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Elghamry MR, Anwar AG, Elbadry AA, Shaaban A. Efficacy of the laryngeal mask airway gastro during trans-esophageal echocardiography in pediatrics: A randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2180577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Mona Raaft Elghamry
- Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Atteia Gad Anwar
- Anesthesia, Surgical Intensive Care, and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Arafa Elbadry
- Lecturer in Anesthesia, Surgical Intensive Care, and Pain Medicine, Tanta University, Tanta, Egypt
| | - Aliaa Shaaban
- Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Zhang L, Li L, Wang J, Zhao C, Zhao E, Li Y, Lv Y. Comparison of the Jcerity endoscoper airway and the endotracheal tube in endoscopic esophageal variceal ligation: a prospective randomized controlled trial. Sci Rep 2023; 13:11849. [PMID: 37481684 PMCID: PMC10363148 DOI: 10.1038/s41598-023-39086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/20/2023] [Indexed: 07/24/2023] Open
Abstract
Various airway techniques have been used in endoscopic esophageal variceal ligation (EVL). In this respect, Jcerity endoscoper airway (JEA) is a novel laryngeal mask airway that is designed for use in gastrointestinal endoscopy. In the present study, 164 patients who underwent EVL were randomly divided into JEA group or endotracheal tube (ETT) group (ratio: 1:1). Success rate of endoscopic procedure, endoscope insertion time, procedure duration, recovery time, airway technique extubation time, anesthesia costs, hospital stay duration, complications, and hemodynamic parameters were recorded. The success rate of EVL in the JEA group was noninferior to that in the ETT group (98.8% vs. 100.0%). The airway insertion time, anesthesia duration, and recovery time were significantly shorter in the JEA group than in the ETT group (p < 0.001). Furthermore, the blood pressure during extubation was more stable in the JEA group (p < 0.001). Moreover, there were less heart rate variations during intubation (p < 0.005) and extubation (p < 0.05) in the JEA group. Nonetheless, the endoscopists' satisfaction scores were comparable between the two groups. Overall, our findings suggest that JEA is efficient and safe for clinical use in EVL.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000031892, Registered April 13, 2020, https://www.chictr.org.cn/searchproj.html .
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Affiliation(s)
- Le Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Lu Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Jun Wang
- Department of Operation Room, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Can Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Erxian Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Yanrong Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China
| | - Yunqi Lv
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou, 450052, Henan, China.
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Gupta A, Subramaniam R, Rathod PR, Agha M. Gastrointestinal endoscopy procedures under intravenous sedation in the prone position: keep LMA gastro handy! J Clin Monit Comput 2023; 37:715-716. [PMID: 36074225 DOI: 10.1007/s10877-022-00912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Gastrointestinal endoscopies are often done in the prone position and anesthesiologists are needed to provide sedation. Airway access is limited in the prone position and may make timely airway management difficult in case of airway obstruction during sedation. Specialized laryngeal mask airway devices customized for endoscopy procedures like LMA® Gastro™ can be inserted in the prone position and may help anesthesiologists tide over such crisis situations while simultaneously allowing the endoscopy procedures through the dedicated conduit available for inserting the endoscopes. We have described one such case managed successfully by inserting LMA® Gastro™ in the prone position.
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Affiliation(s)
- Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pyarelal R Rathod
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Mussavvir Agha
- Department of Anaesthesiology, Pain Medicine and Critical care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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SejalParmar. Abstract No. : ABS1275: Efficacy of novel dual channel LMAGastro™ with colour coded pressure gauge in day care GI endoscopy procedures. Indian J Anaesth 2022. [PMCID: PMC9116744 DOI: 10.4103/0019-5049.340711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background &Aims: The aims and objectives were to evaluate the utility ofGastro™Laryngealmaskairway(LMA) for gastrointestinal(GI)endoscopic procedures for improvement of airway control, to prevent hypoxia andto avoid intubation. Methods: A prospective randomised observational study was conducted in 50 patients, 25 in each group for elective GI endoscopy procedures.Group G : LMA Gastro Group N : Nasal Cannula .All were observed for intraoperative hypoxia/any adverse events/endotracheal intubation. Inclusion criteriawere 18 -60 years, AmericanSocietyofAnesthesiologists(ASA) gradel,ll,lll,ModifiedMallampatiscorEclassIandII,supine/lateral position, Day care,,fasting. Exclusion criteriawere emergency procedure,notnil by mouth,prone position, pregnant and lactating females. Results: 50 patients of ASAI,IIand III undergoing GI endoscopic procedure were divided into two groups. Gastro LMA and nasal prong groups;each having 25 patients. In Gastro™ LMA group, 1 patient (4%) required endotracheal intubation and in nasal prong group, 2 patients (8%) required endotracheal intubation. No postoperative complication was noted in any of the two groups. Conclusion: LMA Gastro™ airway is auser friendly device for the gastro physician and anaesthesiologists. It isa useful airway management tool for clinical use in day care GIendoscopic procedures.
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Zilberman P, Davidovics Z, Benson A. A bench test of a modified gastro LMA for the insertion of the duodenoscope. Indian J Anaesth 2022; 66:159-160. [PMID: 35359468 PMCID: PMC8963231 DOI: 10.4103/ija.ija_179_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/14/2021] [Accepted: 08/26/2021] [Indexed: 12/04/2022] Open
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Gupta N, Gupta A. Comment on: A bench test of a modified gastro LMA for the insertion of the duodenoscope. Indian J Anaesth 2022; 66:546. [PMID: 36111087 PMCID: PMC9468991 DOI: 10.4103/ija.ija_232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022] Open
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Singh Bajwa S, Gowd U, Kurdi M, Sindwani G. In pursuit of the right plan for airway management in gastrointestinal endoscopic procedures…the battle half won? Indian J Anaesth 2022; 66:683-686. [PMID: 36437973 PMCID: PMC9698298 DOI: 10.4103/ija.ija_846_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
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Finlay JE, Leslie K. Sedation/analgesia techniques for nonoperating room anesthesia: new drugs and devices. Curr Opin Anaesthesiol 2021; 34:678-682. [PMID: 34419992 DOI: 10.1097/aco.0000000000001057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review new drugs and devices for nonoperating room anesthesia (NORA). RECENT FINDINGS Remimazolam is an ultra-short-acting, water-soluble intravenous benzodiazepine with a fast onset and offset that has been approved recently for use in procedural sedation. Phase III trials have established the effectiveness of remimazolam sedation compared with placebo and midazolam in gastrointestinal endoscopy and bronchoscopy. More research is required investigating remimazolam in real-world NORA settings, including comparisons with propofol sedation. Oliceridine is a μ-agonist with selectivity for the G protein pathway and low potency for β-arrestin recruitment. As such it may be associated with less nausea, vomiting and respiratory depression than traditional opioids used. Although no studies have been published about oliceridine use in NORA to date, results from surgical studies indicate a potential place in nonoperating room practice. Research continues into alternative methods of drug delivery, such as patient-controlled sedation but no new devices are described. SUMMARY Further studies are required before these new drugs and devices are embraced in NORA.
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Affiliation(s)
- Janna E Finlay
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
| | - Kate Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Uysal H, Senturk H, Calim M, Daskaya H, Guney IA, Karaaslan K. Comparison of LMA® gastro airway and gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography: a prospective randomized observational trial. Minerva Anestesiol 2021; 87:987-996. [PMID: 33982986 DOI: 10.23736/s0375-9393.21.15371-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND New generation airway devices with different designs have been developed as an alternative to endotracheal intubation in order to avoid adverse events associated with sedation in endoscopic procedures and to provide patent airway. We aimed to compare two supraglottic airway devices (SGADs), the LMA®GastroTM Airway and Gastro Laryngeal Tube (GLT), in terms of airway efficiency, performance during procedure and adverse events in Endoscopic Retrograde Cholangiopancreatography (ERCP). METHODS A hundred-three ERCP patients without high risk of aspiration were included. Patients were randomly allocated to the LMA Gastro and GLT groups. The primary study outcomes were the comparison of the two SGADs in terms of oropharyngeal leak pressure (OLP). Secondary study outcome was SGADs-related adverse events. RESULTS Procedures were completed with SGADs in fifty patients in each group. The rate of successful insertion at first attempt was 72% in GLT and 96% in LMA Gastro (p=0.004). The mean OLP of LMA Gastro Group (31.8cm H2O) was significantly higher than that of the GLT Group (26.5cm H2O), (p=0.0001). However endoscopists' satisfaction was higher in GLT (p=0.0001). Mucosal damage and sore throat were lower in LMA Gastro Group. CONCLUSIONS LMA® Gastro™ had a higher OLP than GLT. However, GLT was better for endoscopist satisfaction, as it provides more satisfying maneuverability. As to secondary outcome advers events were lower in LMA® Gastro™. The lower complication rates associated with the device and providing a more patent airway also highlighted the apparent clinical efficacy of LMA® Gastro™ than GLT, in ERCP.
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Affiliation(s)
- Harun Uysal
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey -
| | - Hakan Senturk
- Department of Gastroenterology and Hepatology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Ibrahim A Guney
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Kazim Karaaslan
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
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Taylor CL, Wilson SR, Burgoyne LL, Endlich Y. LMA® Gastro™: A paediatric experience. Anaesth Intensive Care 2021; 49:119-124. [PMID: 33853390 DOI: 10.1177/0310057x20981591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The laryngeal mask airway, the LMA® Gastro™ (Teleflex Medical, Athlone, Ireland), is a novel airway device which permits upper gastrointestinal (GI) endoscopy to be performed via a dedicated large calibre oesophageal lumen. It has been validated in adult studies, but to our knowledge, there have been no data published regarding its use in a paediatric population. Following a brief education programme, the LMA Gastro was introduced on a trial basis at our institution and made freely available. Over a four-month period, our pre-existing endoscopy audit framework captured data on a total of 55 patients who had the LMA Gastro device chosen as the primary airway for elective upper GI endoscopy. These data were collected prospectively by the treating anaesthetist and included a range of airway and endoscopy outcomes. Of the 55 patients, the LMA Gastro provided an adequate airway in 52 (94.5%). Forty-six (88.5%) were sited on first attempt, and 50 (96.2%) insertions were rated 'easy' by the anaesthetist. Aside from three insertion failures, there were no airway events. The endoscopy success rate was 100% in the 52 patients who had an LMA Gastro airway successfully inserted. First-pass oesophageal access was achieved in 51 (98%) cases, and 100% of insertions were rated 'easy' by the gastroenterologist. Despite our relative inexperience with it, the device had a high success rate for airway maintenance and oesophageal access in our paediatric patient population. In our institution, the LMA Gastro provided a useful airway option in older children undergoing elective upper GI endoscopy.
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Affiliation(s)
- Charlotte L Taylor
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia.,Department of Anaesthesia, Flinders Medical Centre, Adelaide, Australia
| | - Steven R Wilson
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia.,Department of Anaesthesia, Flinders Medical Centre, Adelaide, Australia
| | - Laura L Burgoyne
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia
| | - Yasmin Endlich
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia.,Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, Australia
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Liu X, Cao H, Tan X, Qiao L, Zhang Q, Shi L. Comparison of the Effect of Laryngeal Mask Airway Versus Endotracheal Tube on Airway Management in Pediatric Patients with Tonsillar Hypertrophy. J Perianesth Nurs 2020; 36:142-146. [PMID: 33168406 DOI: 10.1016/j.jopan.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The laryngeal mask airway (LMA) has become an important choice in both routine and difficult airway management. We aimed to evaluate the safety and effectiveness of LMA use in pediatric patients with tonsillar hypertrophy. DESIGN This study was a randomized controlled trial. METHODS The study included 100 pediatric patients who had first or second degree tonsillar hypertrophy. Pediatric patients undergoing elective laparoscopic inguinal hernia repair were randomly divided into two groups (n = 50): LMA group and the endotracheal tube (ETT) group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (PETco2). Data for primary outcomes were collected before and 5-, 15-, and 25-minute after opening pneumoperitoneum, and on closing the pneumoperitoneum. Complications such as laryngospasm, bronchospasm, desaturation, severe coughing, blood on the device after removal, and sore throat were recorded. FINDINGS A total of 100 pediatric patients were assessed and 97 eligible patients were randomly assigned to receive an LMA (n = 49) or an ETT (n = 48). There was no statistically significant difference in ventilation leak volume and PETco2 between the LMA and ETT groups (P > .05). Compared with T1-4, peak airway pressure was significantly lower in T0 (LMA group 12.6 ± 0.9, 95% confidence interval 12.2 to 13.0; ETT group 12.8 ± 1.2, 95% confidence interval 12.2 to 13.3; P < .05). The incidences of laryngospasm 11 (22.9%), desaturation 18 (37.5%), and severe coughing 13 (27%) were higher in the ETT group (11 [22.9%] vs 3 [6.1%], 18 [37.5%] vs 6 [12.2%], 13 [27%] vs 3 [6.1%]; P < .05). CONCLUSIONS The application of LMA has a lower incidence of complications. LMA as an airway device is effective and perhaps superior in appropriate patients.
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Affiliation(s)
- Xiang Liu
- Department of Operating Room and Anesthesiology, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Hongyan Cao
- Department of Operating Room and Anesthesiology, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xiaona Tan
- Department of Neurological Rehabilitation, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Li Qiao
- Department of Operating Room and Anesthesiology, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Qi Zhang
- Department of Operating Room and Anesthesiology, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Lei Shi
- Department of Operating Room and Anesthesiology, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China.
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Hakim M, Bryant J, Miketic R, Williams K, Erdman SH, Shafy SZ, Kim SS, Tobias JD. Clinical Outcomes of a Modified Laryngeal Mask Airway (LMA ® Gastro™ Airway) During Esophagogastroduodenoscopy in Children and Adolescents: A Randomized Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:277-282. [PMID: 33061677 PMCID: PMC7518770 DOI: 10.2147/mder.s272557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction During esophagogastroduodenoscopy (EGD), general anesthesia (GA) may be provided using a laryngeal mask airway (LMA) with the endoscope inserted behind the cuff of the LMA into the esophagus. Passage of the endoscope may increase the intracuff of the LMA. We evaluated a newly designed LMA (LMA® Gastro™ Airway) which has an internal channel exiting from its distal end to facilitate EGD. The current study compared the change of LMA cuff pressure between this new LMA and a standard clinical LMA (Ambu® AuraOnce™) during EGD. Methods Patients less than 21 years of age and weighing more than 30 kg were randomized to receive airway management with one of the two LMAs during EGD. After anesthetic induction and successful LMA placement, the intracuff pressure of the LMAs was continuously monitored during the procedure. The primary outcome was the change of intracuff pressure of the LMAs. Results The study cohort included 200 patients (mean age 13.6 years and weight 56.6 kg) who were randomized to the LMA® Gastro™ Airway (n=100) or the Ambu® AuraOnce™ LMA (n=100). Average intracuff pressures during the study period (before and after endoscope insertion) were not different between the two LMAs. Ease of the procedure was slightly improved with the LMA® Gastro™ Airway (p<0.001). Discussion The LMA® Gastro™ Airway blunted, but did not prevent an increase in intracuff pressure during EGD when compared to the Ambu® AuraOnce™ LMA. Throat soreness was generally low, and complications were infrequent in both groups. The ease of the procedure was slightly improved with the LMA® Gastro™ Airway compared to the Ambu® AuraOnce™ LMA.
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Affiliation(s)
- Mohammed Hakim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Bryant
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
| | - Renata Miketic
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
| | - Kent Williams
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
| | - Steven H Erdman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA
| | - Shabana Z Shafy
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Stephani S Kim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA
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