1
|
Kaur N, Saini S, Gupta A. Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy. Expert Rev Med Devices 2024; 21:317-324. [PMID: 38623726 DOI: 10.1080/17434440.2024.2343423] [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: 01/10/2024] [Accepted: 03/20/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques. METHODS In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed. RESULTS OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups. CONCLUSION The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion. CLINICAL TRIAL REGISTRATION www.ctri.nic.in identifier is CTRI/2022/10/046269.
Collapse
Affiliation(s)
- Navdeep Kaur
- Department of Anesthesiology and Intensive Care, VMMC and SJH Hospital, Delhi, India
| | - Suman Saini
- Department of Anesthesiology and Intensive Care, VMMC and SJH Hospital, Delhi, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, AIIMS, New Delhi, India
| |
Collapse
|
2
|
Castillo-Monzón CG, Gaszyński T, Marroquín-Valz HA, Orozco-Montes J, Ratajczyk P. Supraglottic Airway Devices with Vision Guided Systems: Third Generation of Supraglottic Airway Devices. J Clin Med 2023; 12:5197. [PMID: 37629238 PMCID: PMC10455808 DOI: 10.3390/jcm12165197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Supraglottic airway devices are currently widely used for airway management both for anaesthesia and emergency medicine. First-generation SADs only had a ventilation channel and did not provide protection from possible aspiration of gastric content if regurgitation occurred. Second-generation SADs are equipped with a gastric channel to allow the insertion of a gastric catheter and suctioning of gastric content. Additionally, the seal was improved by a change in the shape of the cuff. Some second-generation SADs were also designed to allow for intubation through the lumen using fiberscopes. Although the safety and efficacy of use of SADs are very high, there are still some issues in terms of providing an adequate seal and protection from possible complications related to misplacement of SAD. New SADs which allow users to choose the insertion scope and control the position of SAD can overcome those problems. Additionally, the Video Laryngeal Mask Airway may serve as an endotracheal intubation device, offering a good alternative to fibre-optic intubation through second-generation SADs. In this narrative review, we provide knowledge of the use of video laryngeal mask airways and the possible advantages of introducing them into daily clinical practice.
Collapse
Affiliation(s)
- Caridad G. Castillo-Monzón
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | | | - Javier Orozco-Montes
- Service of Anaesthesiology, Reanimation and Pain Therapy, University General Hospital of Cartagena, 30202 Murcia, Spain;
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| |
Collapse
|
3
|
Kirkham EM. Pediatric Drug-Induced Sleep Endoscopy. Otolaryngol Clin North Am 2022; 55:1165-1180. [DOI: 10.1016/j.otc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
4
|
Features of new vision-incorporated third-generation video laryngeal mask airways. J Clin Monit Comput 2021; 36:921-928. [PMID: 34919170 DOI: 10.1007/s10877-021-00780-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. Both devices are made up of two interlocking components-the SAD and a videoscope. The 3rd generation, direct vision SADs allow vision-guided insertion, corrective manoeuvres, if needed, and correct placement in the hypopharynx and possess additional features which permit insertion of a gastric tube and endotracheal intubation should the need arise. This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLMTM, UE Medical®) and the SafeLM® Video Laryngeal Mask System (SafeLMTM VLMS, Magill Medical Technology®) consist of two parts: (a) a disposable 2nd generation SAD with a silicone cuff and an anatomically curved tube; and (b) a reusable patient-isolated videoscope and monitoring screen, with the flexible scope located into a specially-designed, blind-end channel terminating in the bowl of the SAD, preventing the videoscope from contacting patient body fluids in the SAD bowl. Third generation placement-under-direct-vision supraglottic airway devices possess several theoretical safety and ease of use advantages which now need to be validated in clinical use.
Collapse
|
5
|
Van Zundert AA, Endlich Y, Beckmann LA, Bradley WP, Chapman GA, Heard AM, Heffernan D, Jephcott CG, Khong GL, Rehak A, Semenov RA, Stefanutto TB, O'Sullivan E. 2021 Update on airway management from the Anaesthesia Continuing Education Airway Management Special Interest Group. Anaesth Intensive Care 2021; 49:257-267. [PMID: 34154374 DOI: 10.1177/0310057x20984784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Airway Management is the key for anaesthetists dealing with patients undergoing diagnostic procedures and surgical interventions. The present coronavirus pandemic underpins even more how important safe airway management is. It also highlights the need to apply stringent precautions to avoid infection and ongoing transmission to patients, anaesthetists and other healthcare workers (HCWs). In light of this extraordinary global situation the aim of this article is to update the reader on the varied aspects of the ever-changing tasks anaesthetists are involved in and highlight the equipment, devices and techniques that have evolved in response to changing technology and unique patient and surgical requirements.
Collapse
Affiliation(s)
- André Aj Van Zundert
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Yasmin Endlich
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, Australia
| | - Linda A Beckmann
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Gordon A Chapman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia
| | - Andrew Mb Heard
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia
| | - Drew Heffernan
- Department of Anaesthesia, St Vincent's Hospital, Darlinghurst, Australia
| | | | - Geraldine Ls Khong
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia
| | - Adam Rehak
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia
| | - Richard A Semenov
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | |
Collapse
|
6
|
The case for a 3rd generation supraglottic airway device facilitating direct vision placement. J Clin Monit Comput 2021; 35:217-224. [PMID: 32537697 PMCID: PMC7293959 DOI: 10.1007/s10877-020-00537-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, to visualise insertion of the device, enable immediate manoeuvres to optimise SAD position, verify whether correct 1st and 2nd seals are achieved and check whether size selected is appropriate. We do not provide technical details of such a '3rd generation' device, but rather present a theoretical analysis of its desirable properties, which are essential to overcome the remaining limitations of current 1st and 2nd generation devices. We also recommend that this further milestone improvement, i.e. ability to place the SAD accurately under direct vision, be eligible for the moniker '3rd generation'. Blind insertion of SADs should become the exception and we anticipate, as in other domains such as central venous cannulation and nerve block insertions, vision-guided placement becoming the gold standard.
Collapse
|
7
|
A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®. J Clin Monit Comput 2020; 34:285-294. [PMID: 30953222 DOI: 10.1007/s10877-019-00301-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an 'insert-detect-correct-as-you-go' technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9 cm H2O) compared to the LMA-Supreme (27.7 ± 3.5 cm H2O) group (mean difference 4.0 cm H2O, 95% confidence interval (CI) 2.7-5.3 cm H2O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided.
Collapse
|
8
|
Urbanik D, Martynowicz H, Mazur G, Poręba R, Gać P. Environmental Factors as Modulators of the Relationship between Obstructive Sleep Apnea and Lesions in the Circulatory System. J Clin Med 2020; 9:jcm9030836. [PMID: 32204495 PMCID: PMC7141209 DOI: 10.3390/jcm9030836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/22/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a growing social problem, particularly in well-developed countries. It has been demonstrated that obstructive sleep apnea is a significant risk factor for cardiovascular diseases, including arterial hypertension, ischemic heart disease, heart failure, rhythm/conduction disturbances, as well as cerebral stroke. The pathophysiology of these diseases is complex and multifactorial. We present the current state of research on behavioral and environmental factors that influence the relationship between OSA and cardiovascular changes. We discuss the relationship between obesity, alcohol, sedatives, environmental tobacco smoke, allergic diseases and environmental pollution on the one hand and OSA on the other. In this context, the environment should be considered as an important modulator of the relationship between OSA and cardiovascular diseases.
Collapse
Affiliation(s)
- Dominika Urbanik
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (D.U.); (H.M.); (G.M.); (R.P.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (D.U.); (H.M.); (G.M.); (R.P.)
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (D.U.); (H.M.); (G.M.); (R.P.)
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland; (D.U.); (H.M.); (G.M.); (R.P.)
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland
- Correspondence: ; Tel.: +48-7-1784-1502; Fax: +48-7-1784-1503
| |
Collapse
|
9
|
Jo S, Lee JB, Jin Y, Jeong T, Yoon J, Park B. Change in peak expiratory flow rate after the head-tilt/chin-lift maneuver among young, healthy, and conscious volunteers. Clin Exp Emerg Med 2019; 6:36-42. [PMID: 30944290 PMCID: PMC6453697 DOI: 10.15441/ceem.18.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 11/23/2022] Open
Abstract
Objective The head-tilt/chin-lift (HT/CL) is a simple, routinely used maneuver to open the upper airway. Changes in the peak expiratory flow rate (PEFR) before and after the HT/CL maneuver have not been evaluated among conscious volunteers who are regarded as a control cohort. Methods Sixty healthy 20-year-old volunteers (30 males and 30 females) were enrolled. The supine position was defined as the position at which the ear-eye line was at a 10° angle to the horizontal. The HT/CL position was defined as the position at which the ear-eye line was at a 25° angle to the horizontal. PEFR was measured using a hand-held device with the subject in the supine position (pre-PEFR) and HT/CL position (post-PEFR), respectively. One set was defined as these two measurements. Five sets of measurements were performed on each subject (300 sets). The set with the maximal and minimal difference between pre-PEFR and post-PEFR were excluded from the analysis. We used a paired t-test to compare the mean pre-PEFR and post-PEFR values for the entire group and subgroups divided by sex, height, body weight, body mass index and response status. Results Overall, 360 measurements (180 sets) were analyzed. The mean pre-PEFR and post-PEFR were 316.1±87.6 and 346.5±94.7 L/min, respectively. Further, significant differences were observed for sex, height, body weight, and body mass index. In 10 subjects, post-PEFR was lower than pre-PEFR. Conclusion PEFR increased by 9.6% after the HT/CL maneuver in young conscious subjects, but some subjects showed decreased PEFR after the HT/CL maneuver.
Collapse
Affiliation(s)
- Sion Jo
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jae Baek Lee
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Department of Emergency Medicine, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Youngho Jin
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Department of Emergency Medicine, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Taeoh Jeong
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Department of Emergency Medicine, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Jaechol Yoon
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.,Department of Emergency Medicine, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
van Zundert A, Wyssusek K. Epiglottis folding double with supraglottic airway devices. Br J Anaesth 2018; 120:884-885. [DOI: 10.1016/j.bja.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 10/18/2022] Open
|
11
|
Van Zundert A, Gatt S, Kumar C, Van Zundert T, Pandit J. ‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy. Br J Anaesth 2017; 118:645-649. [DOI: 10.1093/bja/aex093] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Van Zundert A, Gatt S, Kumar C, Van Zundert T. Vision-guided placement of supraglottic airway device prevents airway obstruction: a prospective audit. Br J Anaesth 2017; 118:462-463. [DOI: 10.1093/bja/aex010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
Fleck RJ, Ishman SL, Shott SR, Gutmark EJ, McConnell KB, Mahmoud M, Mylavarapu G, Subramaniam DR, Szczesniak R, Amin RS. Dynamic Volume Computed Tomography Imaging of the Upper Airway in Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:189-196. [PMID: 27784422 PMCID: PMC5263074 DOI: 10.5664/jcsm.6444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/14/2016] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES To describe a dynamic three-dimensional (3D) computed tomography (CT) technique for the upper airway and compare the required radiation dose to that used for common clinical studies of a similar anatomical area, such as for subjects undergoing routine clinical facial CT. METHODS Dynamic upper-airway CT was performed on eight subjects with persistent obstructive sleep apnea, four of whom were undergoing magnetic resonance imaging and an additional four subjects who had a contraindication to magnetic resonance imaging. This Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board, and informed consent was obtained. The control subjects (n = 41) for comparison of radiation dose were obtained from a retrospective review of the clinical picture-archiving computer system to identify 10 age-matched patients per age-based control group undergoing facial CT. RESULTS Dynamic 3D CT can be performed with an effective radiation dose of less than 0.38 mSv, a dose that is less than or comparable to that used for clinical facial CT. The resulting data- set is a uniquely complete, dynamic 3D volume of the upper airway through a full respiratory cycle that can be processed for clinical and modeling analyses. CONCLUSIONS A dynamic 3D CT technique of the upper airway is described that can be performed with a clinically reasonable radiation dose and sets a benchmark for future use.
Collapse
Affiliation(s)
- Robert J. Fleck
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Sally R. Shott
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Ephraim J. Gutmark
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Keith B. McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mohamed Mahmoud
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dhananjay R. Subramaniam
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Rhonda Szczesniak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S. Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
| |
Collapse
|
14
|
van Zundert AAJ, Wyssusek K. Postoperative sore throat - know where your airway is positioned. Anaesthesia 2016; 71:1241-2. [PMID: 27611044 DOI: 10.1111/anae.13661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A A J van Zundert
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - K Wyssusek
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
15
|
Bécret A, Vialet R, Chaumoitre K, Loundou A, Lesavre N, Michel F. Upper airway modifications in head extension during development. Anaesth Crit Care Pain Med 2016; 36:285-290. [PMID: 27481692 DOI: 10.1016/j.accpm.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND One of the requirements of laryngoscopy is to determine which head position will result in optimal visualization. Our hypothesis was that parameters derived from magnetic resonance imaging (MRI) can help quantify the effect of age on airway modifications due to head extension during development. METHOD In children undergoing planned MRI, additional sequences on the upper airways were performed: one in a near-neutral position, the other with the head extended at 35°. The axis of the face, the pharynx, the larynx, the trachea, and the line of glottic visualization were determined. The following angles were calculated: the Visu-Lar angle, formed by the line of glottic visualization and the laryngeal axis, and the Phar-Lar angle, formed by the pharyngeal and laryngeal axes. RESULTS One hundred and fifty-five patients (1 to 222 months of age [25-145] months) were included and 54% were under general anaesthesia. Age had no effect on the variation in the Visu-Lar angle, which diminished as a function of head extension, nor on the variation in the Phar-Lar angle, which was minimal in the neutral position. During extension, anatomical axes rotated similarly, and the visualization axis rotated the most, followed by the pharyngeal and laryngeal axes. These results were not correlated with general anaesthesia. CONCLUSION Regardless of age, head extension diminished the Visu-Lar angle, and increased the Phar-Lar angle. This study supports that, as in adults, head extension is probably the key factor for good visualization conditions during laryngoscopy on children, but clinical data is needed to confirm this result.
Collapse
Affiliation(s)
- Antoine Bécret
- Department of Anesthesia and Intensive Care, Hôpital d'Instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Renaud Vialet
- Department of Anesthesia and Intensive Care, Pediatric and Neonatal Intensive Care Unit, Hôpital Nord, Assistance-Publique des Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France.
| | - Kathia Chaumoitre
- Medical Imaging Department, Hôpital Nord, Assistance-Publique des Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - Anderson Loundou
- Public Health Department, Self-Perceived Health Assessment Research Unit, School of Medicine, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Nathalie Lesavre
- Clinical Investigations Center, Hôpital Nord, Assistance-Publique des Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - Fabrice Michel
- Department of Anesthesia and Intensive Care, Pediatric and Neonatal Intensive Care Unit, Hôpital Nord, Assistance-Publique des Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
16
|
Somnoendoskopie. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0052-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Van Zundert A, Kumar C, Van Zundert T. Malpositioning of supraglottic airway devices: preventive and corrective strategies. Br J Anaesth 2016; 116:579-82. [DOI: 10.1093/bja/aew104] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Kim J, Im KS, Lee JM, Ro J, Yoo KY, Kim JB. Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients. J Int Med Res 2015; 44:136-46. [PMID: 26647074 PMCID: PMC5536577 DOI: 10.1177/0300060515594193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the correlation between anatomical features of the upper airway (evaluated via computed tomography imaging) and the ease of light wand-assisted endotracheal intubation in patients undergoing ear, nose and throat surgery under general anaesthesia. Methods Mallampati class, laryngoscopic grade, thyromental distance, neck circumference, body mass index, mouth opening and upper lip bite class were assessed. Epiglottis length and angle, tongue size and narrowest pharyngeal distance were determined using computed tomography imaging. Intubation success rate, time to successful intubation (intubating time) and postoperative throat symptoms were documented. Results Of 152 patients, 148 (97.4%) were successfully intubated on the first attempt (mean intubating time 11.5 ± 6.7 s). Intubating time was positively correlated with laryngoscopic grade and body mass index in both male and female patients, and Mallampati class and neck circumference in male patients. Epiglottis length was positively correlated with intubating time. Conclusions Ease of intubation was influenced by epiglottis length. Radiological evaluation may be useful for preoperative assessment of patients undergoing endotracheal intubation with light wand.
Collapse
Affiliation(s)
- Joungmin Kim
- Department of Anaesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyong Shil Im
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Myeong Lee
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaehun Ro
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Yeon Yoo
- Department of Anaesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jong Bun Kim
- Department of Anaesthesiology and Pain Medicine, Uijeongbu St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
19
|
Abstract
Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation with each other is important for understanding respiratory physiology. Ventilation to perfusion ratio alters with anaesthesia, body position and with one-lung anaesthesia. Hypoxic pulmonary vasoconstriction, an important safety mechanism, is inhibited by majority of the anaesthetic drugs. Ventilation perfusion mismatch leads to reduced arterial oxygen concentration mainly because of early closure of airway, thus leading to decreased ventilation and atelectasis during anaesthesia. Various anaesthetic drugs alter neuronal control of the breathing and bronchomotor tone.
Collapse
Affiliation(s)
- Apeksh Patwa
- Kailash Cancer Hospital and Research Centre, Muni Seva Ashram, Goraj, Vadodara, Gujarat, India
- Department of Anaesthesia, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
| | - Amit Shah
- Kailash Cancer Hospital and Research Centre, Muni Seva Ashram, Goraj, Vadodara, Gujarat, India
- Department of Anaesthesia, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
| |
Collapse
|
20
|
Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial. PLoS One 2015; 10:e0134130. [PMID: 26252522 PMCID: PMC4529079 DOI: 10.1371/journal.pone.0134130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/02/2015] [Indexed: 01/05/2023] Open
Abstract
Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients’ characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.
Collapse
|
21
|
Ehsan Z, Mahmoud M, Shott SR, Amin RS, Ishman SL. The effects of Anesthesia and opioids on the upper airway: A systematic review. Laryngoscope 2015. [DOI: 10.1002/lary.25399] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Mohamed Mahmoud
- Division of Anesthesia
- Department of Anesthesiology; University of Cincinnati College of Medicine
| | - Sally R. Shott
- Division of Pediatric Otolaryngology-Head & Neck Surgery; Cincinnati Children's Hospital Medical Center
- Department of Otolaryngology Head & Neck Surgery; University of Cincinnati; Cincinnati Ohio U.S.A
| | - Raouf S. Amin
- Division Pulmonary Medicine
- Department of Otolaryngology Head & Neck Surgery; University of Cincinnati; Cincinnati Ohio U.S.A
| | - Stacey L. Ishman
- Division Pulmonary Medicine
- Division of Pediatric Otolaryngology-Head & Neck Surgery; Cincinnati Children's Hospital Medical Center
- Department of Otolaryngology Head & Neck Surgery; University of Cincinnati; Cincinnati Ohio U.S.A
| |
Collapse
|
22
|
Xará D, Santos A, Abelha F. Adverse Respiratory Events in a Post-Anesthesia Care Unit. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.arbr.2014.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
23
|
García Araque HF, Valencia Orgaz O, López Vicente R, Gutiérrez Vidal SE. Airway anatomy for the bronchoscopist: An anesthesia approach. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
24
|
García Araque HF, Valencia Orgaz O, López Vicente R, Gutiérrez Vidal SE. Anatomía de la vía aérea para el broncoscopista. Una aproximación a la anestesia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
25
|
Adverse respiratory events in a post-anesthesia care unit. Arch Bronconeumol 2014; 51:69-75. [PMID: 24974136 DOI: 10.1016/j.arbres.2014.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/16/2014] [Accepted: 04/21/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adverse respiratory events (ARE) are a leading causes of postoperative morbidity and mortality. This study investigated the incidence and determinants of postoperative ARE. METHODS This observational prospective study was conducted in a post anesthesia care unit (PACU). A total of 340 adult subjects were admitted consecutively, and AREs were measured after elective surgery. Population demographics, perioperative parameters, ARE occurrence, and length of stay in the postoperative PACU and in hospital were recorded. Data were analyzed descriptively using the Mann-Whitney U-test and the Chi-square or Fisher's exact test. Multivariate analyses were carried outusing logistic binary regression, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS Postoperative AREs occurred in 67 subjects (19.7%). AREs were more frequent after high-risk procedures (42% vs 24%; P=.003), in patients undergoing major surgery (37% vs 25%; P=.041), those receiving general anesthesia (85% vs 67%; P=.004), and in patients administered intraoperative muscle relaxants (79% vs 55%; P<.001) and neostigmine (69% vs 49%; P=.002). Hypoactive emergence (13% vs 5%; P=.015) and residual neuromuscular blockade (46% versus 11%; P<.001) were more frequent in subjects with postoperative ARE. On multivariate analyses, residual neuromuscular blockade was an independent risk factor for ARE in the PACU (OR 6.4; CI 3.0-13.4; P<.001). CONCLUSIONS ARE is an important and common postoperative complication. Residual neuromuscular blockade was an independent risk factor for ARE in the PACU.
Collapse
|
26
|
Airway anatomy for the bronchoscopist: An anesthesia approach☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442030-00008] [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] Open
|
27
|
Stuth EAE, Stucke AG, Zuperku EJ. Effects of anesthetics, sedatives, and opioids on ventilatory control. Compr Physiol 2013; 2:2281-367. [PMID: 23720250 DOI: 10.1002/cphy.c100061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.
Collapse
Affiliation(s)
- Eckehard A E Stuth
- Medical College of Wisconsin, Anesthesia Research Service, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.
| | | | | |
Collapse
|
28
|
Phasic Genioglossus and Palatoglossus Muscle Activity during Recovery from Sevoflurane Anesthesia. Anesthesiology 2013; 119:562-8. [DOI: 10.1097/aln.0b013e318295a27b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
Inhalational anesthetic effects on upper airway muscle activity in children are largely unknown. The authors tested the hypothesis that phasic inspiratory genioglossus and palatoglossus activity increases during recovery from sevoflurane anesthesia in a dose-dependent manner in children.
Methods:
Sixteen children, aged 2.0 to 6.9 yr, scheduled for elective urological surgery were studied. Electromyogram recordings were acquired using intramuscular needle electrodes during spontaneous ventilation. After a 15-min period of equilibration, electromyogram activity was recorded over 30 s at each of three end-tidal concentrations, 1.5, 1.0, and 0.5 minimum alveolar concentration (MAC), administered in sequence.
Results:
Phasic genioglossus activity was noted in four children at 1.5 MAC, five at 1.0 MAC, and six children at 0.5 MAC sevoflurane. Phasic palatoglossus activity was noted in 4 children at 1.5 MAC, 6 at 1.0 MAC, and 10 children at 0.5 MAC sevoflurane. Both the proportion of children exhibiting phasic activity, and the magnitude of phasic activity increased during recovery from anesthesia. For the genioglossus, decreasing the depth of sevoflurane anesthesia from 1.5 to 1.0 MAC increased phasic activity by approximately 35% and a further decrease to 0.5 MAC more than doubled activity (median [range] at 1.5 and 0.5 MAC: 2.7 μV [0 to 4.0 μV] and 8.6 μV [3.2 to 17.6], respectively; P = 0.029). A similar dose-related increase was recorded at the palatoglossus (P = 0.0002).
Conclusions:
Genioglossus and palatoglossus activity increases during recovery from sevoflurane anesthesia in a dose-dependent manner over the clinical range of sevoflurane concentrations in children.
Collapse
|
29
|
Diedrich DA, Rose PS, Brown DR. Airway Management in Cervical Spine Injury. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0022-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
30
|
Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol 2012; 85:e1018-31. [PMID: 22898157 PMCID: PMC3500799 DOI: 10.1259/bjr/28871143] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 03/17/2012] [Accepted: 04/02/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. METHODS The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. RESULTS Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. CONCLUSION Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment.
Collapse
Affiliation(s)
- Y Arlachov
- Nottingham University Hospitals NHS Trust-Queen's Medical Centre Campus, Nottingham, UK.
| | | |
Collapse
|
31
|
Postoperative complications in obstructive sleep apnea. Sleep Breath 2012; 17:727-34. [PMID: 22821225 DOI: 10.1007/s11325-012-0750-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVES This study was conducted to determine whether postoperative complications are increased in patients with obstructive sleep apnea (OSA) and to study the impact of the severity of OSA and preoperative use of continuous positive airway pressure (CPAP) on the postoperative outcome. DESIGN AND SETTING This study is retrospective in nature and was undertaken at the VA Medical Center. PARTICIPANTS AND METHODS Three hundred seventy patients who had undergone both a major surgical procedure and a sleep study from 2000 to 2010 were identified. Patients were divided into four groups: OSA negative (apnea-hypopnea index (AHI) < 5/h), OSA positive; mild: AHI 5 to <15/h; moderate: AHI 15 to <30/h; and severe: AHI ≥ 30/h. No intervention was made during the course of the study. Postoperative complications namely respiratory, cardiac, neurological, and unplanned intensive care unit transfers were collected. RESULTS There were 284 (76.8 %) patients having OSA and 86 (23.2 %) without OSA. The overall incidence of total complications was significantly higher in the OSA patients compared with the control patients (48.9 vs. 31.4 %; odds ratio 2.09, 95 % CI 1.25-3.49). There was no significant difference in total complications between those using and not using CPAP prior to hospitalization. Patients with sleep apnea had a higher incidence of respiratory complications compared to patients without sleep apnea (40.4 vs. 23.2 %; odds ratio 2.24, 95 % CI 1.29-3.90). There was no significant difference in major cardiac complications in the OSA patients compared with the control patients (13.0 vs. 9.3 %; odds ratio 1.46, 95 % CI 0.65-3.26). CONCLUSION OSA is associated with a significantly increased rate of postoperative complications.
Collapse
|
32
|
|
33
|
Ankichetty S, Wong J, Chung F. A systematic review of the effects of sedatives and anesthetics in patients with obstructive sleep apnea. J Anaesthesiol Clin Pharmacol 2011; 27:447-58. [PMID: 22096275 PMCID: PMC3214547 DOI: 10.4103/0970-9185.86574] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The objective of this review is to determine the effects of perioperative sedatives and anesthetics in surgical patients with obstructive sleep apnea (OSA) on respiratory events, medication requirements, hemodynamics, pain, emergence, and hospital stay. We searched The Cochrane CENTRAL Register of Controlled Trials, Medline, Embase, and Cochrane Database of Systematic Reviews from 1950 to June 2010 for relevant articles. All prospective and retrospective studies were eligible for inclusion if the effects of perioperative administration of sedation and anesthetics on medication requirements, pain, emergence, hemodynamics, respiratory events, and length of hospital stay in OSA patients were reported. The search strategy yielded 18 studies of 1467 patients. Of these, 456 patients were documented as having OSA. Few adverse respiratory effects were reported. Eight out of 700 (1.14%) patients undergoing middle ear surgery with midazolam and fentanyl had impaired upper airway patency and were retrospectively diagnosed as having OSA by polysomnography. Also, intraoperative snoring causing uvular edema in the postoperative period was described in an OSA patient undergoing upper limb surgery when propofol was administered with midazolam and fentanyl for sedation. A decrease in oxygen saturation in the postoperative period was described with propofol and isoflurane in 21 OSA patients undergoing uvulo-palato-pharyngoplasty and tonsillectomy surgery (P<0.05). Perioperative alpha 2 agonists were shown to decrease the use of anesthetics (P<0.05), analgesics (P=0.008) and anti-hypertensives (P<0.001) in OSA patients. Contradictory reports regarding emergence occurred with intraoperative dexmedetomidine. Intraoperative opioids decreased the analgesic consumption (P=0.03) and pain scores (P<0.05) in the postoperative period. There was limited data on the length of hospital stay. There were few adverse effects reported when patients with known OSA underwent elective surgery with the currently available sedatives and anesthetics. Adverse events were reported with midazolam. However, the quality and number of patients in the studies were limited. There is a need for further trials with large numbers and uniform reporting of outcomes.
Collapse
Affiliation(s)
- Saravanan Ankichetty
- Department of Anesthesia, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | | | | |
Collapse
|
34
|
Vorperian HK, Wang S, Schimek EM, Durtschi RB, Kent RD, Gentry LR, Chung MK. Developmental sexual dimorphism of the oral and pharyngeal portions of the vocal tract: an imaging study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2011; 54:995-1010. [PMID: 21106698 PMCID: PMC3135757 DOI: 10.1044/1092-4388(2010/10-0097)] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE The anatomic origin for prepubertal vowel acoustic differences between male and female subjects remains unknown. The purpose of this study is to examine developmental sex differences in vocal tract (VT) length and its oral and pharyngeal portions. METHOD Nine VT variables were measured from 605 imaging studies (magnetic resonance imaging and computed tomography) of subjects between birth and age 19 years. Given sex differences in growth rate (Vorperian et al., 2009), assessment of sex differences was done through use of a localized comparison window of 60 months. Analysis entailed applying this comparison window first to 4 discrete age cohorts, followed by a progressive assessment in which this comparison window was moved in 1-month increments from birth across all ages. RESULTS Findings document significant postpubertal sex differences in both the oral and pharyngeal portions of the VT. They also document periods of significant prepubertal sex differences in the oral region first, followed by segments in the pharyngeal region. CONCLUSIONS Assessment of developmental sex differences using localized age ranges is effective in unveiling sex differences that growth rate differences may conceal. Findings on the presence of prepubertal sex differences in the oral region of the VT may clarify, in part, the anatomic basis of documented prepubertal acoustic differences.
Collapse
|
35
|
Mahmoud M, Radhakrishman R, Gunter J, Sadhasivam S, Schapiro A, McAuliffe J, Kurth D, Wang Y, Nick TG, Donnelly LF. Effect of increasing depth of dexmedetomidine anesthesia on upper airway morphology in children. Paediatr Anaesth 2010; 20:506-15. [PMID: 20412456 DOI: 10.1111/j.1460-9592.2010.03311.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This prospective study examines the dose-response effects of dexmedetomidine on upper airway morphology in children with no obstructive sleep apnea (OSA). AIM To determine the effect of increasing doses of dexmedetomidine on static and dynamic magnetic resonance (MR) images of the upper airway in spontaneously breathing children with no OSA. BACKGROUND General anesthetics and sedatives attenuate upper airway muscle activity, rendering the airway vulnerable to obstruction. Dose-response effects of dexmedetomidine on upper airway of children are not known. We prospectively examined the dose-response effects of dexmedetomidine on upper airway morphology in children. METHODS/MATERIALS Increasing doses of dexmedetomidine was administered to 23 children scheduled for MR imaging of the brain while breathing spontaneously via the native airway. Static axial and dynamic sagittal midline MR ciné images of the upper airway were obtained during low (1 mcg.kg(-1).h(-1)) and high (3 mcg.kg(-1).h(-1)) doses of dexmedetomidine. The airway anteroposterior diameter, transverse diameter, and cross-sectional areas were measured manually by two independent observers. Static airway measurements were taken at the level of the nasopharyngeal airway (sagittal images) and retroglossal airway (RGA) (sagittal and axial images). Dynamic change in cross-sectional area of airway between inspiration and expiration was considered a measure of airway collapsibility. RESULTS Static axial measurements of RGA did not change with increasing dose of dexmedetomidine. Most sagittal airway dimensions demonstrated clinically modest, although statistically significant, reductions with high dose compared to low dose dexmedetomidine. Although, the dynamic changes in nasopharyngeal and retroglossal area with respiration were marginally greater for high dose than for low dose dexmedetomidine, no subject exhibited any clinical evidence of airway obstruction. CONCLUSION Upper airway changes associated with increasing doses of dexmedetomidine in children with no OSA are small in magnitude and do not appear to be associated with clinical signs of airway obstruction. Even though these changes are small, all precautions to manage airway obstruction should be taken when dexmedetomidine is used for sedation.
Collapse
Affiliation(s)
- Mohamed Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Durtschi RB, Chung D, Gentry LR, Chung MK, Vorperian HK. Developmental craniofacial anthropometry: Assessment of race effects. Clin Anat 2009; 22:800-8. [PMID: 19753647 PMCID: PMC2846695 DOI: 10.1002/ca.20852] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Differences in craniofacial anatomy among racial groups have been documented in a variety of structures, but the oral and maxillofacial regions have been shown to be a particularly defining region of variability between different racial/ethnic groups. Such comparisons are informative, but they neither address developmental changes of the craniofacial anatomy nor do they assess or take into account the natural variability within individual races that may account for similar reported, across-group variations. The purpose of this report was to compare-using medical imaging studies-the growth trend of select race-sensitive craniofacial variables in the oral and pharyngeal regions when all races [White, Asian, Black, and Hispanic (AR)] are included versus only a single race category [White (WR)]. Race effect was tested by comparing sex-specific growth fits (fourth degree polynomial model) for AR versus WR data. Findings indicate that the inclusion of all races versus a single race did not significantly alter the growth model fits. Thus, the inclusion of all races permits the advancement of general growth models; however, methodologically, it is best to treat the race variable as a covariate in all future analysis to test for both potential all race effects or individual race effects, on general growth models.
Collapse
Affiliation(s)
- Reid B. Durtschi
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, # 429, Madison, Wisconsin 53705
| | - Dongjun Chung
- Department of Statistics, University of Wisconsin Madison, 1220 Medical Sciences Center, 1300 University Ave, Madison, WI 53706
| | - Lindell R. Gentry
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, E1-311 Clinical Science Center, Madison, Wisconsin 53792
| | - Moo K. Chung
- Departments of Biostatistics & Medical Informatics, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705
| | - Houri K. Vorperian
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, # 481, Madison, Wisconsin 53705
| |
Collapse
|
37
|
Chung SA, Yuan H, Chung F. A Systemic Review of Obstructive Sleep Apnea and Its Implications for Anesthesiologists. Anesth Analg 2008; 107:1543-63. [DOI: 10.1213/ane.0b013e318187c83a] [Citation(s) in RCA: 229] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
38
|
Vialet R, Nau A, Chaumoître K, Martin C. Effects of head posture on the oral, pharyngeal and laryngeal axis alignment in infants and young children by magnetic resonance imaging. Paediatr Anaesth 2008; 18:525-31. [PMID: 18363622 DOI: 10.1111/j.1460-9592.2008.02530.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Objective anatomical studies supporting the different recommendations for laryngoscopy in infants and young children are scarce. The objective of this study was to measure by magnetic resonance imaging (MRI) the consequences of head extension on the oral, pharyngeal and laryngeal axes in infants and young children. METHODS Thirty patients (age: 33 +/- 28 months; weight 14 +/- 9 kg), under general inhalated anesthesia delivered via a laryngeal mask airway, were studied in two anatomic positions: head in the resting position and in simple extension. The following measurements were made on each scan: the face and the neck axes, the pharyngeal axis, the laryngeal axis, and the line of vision of glottis. The various angles between these axes were defined: delta angle between line of vision and laryngeal axis, and beta angle between pharyngeal axis and laryngeal axis. From an anatomical point of view, laryngoscopy and passage of a naso-tracheal tube would be facilitated if these angles are narrow. RESULTS Placing the patient from the resting position into extension led to a narrowing of the angle delta but a widening of the angle beta. CONCLUSIONS In infants and young children, under general anesthesia and with a laryngeal mask airway in place, just a slight head extension improves alignment of the line of vision of the glottis and the laryngeal axis (narrowing of angle delta) but worsened the alignment of the pharyngeal and laryngeal axes (widening of angle beta).
Collapse
Affiliation(s)
- Renaud Vialet
- Réanimation Pédiatrique et Néonatale, Département d'Anesthésie-Réanimation CHU Nord Bd. P. Dramard, Marseille, France.
| | | | | | | |
Collapse
|
39
|
Schieble T, Patel A, Davidson M. Laryngeal mask airway (LMA) artefact resulting in MRI misdiagnosis. Pediatr Radiol 2008; 38:328-30. [PMID: 17994296 DOI: 10.1007/s00247-007-0671-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 08/27/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
Abstract
We report a 7-year-old child who underwent brain MRI for a known seizure disorder. The technique used for general anesthesia included inhalation induction followed by placement of a laryngeal mask airway (LMA) for airway maintenance. Because the reviewing radiologist was unfamiliar with the use of an LMA during anesthesia, and because the attending anesthesiologist did not communicate his technique to the radiologist, an MRI misdiagnosis was reported because of artefact created by the in situ LMA. As a result of this misdiagnosis the child was subjected to unnecessary subsequent testing to rule out a reported anatomic abnormality induced by the LMA. Our case illustrates the need for coordination of patient care among hospital services.
Collapse
Affiliation(s)
- Thomas Schieble
- Department of Anesthesiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
| | | | | |
Collapse
|
40
|
Caruso LJ, Sungur M. Bag and mask ventilation. N Engl J Med 2007; 357:2090-1; author reply 2092. [PMID: 18003970 DOI: 10.1056/nejmc072473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Abstract
Patients with obstructive sleep apnea are at risk of mortality and morbidity related to the administration of sedatives, anesthetics, and opioids. Commonly employed sedatives and analgesics promote pharyngeal collapse and alter normal respiratory responses to obstruction and apnea. Literature concerning patients with obstructive sleep apnea undergoing moderate and deep sedation in the endoscopy suite is lacking. The purpose of this article is to provide the reader with a review of normal airway patency, the effects of obstructive sleep apnea on airway patency, and the impact that analgesics and sedatives may impart on the airway of patients with obstructive sleep apnea. The goal of this article is to increase awareness, stimulate discussions within the gastroenterological community, and encourage research regarding sedation in this at-risk population.
Collapse
Affiliation(s)
- Daniel D Moos
- Kearney Anesthesia Associates, Kearney, Nebraska 68847, USA.
| |
Collapse
|
42
|
Ikeda H, Ayuse T, Oi K. The effects of head and body positioning on upper airway collapsibility in normal subjects who received midazolam sedation. J Clin Anesth 2006; 18:185-93. [PMID: 16731320 DOI: 10.1016/j.jclinane.2005.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2004] [Accepted: 08/15/2005] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that the change of body and head position affects upper airway patency during midazolam sedation. DESIGN Clinical study using 30 healthy subjects. SETTING Research unit for sleep study. INTERVENTIONS We used a pressure-flow relationship to evaluate critical closing pressure (Pcrit) and upper airway resistance (Rua) in different condition of body and head position. A pressure-flow relationship was obtained in 3 body postures (supine, 15 degrees elevation, and 30 degrees elevation) and was obtained in 3 head positions (supine with the head in the neutral, supine with head extension, and supine position with head rotated). MEASUREMENTS The pressure and inspiratory flow at subjects' nose mask were recorded. Polysomnographic parameters (electroencephalograms, electrooculograms, submental electromyograms, upper esophageal pressure, and plethysmogram) were also recorded. MAIN RESULTS In experiment 1, 30 degrees elevation of the body significantly decreased Pcrit (P < 0.05) to -13.3 +/- 1.3 cm H(2)O compared with -8.2 +/- 1.4 cm H(2)O in supine condition without changing the slope (1/Rua). In experiment 2, head extension significantly decreased Pcrit (-12.5 +/- 1.3 cm H(2)O) (P < 0.05) compared with the value (-8.2 +/- 1.0 cm H(2)O) in supine condition without changing the slope (1/Rua). CONCLUSIONS Our findings indicate that 30 degrees body elevation and head extension significantly decreased upper airway collapsibility during midazolam sedation and established the relative potency of maneuvers that maintain upper airway patency.
Collapse
Affiliation(s)
- Hidetoshi Ikeda
- Division of Clinical Physiology, Department of Translational Medical Sciences, College of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | | |
Collapse
|
43
|
Pritchard SE, McRobbie DW. Studies of the human oropharyngeal airspaces using magnetic resonance imaging. II. The use of three-dimensional gated MRI to determine the influence of mouthpiece diameter and resistance of inhalation devices on the oropharyngeal airspace geometry. ACTA ACUST UNITED AC 2005; 17:310-24. [PMID: 15684731 DOI: 10.1089/jam.2004.17.310] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The anatomical geometry of the upper airways of 20 volunteers has been studied using three-dimensional (3D)inhalation-gated magnetic resonance imaging (MRI)for four separate dummy inhalation devices of varying diameters and resistances. The only anatomical parameters showing a consistent dependence upon device characteristics were the total airway and buccal volumes between large and small mouthpieces and the distance from the back of the teeth to the first solid obstacle encountered. Individual subjects showed varied device dependent changes: 45% having an increase in regional airway volumes, particularly in the nasopharynx (+46% volume increase)and laryngo-pharynx (+36% volume increase)for the high-resistance devices compared with the low-resistance ones. However, 30% of subjects showed the opposite behavior, a reduction in naso-pharynx volume (-17%), laryngo-pharynx volume (-17%), and laryngeal cavity (-11%). 25% showed no significant difference in airway volume between high- and low-resistance devices. There was a correlation between maximum inspiratory pressure (MIP)and change in airway volume for high-resistance devices, with those exhibiting expansion having generally lower MIP than the group showing contraction (with the non-responders intermediate). Mean airway minimum and maximum cross-sectional areas and radii were not influenced by device. The geometric mean radius at the epiglottis was 5.1 mm (standard deviation [SD] 1.1) and 5.7 mm (SD 1.1) at the vocal cords. Significant differences observed between males and females included MIP for high-resistance devices, the volume and minimum and maximum radii of the laryngeal and laryngeo-pharynx regions, and total airway volume. A cadaver cast exhibited a number of striking differences in comparison with the in vivo data, most notably a significantly greater total volume.
Collapse
Affiliation(s)
- Susan E Pritchard
- Radiological Sciences Unit, Hammersmith Hospitals NHS Trust, Charing Cross Hospital, London, United Kingdom
| | | |
Collapse
|
44
|
Vorperian HK, Kent RD, Lindstrom MJ, Kalina CM, Gentry LR, Yandell BS. Development of vocal tract length during early childhood: a magnetic resonance imaging study. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2005; 117:338-50. [PMID: 15704426 DOI: 10.1121/1.1835958] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Speech development in children is predicated partly on the growth and anatomic restructuring of the vocal tract. This study examines the growth pattern of the various hard and soft tissue vocal tract structures as visualized by magnetic resonance imaging (MRI), and assesses their relational growth with vocal tract length (VTL). Measurements on lip thickness, hard- and soft-palate length, tongue length, naso-oro-pharyngeal length, mandibular length and depth, and distance of the hyoid bone and larynx from the posterior nasal spine were used from 63 pediatric cases (ages birth to 6 years and 9 months) and 12 adults. Results indicate (a) ongoing growth of all oral and pharyngeal vocal tract structures with no sexual dimorphism, and a period of accelerated growth between birth and 18 months; (b) vocal tract structure's region (oral/anterior versus pharyngeal/posterior) and orientation (horizontal versus vertical) determine its growth pattern; and (c) the relational growth of the different structures with VTL changes with development-while the increase in VTL throughout development is predominantly due to growth of pharyngeal/posterior structures, VTL is also substantially affected by the growth of oral/anterior structures during the first 18 months of life. Findings provide normative data that can be used for modeling the development of the vocal tract.
Collapse
Affiliation(s)
- Houri K Vorperian
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin 53705, USA.
| | | | | | | | | | | |
Collapse
|
45
|
McRobbie DW, Pritchard S, Quest RA. Studies of the Human Oropharyngeal Airspaces using Magnetic Resonance Imaging. I. Validation of a Three-Dimensional MRI Method for ProducingEx VivoVirtual and Physical Casts of the Oropharyngeal Airways During Inspiration. ACTA ACUST UNITED AC 2003; 16:401-15. [PMID: 14977431 DOI: 10.1089/089426803772455668] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The oropharyngeal region of the human airways has been scanned using 3D MRI and the data used to produce a model cast. The scanning method used a triggering device, which enabled data collection at the same pressure drop in each breathing cycle to produce clear images free of motion-related artefacts. A comparison between two differing MR acquisition strategies was made in a single subject, multi-session study. 3D FISP MR imaging was found to produce the most reliable data. Excluding the buccal cavity, where tongue position was critical, the reproducibility of measured airway volumes and cross sectional areas between sessions was demonstrated. Inter-session total airway volume (excluding the mouth) reproducibility was of the order of 5% and for minimum cross sectional areas at the epiglottis and vocal cords was 10%. The production of a physical cast from the images led to a 5% increase in airway volume compared with the anatomical images but with some loss of fine detail. The data demonstrated the robustness of an ex-vivo means of studying oropharyngeal dimensions and dynamics which may contribute to advancements in the understanding of aerosol delivery of therapeutic agents.
Collapse
Affiliation(s)
- Donald W McRobbie
- Radiological Sciences Unit, The Hammersmith Hospital NHS Trust & Imperial College, Charing Cross Hospital, London, United Kingdom.
| | | | | |
Collapse
|
46
|
Dilworth K, Thomas J. Anaesthetic consequences for a child with complex multilevel airway obstruction -- recommendations for avoiding life-threatening sequelae. Paediatr Anaesth 2003; 13:620-3. [PMID: 12950864 DOI: 10.1046/j.1460-9592.2003.01011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A boy with a suspected lymphoid malignancy presented with gross head and neck lymphadenopathy, a middle mediastinal mass, and rapidly worsening airway obstruction. General anaesthesia was required for definitive histopathological diagnosis. The combination of nasopharyngeal obstruction, malignant infiltration of the tonsils and pharynx, laryngeal displacement, and potential tracheal compression put this patient at extreme risk for perioperative airway complications. Risk assessment, and the impact of anaesthesia on pharyngeal neuromechanical function and mediastinal masses are discussed. Caution with volatile anaesthetic agents is recommended in the patient with an inherently unstable pharynx and/or trachea, in whom airway patency relies on a spontaneously breathing technique and intact airway reflexes.
Collapse
Affiliation(s)
- Kelly Dilworth
- Department of Anaesthetics, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | |
Collapse
|
47
|
Soh CR, Ng AS. Laryngeal mask airway insertion in paediatric anaesthesia: comparison between the reverse and standard techniques. Anaesth Intensive Care 2001; 29:515-9. [PMID: 11669434 DOI: 10.1177/0310057x0102900512] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sixty-seven children between one and 15 years of age were randomized to have Laryngeal Mask Airway (LMA) insertion using either the standard technique (Group A) as described by Brain or the "reverse technique" (involving a 180 degree turn after insertion with the cuff facing the palate) (Group B). A blinded observer using a fibreoptic bronchoscope assessed the final position of the LMA. The LMA had to be placed within 15 seconds for the procedure to be considered "successful". The success rate using the standard technique was 90.3% (28/31) and 100% (36/36) using the reverse technique (P value 0.06). The 95% confidence interval for the difference in success rates between Group B and A (B-A) was -0.73% to 20.1%. It is our opinion that the reverse technique of insertion of the LMA is an acceptable alternative to the standard technique.
Collapse
Affiliation(s)
- C R Soh
- Department of Anaesthesia (Children), Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore
| | | |
Collapse
|
48
|
Sacks MD, Marsh D. Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity. Paediatr Anaesth 2000; 10:435-7. [PMID: 10886703 DOI: 10.1046/j.1460-9592.2000.00550.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 4-year-old boy who developed bilateral recurrent laryngeal nerve neuropraxia following a routine anaesthetic with a laryngeal mask airway. The possible mechanisms of injury and the ways that this rare but critical complication might be avoided are discussed.
Collapse
Affiliation(s)
- M D Sacks
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | |
Collapse
|
49
|
Reissmann H, Pothmann W, Füllekrug B, Dietz R, Schulte am Esch J. Resistance of laryngeal mask airway and tracheal tube in mechanically ventilated patients. Br J Anaesth 2000; 85:410-6. [PMID: 11103183 DOI: 10.1093/bja/85.3.410] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We compared the airflow resistance of 7.5 and 8.5 mm internal diameter (i.d.) endotracheal tubes (ETTs) with that of a size 4 laryngeal mask airway (LMA). We thought that any difference in the resistance of the devices alone might be offset by the resistance of the larynx. Sixteen adult ASA physical status I and II patients (14 males, two females) undergoing general anaesthesia were anaesthetized and paralysed with intravenous propofol, ketamine and vecuronium. After insertion of the LMA, controlled ventilation (tidal volume 10 ml kg-1, frequency 12 min-1) was established with three different settings for inspiratory flow (5.5, 7.5 and 12.5 ml kg-1 s-1). Ventilation with the same settings was used after orotracheal intubation with an ETT of i.d. 7.5 mm (females) or 8.5 mm (males). The position of the LMA mask and the tip of the ETT were checked through a fibrescope. The resistance of the devices and, in case of the LMA, of the larynx, was derived by relating proximal and distal pressures (measured via catheters) to inspiratory flow. Four patients--young, tall men--had to be excluded from further study because of a leak around the LMA. In the remaining 10 males and two females, resistance of the LMA (mean (SD) at high flow, 1.19 (0.22) mbar.s litre-1 in males) was less than that of the 8.5 mm i.d. ETT (3.34 (0.52) mbar.s litre-1) (P < 0.01). However, the structures between the LMA and the trachea added another, highly variable, resistance component, so that the mean resistance of the LMA and larynx together was similar (in males: 3.20 (2.71) mbar.s litre-1) to that of the 8.5 mm ETT. In eight patients the epiglottis projected on to one-tenth to two-thirds of the distal opening of the LMA; this was in no case associated with greater resistance. Greater resistance occurred in two patients with a central LMA position and unobstructed view of the glottis and in one patient with marked lateral deviation. In conclusion, there is no clinically relevant difference between the resistance of a size 4 LMA plus that of the larynx and that of an 8.5 mm i.d. ETT.
Collapse
Affiliation(s)
- H Reissmann
- Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany
| | | | | | | | | |
Collapse
|
50
|
Martins RH, Braz JR, Defaveri J, Gregório EA, Abud TM. Effect of high laryngeal mask airway intracuff pressure on the laryngopharyngeal mucosa of dogs. Laryngoscope 2000; 110:645-50. [PMID: 10764012 DOI: 10.1097/00005537-200004000-00020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of increased of laryngeal mask airway (LMA) intracuff pressures on the laryngopharyngeal mucosa. STUDY DESIGN Animal model. METHODS Sixteen mixed-breed dogs were randomly allocated to two groups, G1 (intracuff volume, 30 mL; n = 8) and G2 (intracuff volume, 54 mL; n = 8), to produce, respectively, high or very high intracuff pressures. Anesthesia was induced and maintained with pentobarbital. Intracuff pressures were measured immediately after insertion and inflation of a No. 4 laryngeal mask airway (LMA) and 30, 60, 90, and 120 minutes thereafter. The dogs were euthanized, and biopsy specimens from eight predetermined areas of the laryngopharynx in contact with LMA cuff were collected for light microscopic (LM) and scanning electron microscopic (SEM) examination. RESULTS Initial LMA cuff inflation in G1 and G2 resulted in intracuff pressures of 119 mm Hg +/- 4 mm Hg and 235 mm Hg +/- 13 mm Hg, respectively. Over a 2-hour period, the intracuff pressure decreased significantly in G1 (P < .001) and G2 (P < .01), and there was a significant difference between the groups over time (P < .001). The LM study of laryngopharyngeal mucosa in both groups showed mild congestion in the subepithelial layer. There were no differences between the groups (P > .10) or among the areas sampled (P > .10). In some areas of G2, the SEM study showed epithelial desquamation that was more intense than that in G1. CONCLUSIONS The increase in LMA intracuff pressure caused only mild alterations in the laryngopharyngeal mucosa of the dog.
Collapse
Affiliation(s)
- R H Martins
- Department of Otorhinolaryngology, College of Medicine, University of São Paulo State, Botucatu, Brazil
| | | | | | | | | |
Collapse
|