088.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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