Comparison of I-gel and Laryngeal mask airway (LMA) Supreme during laparoscopic Gynecological procedure

Background: The I-gel is a latex-free SAD that has a non-inflatable cuff and medical-grade thermoplastic elastomer. The design allows for a more close interaction when engaging with supraglottic tissue. The goal of the present prospective study was to compare the performance of the I-gel with that of the LMA-Supreme. Methods: The present prospective study was conducted on 100 adult patients with age between 18 to 60 years with American Society of Anesthesiologists (ASA) physical status I or II who were scheduled to undergo elective laparoscopic Gynecological procedure under general anesthesia were included in the study. Patient having gastric reflux, Obesity (BMI >30kg/m2), cervical spine disease or difficult airway were excluded from the study. The study was conducted after obtaining approval from the Institutional Review Board. A written informed consent for participation in the study was obtained from each patient. Results: The mean time for insertion in the Group SLMA was 29 sec which was significantly more as compared to 21 sec in Group I-gel (p<0.0001). 84% cases from the Group I-gel had ease of insertion which was significantly more as compared to 82% among the Group SLMA. There was no significant difference in the incidence of postoperative complications between the groups (p>0.05). Conclusion: In conclusion, both devices were similarly successful ventilatory devices for gynaecological laparoscopic procedures in terms of ease of insertion, first-time success rates, time to insertion, and oropharyngeal leak pressure

COMPARISON OF TWO SECOND GENERATION SUPRAGLOTTIC AIRWAY DEVICES I-GEL VERSUS LMA PROSEAL IN PATIENTS UNDERGOING ELECTIVE SURGERIES.

INTRODUCTION:Management of airway is one of the primary responsibilities of anesthesiologist1.Supraglottic airway devices have become a standard fixture in airway management, filling aniche between the face mask and tracheal tube in terms of both anatomical position anddegree of invasiveness. They have separate gastric channel to reduce regurgitation &pulmonary aspiration2.Proseal LMA has unique double cuff arrangement, main cuff is inflated to seal the laryngealopening and additional pharyngeal cuff helps to improve the airway seal which make thePLMA ideal for positive pressure ventilation. ‘I-gel’ is a non-inflatable supraglottic airwaydevice designed to avoid compression trauma.Objectives of the study were Quality of insertion, Complications duringinsertion, Quality of airway sealing, Analysis of hemodynamic parameters, Postoperative complications.METHODS: Total 60 patients were divided in 2 groups: A & B. Airway secured with I-gel& PLMA respectively.Ease of insertion of devices, airway sealing quality score, ease & number of attempts ofgastric tube insertion were noted.RESULTS: I-gel is better than PLMA in term of faster & easy insertion requiring lessmanipulation with low incidence of complications during insertion, less hemodynamic stressresponse and lower postoperative complications.CONCLUSION: Among the second generation supraglottic airway device I-gel is a better &safe alternative to PLMA during elective surgeries

Comparison of Sevoflurane and Propofol for Insertion of I-Gel in Patients Undergoing Minor Elective Surgical Procedures under General Anaesthesia

A popular method of providing anaesthesia for I-Gel insertion is with the use of propofol. However, boluspropofol has been associated with adverse effects such as hypotension, apnea and pain on injection. Hence,time is needed to search an alternative. We aimed to compare the induction characteristics, ease of I-Gelinsertion, hemodynamic changes and complications with inhalation of 8% sevoflurane vital capacity breathand propofol. A prospective randomized study of 60 American Society of Anaesthesiologists’ Grade I and IIpatients was conducted and distributed among two groups with 30 each undergoing minor surgical proceduresunder general anaesthesia. Group P received the injection propofol and Group S received sevoflurane. At theend point of induction, the I-Gel insertion was attempted. Scoring systems were used to grade the conditionsfor insertion of the I-Gel. Induction, I-Gel insertion characteristics and hemodynamic changes were assessed.Data were recorded and analysed. Comparison among the study groups was done with unpaired t-test,Mann–Whitney test and Chi square test. Sevoflurane took a longer time for induction and for I-Gel insertionthan propofol. There was no statistically significant difference between the two groups, with respect to I-Gelinsertion characteristics, heart rate, and mean arterial pressure. It is concluded that sevoflurane is associatedwith good hemodynamic stability and may prove useful in cases where propofol is to be avoided. However,the ease of insertion provided with propofol is better.

A comparative evaluation of I-gel and laryngeal mask airway supreme in laparoscopic surgeries: a randomized comparative study

Background: Supraglottic airway device results in less hemodynamic responses during laparoscopic surgery but supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation as laparoscopic surgery also leads to higher airway pressure. In this study the efficiency of the I-gel with SLMA is compared in patients undergoing laparoscopic cholecystectomy surgeries.Methods: Sixty patients were randomized in to two groups, group A where I-gel was considered for airway management and group B where LMA Supreme was the device chosen for airway management.Results: Oropharyngeal seal pressure was significantly lower in group A than group B, 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in group A than group B. Hemodynamics were comparable between the two groups. Time taken to insert the airway device and Ryle’s tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in group A than group B with no significant (p>0.05) association.Conclusions: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to I-gel group.

A Comparative Study Between I-Gel And Endotracheal Tube For Volume Controlled Ventilation In Patients Undergoing Laparoscopic Cholecystectomy

INTRODUCTION The endotrachealtube is the gold standard for controlling the airway. Laparoscopic procedures mark the new era. However, with various advantages they have their complications. Endotracheal intubation evokes significant hemodynamic changes. We have used I-gel, to find a suitable alternative. The study was conducted to compare haemodynamic changes, efficacy of ventilation, and complications laparoscopic cholecystectomy. MATERIALS AND METHODS: After ethical approval the study was completed with 100 ASA PS I or II patients undergoing elective laparoscopic cholecystectomy. They were randomly allocated into either: Group-I (I-gel) or Group-E (ETT). Ease of insertion of device, haemodynamic and ventilatory parameters and perioperative complications were recorded. RESULTS: Ease of insertion was difficult in Group E compared to Group I. HR variation and MAP variation was highly significant between the groups. Leak Pressures were high throughout in GroupE. Mean Peak Airway Pressure was though higher in I-gel but was less than leak pressure and was clinically acceptable. CONCLUSION: I-gel may be an alternative to endotracheal intubation for laparoscopic cholecystectomy under general anaesthesia for its design, less haemodynamic perturbations and similar efficacy in maintaining oxygenation and ventilation.

A Comparative Study of Airway Management and Hemodynamic Response During Insertion of I-Gel Airway, Laryngeal Mask Airway, Cuffed Endo-Tracheal Tube

Securing a safe airway is essential for oxygenation and ventilation in management of critical patients in all specialities and during conduction of anaesthesia. Endotracheal tubes has been the mainstay for airway control. Hence need for various devices to secure airway was realized, leading to development of many supraglottic devices. Methods: This prospective, randomized study was conducted in a tertiary care teaching hospital. It included 90 American Society of Anesthesiologists (ASA) grade I-II patients, randomly allocated into 3 groups, undergoing elective surgical procedures under general anaesthesia. It was designed to compare cETT, cLMA and i-gel LMA. Primary outcome measure was number of insertion attempts. We also compared ease of insertion, insertion time, haemodynamic changes and incidences of airway trauma and complications. For statistical comparison pearson's chi-square test for nominal data, ANOVA test for comparison between multiple variables within the study and control groups and unpaired t-test to compare numerical variables were used. Results: The First attempt insertion success and ease of insertion for the three devices were comparable, with i-gel scoring the highest among all. Mean time of insertion was lowest for i-gel (16.83s±3.49s) followed by cLMA (25.23±5.46s) and cuffed ETT (27.6±4.3s), which was statistically significant. The basal vitals with respect to heart rate, systolic, diastolic and mean blood pressure were comparable in all the three groups. Conclusion: It may be concluded that use of i-gel airway offers more favourable hemodynamic stability as compared to endotracheal tube and cLMA and is associated with less postoperative complication.

A study of clinical findings among newly diagnosed TB patients who are diagnosed diabetics under medications

Background: Tuberculosis remains a leading cause of death globally. In 2014 there were an estimated 12.8 million new cases of tuberculosis worldwide. The incidence of tuberculosis is greatest among those with conditions impairing immunity such as HIV infection and diabetes. Type 2 Diabetes mellitus amongst Indians occur a decade earlier when compared to the western population. Indians have more abdominal obesity and the waist-hip ratio. Aim of the study: Clinical findings Among Newly Diagnosed Tb Patients who are diagnosed Diabetics under Medications. Materials and methods: 100 cases of newly diagnosed sputum positive pulmonary tuberculosis with diabetes were fitting the inclusion criteria admitted over the period of 2 years from 2016-2017. Subjects were selected from medicine ward, pulmonology ward andTuberculosis ward under DTC. The diagnosis of Pulmonary tuberculosis was made with clinical presentation and verification by detection of acid-fast bacilli under a microscope. Results: Among the study population, 33(33.00%) were smokers, 38 (38.00%) were alcoholics and 9 (9.00%) were habituated to pan chewing. Among the study population, 53 (53.00%) had dyspnoea, 41 (41.00%) had chest pain, 66(66.00%) had a loss of appetite, 60 (60.00%) had an evening rise of temperature, 81(81.00%) had a loss of weight, 32 (32.00%) had hemoptysis, 78(78.00%) had a cough. Conclusion: DM was associated with more symptoms but not with increased severity of TB and had a negative effect on the outcome of anti-TB treatment. The findings of this study underline the need to improve the care of patients with concomitant DM and TB, especially in developing countries. Therefore, we advocate screening patients with TB for DM, especially those aged >35 years. Vijayaraju, J.A. Elanchezhian. A study of clinical findings among newly diagnosed TB patients who are diagnosed diabetics under medications. IAIM, 2019; 6(2): 96-101. Page 97 Prospective studies are needed to determine the effects of tighter glycemic control on TB treatment and outcome.

A comparative study of I-gel and LMA fastrach as a conduit for blind endotracheal intubation

Background: The most important duty of an anesthesiologist is to protect the patient‟s airway and to provide adequate ventilation. The anesthesiologist should be skilled enough to make decisions at the circumstances of difficult intubations. We compared the success rate of blind tracheal intubation through two different supraglottic airway devices, I-GEL and ILMA using PVC endotracheal tube. We studied the complications in both the techniques. The aim of the study: To compare the advanced I-GEL, to ILMA as a conduit for blind endotracheal intubation for patients posted for elective procedures under general anesthesia. Materials and methods: A Prospective randomized study was conducted in 80 adult patients who undergone elective surgery under general anesthesia. They were divided into 2 groups- each group included 40 patients. Group A - I-GEL, Group B- ILMA. We noted the Ease of insertion, Duration of successful attempts, No. of failed attempts, Total intubation time and First attempt success rate. We recorded Heart rate, Blood pressure, Pulse oximetry, EtCO2 and Complications of I-gel and ILMA insertion. Results: Supraglottic device insertion time (15.62s vs 17.17s) and Supraglottic device removal time (15.82s vs 16.55s) were the least I-GEL group. The first attempt success rate for tracheal intubation (87.5% vs 60%) and Success rate for insertion (95% vs 72.5%) were high in the ILMA group. There was no statistical difference in Total intubation time, Complications, Hemodynamic response to intubation, No. of attempts for supraglottic device insertion and Time for first attempt tracheal intubation. Ebenezer Joel Kumar E, Bridgit Merlin J, Anu Asheetha R. A comparative study of I-gel and LMA fastrach as a conduit for blind endotracheal intubation. IAIM, 2019; 6(2): 87-95. Page 88 Conclusion: We concluded I-GEL aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

A comparison of clinical performance between i-gel and endotracheal tube in pediatric laparoscopic surgeries

BACKGROUND: The current evidence on the safe use of supraglottic airway for pediatric laparoscopic surgeries is limited. Although i-gel has been successfully used in adult laparoscopic surgeries, to our knowledge, no studies have compared it to the endotracheal tube (ETT) in pediatric laparoscopic surgeries. This study evaluated the effectiveness of i-gel over ETT with regards to the respiratory and hemodynamic parameters during pediatric laparoscopic surgeries. METHODS: A total of 60 pediatric patients undergoing elective laparoscopic surgeries were randomly allocated to either the i-gel or ETT groups. Anesthetics used included ketamine, sevoflurane, and rocuronium. The primary outcome measured was the peak airway pressure (PAP) and the secondary outcomes measured were leak fraction, end-tidal CO₂, respiratory rate, insertion time, heart rate, blood pressure and perioperative complications. RESULTS: The PAP during surgeries was higher in the ETT group than in the i-gel group. There were no statistically significant differences in the leak fraction, end-tidal CO₂, and respiratory rate. The i-gel group had a shorter insertion time compared with the ETT group. The changes in heart rate were comparable in both groups. However, systolic and diastolic pressures were higher in the ETT group following intubation, before and after the creation of pneumoperitoneum. The incidence of perioperative complications was similar in both groups. CONCLUSIONS: The i-gel provided adequate ventilation with lower PAP compared with ETT. In addition, it provided minimal hemodynamic changes compared with ETT. Therefore, the i-gel may provide a suitable alternative to ETT in pediatric laparoscopic surgeries.

A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy

Background and Aims: Baska mask is a newly introduced membranous cuffed supraglottic device whereas I-gel is made up of thermoplastic elastomer, both suitably designed from the anatomical perspective of the airway. Settings and Design: We conducted randomized controlled comparative trial of the Baska mask versus I-gel in a patient undergoing laparoscopic cholecystectomy. Subjects and Methods: A total of 100 adult patients in the age group of 20–70 years undergoing elective laparoscopic cholecystectomy were randomly divided into two groups as follows: (1) Baska mask group and (2) I-gel group. The primary outcome was to compare oropharyngeal leak pressure (OLP) of Baska mask and I-gel groups. The secondary outcome was the ease of insertion and removal, number of attempts, insertion time, leak fraction, and laryngopharyngeal morbidity. Statistical Analysis Used: Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Mean OLP was significantly higher in Baska mask group than I-gel group at insertion (29.54 ± 1.41 cm H2O vs. 23.16 ± 3.07 cm H2O, P = 0.02) and 30 min after insertion (33.54 ± 1.16 cm H2O vs. 25.97 ± 2.25 cm H2O, P = 0.001). Insertion time was 12.33 ± 2.61 s with Baska mask and 11.31 ± 1.84 s with I-gel (P = 0.02). Insertion was very easy in 58% of patients in Baska mask and 76% of patients in I-gel (P = 0.03). The leak fraction of Baska mask was significantly less than I-gel (3.56 ± 3.6 vs. 7.16 ± 2.45, P = 0.01). Laryngopharyngeal morbidity was comparable in the two groups. Conclusion: Baska mask is more effective in providing greater OLP compared to I-gel without any increase in laryngopharyngeal morbidity.

Comparison of I-gel and ProSeal laryngeal mask airway during volume controlled ventilation

Introduction: I-gel and the ProSeal laryngeal mask airway (PLMA) are two supra-glottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of I-gel compared with PLMA for airway maintenance in patients under general anesthesia with controlled ventilation. The aim of the study: To compare the supra-glottic airway devices, I-Gel and ProSeal Laryngeal mask airway with respect to Ease of insertion, Time taken for insertion, Airway leak pressure, Hemodynamic response during intubation. Materials and methods: A total number of, 40 patients were randomized into two groups of 20 each. After induction of anesthesia using a standardized protocol for all the patients, one of the supra-glottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion, airway leak pressure, hemodynamic changes, were noted. Results: There was no significant difference in the incidence of adverse effects in both the groups. One incidence of airway trauma was noted in I-gel group. No gastric insufflations and laryngo or bronchospasm in both groups. Conclusion: Based on the result of our study we conclude that I-gel had an acceptable airway leak pressure of 23 cm H2O when compared to ProSeal whose airway leak pressure is significantly higher i-e 29 cm H2O.Both the devices provided optimal oxygenation and no fall in saturation was observed in both the groups.

Optimal propofol dosage for i-gel® insertion in healthy paralyzed patients / 대한마취과학회지

BACKGROUND: Propofol is used for supraglottic airway device insertion, often with the i-gel. However, the propofol requirement for i-gel insertion has not been explored in paralyzed patients. This study was performed to explore hemodynamic changes and sedation level with different propofol doses in healthy paralyzed patients when the i-gel was inserted. METHODS: A total of 141 patients undergoing a urologic operation were randomly allocated to three groups depending on the propofol dose (1.5, 2, and 2.5 mg/kg; Groups P1.5, P2, and P2.5, respectively). After patients had been administered each propofol dose and rocuronium, the i-gel was inserted and changes in hemodynamic parameters and bispectral index were evaluated. RESULTS: Group P2 showed a lower incidence of complications (17%) such as hemodynamic instability and inadequate sedation than Group P1.5 (55.3%, P < 0.001) or Group P2.5 (40.4%, P = 0.012). The incidence and dose of additional propofol increased in Group P1.5 (51%, median [range]; 20 [0–50]) compared with those in the other groups (0%, 0 [0–0] in Group P2 and 8.5%, 0 [0–50] in Group P2.5, all P < 0.001), and the incidence and dose of additional ephedrine were significantly higher in Group P2.5 (31.9%; 0 [0–20]) than in Group P1.5 (10.6%, P = 0.012; 0 [0–5], P = 0.007, respectively). CONCLUSIONS: For the stable maintenance of hemodynamic parameters and proper sedation level during i-gel insertion, 2 mg/kg propofol has an advantage over 1.5 mg/kg or 2.5 mg/kg propofol in healthy paralyzed patients.

A comparison of i-gel™ and Laryngeal Mask Airway Supreme™ during general anesthesia in infants / 대한마취과학회지

BACKGROUND: The i-gel™ (i-gel) and Laryngeal Mask Airway Supreme™ (LMA Supreme) have been safely used in children. We compared the airway performance of the i-gel and LMA Supreme in infants undergoing general anesthesia. METHODS: Sixty infants with American Society of Anesthesiologists physical status I or II were randomly assigned to place either the i-gel or the LMA Supreme. The size 1 or 1.5 of each airway was selected by the weight of infants. The primary outcome variable was oropharyngeal leak pressure (OLP). We also assessed insertion success rate, insertion time, fiberoptic view of the larynx, airway quality, airway manipulations, and perioperative complications. RESULTS: Demographic data did not differ between the two groups. Insertion success rate was similar in both groups. OLP for the i-gel (26.0 ± 3.8 cmH2O) was higher than for the LMA Supreme (23.7 ± 3.2 cmH2O) (P = 0.016). Insertion time for the i-gel (16.4 ± 2.8 s) was shorter than for the LMA Supreme (18.5 ± 2.7 s) (P = 0.002). There were no differences in fiberoptic view of the larynx, airway quality, airway manipulations, and complications between the two groups. CONCLUSIONS: This study demonstrated that the i-gel and LMA Supreme provided a similar performance of airway in infants. Compared with the LMA Supreme, the i-gel provided shorter insertion time and higher OLP in infants.

Application of I-gel laryngeal mask airway in EBUS-TBNA performed under intravenous anesthesia / 中国内镜杂志

Objective To seek better anesthesia management methods for clinical applications guidance by retrospectively analyze the clinical effects of I-gel laryngeal mask for endobronchial ultrasound-guided transbronchial needleaspiration (EBUS-TBNA) performed under local and intravenous anesthesia modes. Methods Review the differences in the operative time, the number of SpO2 <95%, body motion, cough, laryngospasm, nausea, surgical puncture, operator suspension, postoperative throat discomfort, and satisfaction scores among the patient, the operator and the anesthetist between the two kinds of anesthesia of 60 patients for EBUS-TBNA in 3 years from 2013 to 2016. Results From June 2014, patients with I-gel laryngeal mask for EBUS-TBNA under intravenous anesthesia had fewer cough, nausea, physical activity, shorter operative time, and higher anesthesia satisfaction scores. Conclusion The perioperative management method of I-gel laryngeal mask for EBUS-TBNA in intravenous anesthesia is more secure and more feasible, recommended for clinical use.

Application of I-gel laryngeal mask airway in general anesthesia for laparoscopic surgery in neonates / 实用医学杂志

Objective To evaluate the effect of I-gel laryngeal mask airway in general anesthesia for lapa-roscopic surgery in neonates. Methods 40 neonates to undergo neonatal laparoscopic surgery were divided into I-gel laryngeal mask group(group I)and tracheal intubation group(group E)randomly,20 in each group. After the induction of anesthesia,I-gel laryngeal mask(size 4 each)was used for ventilation in Group I,and tracheal intu-bation with ID(3.0 or 3.5 mm)was performed for ventilation in group E. The two groups were compared in terms of intubation duration,success rate,the hemodynamic parameters like mean arterial pressure (MAP),heart rate (HR)and plus oxygen saturation(SpO2)at each time point.,the end-tidal carbon dioxide pressure(PETCO2), peak airway pressure (Ppeak),the airway sealing pressure (Pleak),and the postoperative complications. Results There was no significant difference between the two groups in the success rate of intubation (laryngeal mask). However,the duration required for laryngeal mask insertion in I group was significantly shorter than that in E group(P<0.01). MAP and HR were significantly lower than group E at the time point of T1(P<0.05). Pleak in group I was significantly lower than E group at the time points of T1 ~ T3(P < 0.01). The adverse reactions was significantly lower than that in the E group (P < 0.05). There was no reflux aspiration in both groups. Conclusion I-gel laryngeal mask airway can achieve the same effect as tracheal intubation does for general anes-thesia during laparoscopic surgery. It is easy to operate ,with high success rate and few complications.

Application of I-gel laryngeal mask airway in general anesthesia for laparoscopic surgery in neonates / 实用医学杂志

Objective To evaluate the effect of I-gel laryngeal mask airway in general anesthesia for lapa-roscopic surgery in neonates. Methods 40 neonates to undergo neonatal laparoscopic surgery were divided into I-gel laryngeal mask group(group I)and tracheal intubation group(group E)randomly,20 in each group. After the induction of anesthesia,I-gel laryngeal mask(size 4 each)was used for ventilation in Group I,and tracheal intu-bation with ID(3.0 or 3.5 mm)was performed for ventilation in group E. The two groups were compared in terms of intubation duration,success rate,the hemodynamic parameters like mean arterial pressure (MAP),heart rate (HR)and plus oxygen saturation(SpO2)at each time point.,the end-tidal carbon dioxide pressure(PETCO2), peak airway pressure (Ppeak),the airway sealing pressure (Pleak),and the postoperative complications. Results There was no significant difference between the two groups in the success rate of intubation (laryngeal mask). However,the duration required for laryngeal mask insertion in I group was significantly shorter than that in E group(P<0.01). MAP and HR were significantly lower than group E at the time point of T1(P<0.05). Pleak in group I was significantly lower than E group at the time points of T1 ~ T3(P < 0.01). The adverse reactions was significantly lower than that in the E group (P < 0.05). There was no reflux aspiration in both groups. Conclusion I-gel laryngeal mask airway can achieve the same effect as tracheal intubation does for general anes-thesia during laparoscopic surgery. It is easy to operate ,with high success rate and few complications.

Aphonia after shoulder surgery: case report / Afonia após cirurgia do ombro: relato de caso

ABSTRACT In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site.

RESUMO Relativamente a este relato de caso destacamos a sua singularidade, uma vez que não se encontram descritos na literatura, tanto ou quanto os autores puderam investigar, casos de afonia após uma anestesia combinada com bloqueio do plexo braquial via interescalénica (BPBI). Embora a rouquidão seja uma complicação frequente do BPBI, a afonia não o é. Desse modo, pensamos ser importante dar a conhecer o primeiro caso de afonia após o BPBI, que na opinião dos autores surgiu apenas por causa de uma lesão crônica do nervo laríngeo recorrente contralateral ao local do BPBI.

Pressure support ventilation with the I-gel in intensive care unit: case report / Ventilação controlada por pressão com I-gel em unidade de terapia intensiva: relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The I-gel supraglottic airway has a non-inflatable cuff made from a gel-like thermoplastic elastomer. The use of the I-gel during anesthesia for spontaneously breathing patients or intermittent positive pressure ventilation has been reported. But there are a few published reports about the use of the I-gel with pressure-controlled ventilation. CONTENTS AND CONCLUSIONS: In this case report we described the use of the I-gel supraglottic airway along 48 h in intensive care unit for the management of ventilation in a patient needed mechanic ventilation but in whom tracheal intubation could not be performed.

RESUMO JUSTIFICATIVA E OBJETIVOS: O dispositivo supraglótico I-gel para o manejo das vias aéreas tem um manguito não insuflável feito de um elastômero termoplástico semelhante ao gel. Há relato sobre o uso do I-gel em pacientes sob anestesia para a ventilação, espontânea ou com pressão positiva intermitente. Porém, há poucos relatos publicados sobre o uso do I-gel com ventilação controlada por pressão. CONTEÚDO E CONCLUSÕES: Descrevemos neste relato de caso o uso do dispositivo supraglótico I-gel durante 48 horas em unidade de terapia intensiva para o manejo das vias aéreas em paciente que precisou de ventilação mecânica, mas no qual a intubação traqueal não pôde ser feita.

The association between thenar eminence and I-gel(tm) dimensions in paediatric patients / Associação entre as dimensões da eminência tênar e I-gel(tm) em pacientes pediátricos

ABSTRACT OBJECTIVES: A practical anatomic landmark may be helpful to perform the appropriate size of the airway devices easily in paediatric patients. The aim of this study was to investigate the association between thenar eminence and I-gel dimensions in children. METHODS: After Institutional Ethics Committee approval, two hundred and seventy ASA Class I-II patients between 0 and 12 years old, who were scheduled for elective procedures under general anaesthesia not requiring tracheal intubation, were recruited to the study. The size of the I-gel selected was based on the patient's body weight according to the manufacturer's recommendation. After successful insertion of the I-gel, thenar eminence dimensions were determined. Long-axis (Th-l) was measured from junction point of the thumb to wrist curl and short-axis (Th-w) constitutes the largest portion of the thenar eminence from lateral end of the thumb to the first hand line. The manufacturer's dimensions of the I-gel which was inserted into the patients were compared with the measurements obtained from thenar eminence. RESULTS: The mean (SD) values for (Ig-w) and (Ig-l) were 2.98 cm (0.53) and 4.54 cm (0.82), and the mean (SD) values for (Th-w) and (Th-l) were 2.99 cm (0.60) and 3.88 cm (0.93), respectively. There was a statistically significant correlation between Th-w and Ig-w (r = 0.794,p < 0.001), and between Th-l and Ig-l (r = 0.820, p < 0.001). CONCLUSION: The dimensions of thenar eminence were fitted to that of the weight based size of I-gel and this anatomic landmark may be a practical tool to assess appropriate size for paediatric patients.

RESUMO OBJETIVOS: Uma referência anatômica prática pode ser útil para determinar o tamanho adequado dos dispositivos para vias aéreas em pacientes pediátricos. O objetivo deste estudo foi investigar a associação entre as dimensões da eminência tênar e do dispositivo I-gel em crianças. MÉTODOS: Após aprovação do Comitê de Ética Institucional, 270 pacientes com estado físico ASA I-II, entre 0-12 anos, programados para cirurgias eletivas sob anestesia geral, sem necessidade de intubação traqueal, foram recrutados para o estudo. A escolha do tamanho do I-gel foi baseada no peso corporal do paciente, de acordo com a recomendação do fabricante. Após a inserção bem-sucedida do I-gel, a dimensão da eminência tênar era determinada. O eixo longo (Th-l) foi medido do ponto de junção do polegar ao vinco do pulso e o eixo curto (Th-w) constitui a maior parte da eminência tênar da extremidade lateral do polegar à primeira linha da mão. As dimensões de fábrica do I-gel inserido no paciente foram comparadas com as dimensões obtidas a partir da eminência tênar. RESULTADOS: As médias (DP) dos valores para (Ig-w) e (Ig-l) foram 2,98 cm (0,53) e 4,54 cm (0,82) e as médias (DP) dos valores para (Th-w) e (TH l) foram 2,99 cm (0,60) e 3,88 cm (0,93), respectivamente. Houve uma correlação estatisticamente significativa entre Th-w e Ig-w (r = 0,794, p < 0,001) e entre Th-l e Ig-l (r = 0,820, p < 0,001). CONCLUSÃO: As dimensões da eminência tênar foram ajustadas àquelas do tamanho do I-gel baseado no peso e essa referência anatômica pode ser uma ferramenta prática para avaliar o tamanho apropriado em pacientes pediátricos.

A Comparison Of Ease Of Insertion AndWorking Performance Of Pro-seal And I Gel - The Supra Glottic Airway Devices In Elective Surgeries.

Background: PLMA has improved features of cuff design and incorporation of gastric drain channel led to better seal achievement around the glottis. I gel single-use, cuff less, utilizes a thermoplastic elastomer to create a more intimate interface for interaction with the supraglottic tissue. Supraglottic airway devices provide good seal during anaesthesia for spontaneously breathing and controlled ventilation with moderate airway pressures. Methodology: Hundred patients from routine elective surgical procedure were randomized to receive mechanical ventilation, through either I gel or PLMA. Insertion characteristics, working performance, ease of gastric tube insertion and hemodynamic characteristics was assessed. Results: The shorter insertion time (Group I was 20.98 ± 2.29 sec and Group P 30.04 ± 2.6 sec; P value <0.05) was found with I gel as compared to PLMA. There was no statistical difference in insertion attempts, ease of insertion, failure of insertion and airway manipulation. The success and ease of gastric tube placement was more with I gel than with PLMA. Expired tidal volume and leak pressures were better with group P as compared to group I and the leak volume was insignificant in both the groups. The incidence of sore throat and blood staining was similar in both the groups. Conclusion: In comparison to PLMA, I gel is a cheaper, easier to insert, requires less manipulation and cuff inflation is not needed. It has other potential advantages like easier gastric tube placement and fewer traumas to oropharyngeal structure.