Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Proseal laryngeal mask airway and endotracheal intubation in lower abdominal gynecological surgeries for perioperative gastric volume assessment and assessing postoperative recovery of gastrointestinal functions: A randomized controlled trial

Background

In the context of perioperative care, the concern of gastric content aspiration during surgical procedures is crucial, though relatively rare. Supraglottic devices after the creation of pneumoperitoneum and positive pressure ventilation may cause gastric insufflation. This study explores the unique aspects of antral cross-sectional area (CSA) measurement as a novel indicator in comparing the use of ProSeal laryngeal mask airway (LMA) and endotracheal intubation in airway management during lower abdominal surgeries and assessing postoperative recovery in both the groups.

Methods

The study commenced after obtaining approval from Institutional Ethical Committee (IEC number-AIIMS/IEC/22/251 Date: 27/05/2022) and after registration in Clinical Trials Registry - India (CTRI) (CTRI/2022/07/044102 Registered on: 18/07/2022) and was conducted from August 2022 to August 2023. A total of 72 ASA I and II participants were included in two groups: endotracheal tube (ETT) (Group E) and PLMA (Group P). The primary outcome was the antral CSA, and secondary outcomes included hemodynamic and respiratory parameters, time to start clear fluid, light diet, and length of stay.

Results

Our results showed that there was no statistically significant difference between the two groups in antral CSA at various time intervals. The hemodynamic variables were significantly higher in the endotracheal tube group (P < 0.0001). The absence of significant differences in time to start clear liquids, time to start a light diet, and time to achieve bowel movements between the ETT and PLMA groups suggested that both airway management techniques are equally safe in facilitating postoperative recovery concerning gastrointestinal functions.

Conclusions

Patients who underwent minimally invasive lower abdominal surgeries, choice of airway management technique, whether ETT or PLMA, did not substantially impact antral CSA, vital parameters, respiratory parameters, or postoperative recovery.

Gastric insufflation with and without an inserted gastric tube in second-generation laryngeal mask airways: A randomized controlled cross-over trial

STUDY OBJECTIVE

Second-generation laryngeal mask airways are equipped with an additional lumen for a gastric tube, with the intention to reduce the risk of aspiration by draining gastric content. However, the effect of an inserted gastric tube through the gastric channel on gastric insufflation, a substantial part of the pathomechanism of aspiration, during positive-pressure ventilation is not clear. We hypothesized, that an inserted gastric tube increases the risk of gastric insufflation.

DESIGN

Single center, prospective, randomized-controlled cross-over trial.

SETTING

Tertiary academic hospital in Germany.

PATIENTS

152 patients, ASA I-III, scheduled for general anesthesia with a laryngeal mask airway.

INTERVENTIONS

Gastric insufflation was investigated during an incremental pressure trial up to a maximum airway pressure of 30 cmH2O and during oropharyngeal leak pressure measurement with and without an inserted gastric tube while one of two laryngeal mask airways with different cuff designs (inflatable or thermoelastic) was used.

MEASUREMENTS

Gastric insufflation was detected with real-time ultrasound.

MAIN RESULTS

Frequency of gastric insufflation was higher with than without inserted gastric tube during the incremental pressure trial (10.9 % (16/147) vs. 2.7 % (4/147), p = 0.009) and during oropharyngeal leak pressure measurement (16.3 % (24/147) vs. 5.4 % (8/147), p = 0.004). Risk of gastric insufflation didn't differ between the two cuff-types (p = 0.100). Flow over the open gastric channel was associated with gastric insufflation during positive-pressure ventilation (p = 0.003) and during oropharyngeal leak pressure measurement (p = 0.049). Incidence of postoperative nausea and vomiting was higher in patients in which gastric insufflation was detected, compared to others (17.1 % (6/35) vs. 5.4 % (6/112), p = 0.037).

CONCLUSION

Placement of a gastric tube through the gastric channel of a second-generation laryngeal mask airway, independent of the cuff-type, increases the risk of gastric insufflation. Flow over the gastric channel indicate a higher risk of gastric insufflation and gastric insufflation may increase the risk of postoperative nausea and vomiting.

Supraglottic airway devices: a powerful strategy in airway management

The escalating airway management demands of cancer patients have prompted us to continually curate airway devices, with supraglottic airway devices (SADs) playing a significant role in this regard. SADs serve as instrumental tools for maintaining an open upper airway. Since the inception of the earliest SADs in the early 1980s, an array of advanced and enhanced second-generation devices have been employed in clinical settings. These upgraded SADs integrate specific features designed to enhance positive-pressure ventilation and mitigate the risk of aspiration. Nowadays, they are extensively used in general anesthesia procedures and play a critical role in difficult airway management, pre-hospital care, and emergency medicine. In certain situations, SADs may be deemed a superior alternative to endotracheal tube (ETT) and can be employed in a broader spectrum of surgical and non-surgical cases. This review provides an overview of the current evidence, a summary of classifications, relevant application scenarios, and areas for improvement in the development or clinical application of future SADs.

Effects of laryngeal mask ventilation on postoperative atelectasis in children undergoing day surgery: a randomized controlled trial

BACKGROUND

To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery.

METHODS

Children aged 3-7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators.

RESULTS

The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05).

CONCLUSION

Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn't encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management.

TRIAL REGISTRATION

The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. ( https://www.chictr.org.cn . Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).

Comparison of Gastric Insufflation Volume Between Ambu AuraGain and ProSeal Laryngeal Mask Airway Using Ultrasonography in Patients Undergoing General Anesthesia: A Randomized Controlled Trial

Introduction: Ambu AuraGain and ProSeal laryngeal mask airway are second-generation supraglottic airway devices (SADs) with added advantage of gastric drain and better oropharyngeal sealing pressure. The primary objective was to study the difference in the gastric insufflation volume between Ambu AuraGain and ProSeal LMA in patients undergoing general anesthesia.

Methods: This randomized controlled trial involving 120 adult patients scheduled under general anesthesia were randomized into either Ambu AuraGain or LMA ProSeal group. Gastric cross-sectional area was measured using ultrasonography at baseline, after mask ventilation, and at the end of surgery. Gastric volume was calculated from the measured cross-sectional area. Oropharyngeal sealing pressure, peak airway pressure, and postoperative complications were noted. Statistical analysis was done using SPSS version 22 (Armonk, NY: IBM Corp.) and p < 0.05 was considered statistically significant.

Results: Demographic profile of the study groups was comparable. There was a significant difference in gastric volume between the groups at the end of surgery with 5.91 ml (±9.68 ml) in Ambu AuraGain group and 12.28 ml (±13.05 ml) in the LMA ProSeal group (p = 0.001). Similarly, there was a difference in volume between baseline and at the end of the surgery within the groups also (Ambu AuraGain group, p=0.0012; LMA ProSeal group, p=0.0015, respectively). Though the oropharyngeal sealing pressure and peak airway pressures were comparable, increased incidence of postoperative complications was observed with LMA ProSeal.

Conclusion: Thus, Ambu AuraGain resulted in a lower gastric insufflation volume than LMA ProSeal with lesser incidence of postoperative complications.

Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients

Objective

This study is aimed at exploring the effects of the concept of fast-track surgery (FTS) combined with empathic nursing on perioperative complication prevention and postoperative recovery of gynecological malignant tumor patients.

Methods

A total of 180 patients with gynecological malignant tumor treated by surgery in our hospital from September 2018 to October 2021 were randomly divided into three groups: group A, group B, and group C, with 60 patients in each group. Group C was given conventional nursing intervention, group B was given FTS intervention, and group A was given FTS intervention combined with empathic care. Psychological stress state (systolic blood pressure, diastolic blood pressure, and heart rate), postoperative recovery indicators (time of first anal exhaust, time of first defecation, time of getting out of bed, and length of postoperative hospital stay), postoperative complications, and psychological state (Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)) levels of patients in the three groups were compared.

Results

Systolic blood pressure, diastolic blood pressure, and heart rate in group A were lower than those in group B, and those in group B were lower than those in group C (all P < 0.05). The time of first anal exhaust, time of first defecation, time of getting out of bed, and postoperative hospital stay in groups A and B were shorter than those in group C (all P < 0.05).The incidence of postoperative complications in groups A and B was 8.33% and 8.33%, respectively, lower than 23.33% in group C (both P < 0.05). SAS and SDS scores of group A were lower than those of groups B and C after intervention (all P < 0.05).

Conclusion

The concept of FTS combined with empathic nursing is beneficial to reduce the stress response of patients with gynecological malignant tumor before surgery, reduce the risk of postoperative complications, improve patients' mood, and speed up the rehabilitation process of patients.

Laryngeal Masks in Neonatal Resuscitation-A Narrative Review of Updates 2022

Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.

LMA® protector™ in patients undergoing laparoscopic surgeries: a multicenter prospective observational study

BACKGROUND

Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery.

METHODS

Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™.

RESULTS

Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients.

CONCLUSIONS

The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry ( ChiCTR1800018300 , date of registration: September 2018).

Baska mask versus endotracheal tube in laparoscopic cholecystectomy surgery: a prospective randomized trial

Background: Supraglottic airway devices have increasingly been used as the airway technique of choice in laparoscopic surgeries. This study compared the efficacy and safety of the Baska Mask with endotracheal tube (ETT) in patients undergoing elective laparoscopic cholecystectomy.Research design and methods: This single-center, prospective, randomized controlled trial recruited 60 patients aged 18-75 years with American Society of Anesthesiologists' classifications I to III. The time taken to achieve effective airway, number of attempts, ease of insertion, ventilation parameters, hemodynamics data, and pharyngolaryngeal complications were recorded.Results: The time taken to achieve effective airway was shorter for the Baska group (26.6 ± 4.7 vs. 47.2 ± 11.8 s; p < 0.001), although the first-time insertion success rate was ≥90% for both groups. The ETT group experienced more pharyngolaryngeal complications, including cough, trauma, spasm, dysphonia, and sore throat, during device insertion and removal and had higher systolic and diastolic blood pressures during intubation (p = 0.001). The Baska Mask achieved significantly lower peak airway pressure (p = 0.024) with stable oropharyngeal leak pressure ≥33 cmH₂O throughout the surgery.Conclusions: The Baska Mask is a suitable alternative to endotracheal intubation in selected patients undergoing laparoscopic cholecystectomy, with shorter insertion times, fewer perioperative complications, and improved ventilatory performance and hemodynamic response.Trial registration: The trial is registered at ClinicalTrials.gov (NCT03045835), 8 February 2017.