A Prospective Study of Various Anesthetic Techniques in Patients with Acyanotic Congenital Heart Diseases Undergoing Device Closure

Background and Aims:Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. Methods: In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S?FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. Results: GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S?FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. Conclusion: In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.

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

Anaesthetic Management of Turner's Syndrome posted for Modified Radical Mastoidectomy

A 25 year old female, known case of Turner's syndrome was posted for elective Radical Modified Mastoidectomy. Patient had tachycardia, high BP and ECG changes along with all signs and symptoms of Turner's syndrome. During surgery, the aims of anaesthetist were: 1.) To maintain hemodynamic stability, 2.) To provide optimum analgesia intraoperatively and post operatively and 3.) To maintain Peak Airway Pressure within normal limits. Patient was managed intra-operatively by monitoring vitals and maintaining airway pressures. Also airway was secured with blockbuster LMA in order to minimize haemodynamic fluctuations. Surgery was well managed and lasted for 3.5 hours. Patient was managed well intraoperatively with newer supraglottic device and all parameters were served. Patient was smoothly extubated and shifted to recovery with Aldrete score 8 out of 10. Thus, surgery was managed well both intraoperatively and postoperatively and also throughout surgery, patient remained stable. Use of LMA blockbuster was found to be useful and effective in such case for securing airway.

Comparison of the performance of CLASSIC LMA Vs AMBU LMA in minor gynecological surgeries

Background : Supraglottic airway devices are quicker airway control devices even in inexperienced personel. It has better hemodynamic control, less complications and better avoids the disadvantages of the ET insertion. In our study, We compare the performance of CLASSIC LMA and AMBU LMA in minor gynecological procedures. Materials & Methods : In a Prospective randomised case control study, 30 patients in each group were enrolled. size 3 or 4 LMA was used in all adult patients under General anaesthesia without muscle relaxant. Results : AMBU LMA has 90% ease of insertion, 93.3% in first attempt, less time taken for insertion (15 seconds), better hemodynamic control in 5 minutes compared to CLASSIC LMA ( 63%,83.3%,24seconds respectively). Complications like sore throat, blood stain in throat is comparable in both LMA. Conclusion : AMBU LMA has superior performance compared to CLASSIC LMA, and has no significance in view of complications like sore throat.

Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway Supreme™ in geriatric patients: a prospective and randomized study / 대한마취과학회지

BACKGROUND: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA Supreme™) in geriatric patients. METHODS: The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA Supreme™ group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. RESULTS: Insertion time was significantly shorter for the i-gel® than the LMA Supreme™ (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA Supreme™ (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA Supreme™ (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. CONCLUSIONS: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA Supreme™ in geriatric patients.

Comparison of Air-QⓇ insertion techniques in pediatric patients with fiber-optic bronchoscopic assessment: a prospective randomized control trial / 대한마취과학회지

BACKGROUND: Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques.METHODS: This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied.RESULTS: FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups.CONCLUSIONS: The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.

Survival differences between definitive radiotherapy and surgery followed by adjuvant radiotherapy in supraglottic and hypopharyngeal carcinoma / 中华医学杂志(英文版)

Background@#Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcinoma to improve the quality of life (QOL). Definitive radiotherapy (DRT) with or without systematic treatment, such as chemotherapy, is always the first choice to achieve improved QOL. This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy (S + RT) in supraglottic and hypopharyngeal carcinoma.@*Methods@#This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S + RT between January 2012 and August 2016. A total of 59 patients were identified, of whom 31 were treated with DRT, and 28 were treated with S + RT. In the 31 cases of DRT, 23 cases were treated with concurrent chemoradiotherapy (CRT), one case was treated with DRT plus cetuximab, and seven cases were treated with DRT alone. Of the other 28 cases of S + RT, 15 cases were treated with adjuvant concurrent CRT. Survival analysis was used to compare the overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) between DRT and S + RT groups.@*Results@#The median follow-up was 20 months (range, 4-67 months). The patients of the two groups were similar with respect to mean age, original sites, and tumor stages. The 1-, 2-, and 5-year OS rates were 80.6%, 53.4%, and 24.7% for the DRT group and 85.7%, 67.1%, and 24.7% for the S + RT group, respectively. There was no significant difference between the two groups (χ2 = 3.183, P = 0.074). The 1-, 2-, and 5-year LRFS and DMFS were 90.4%, 61.7%, and 18.0% and 87.4%, 49.2%, and 9.9%, respectively, and no statistical difference was observed between the two groups (LRFS: χ2 = 0.028, P = 0.868; DMFS: χ2 = 3.347, P = 0.067). No significant difference was found between the two groups in acute radiotoxicity.@*Conclusions@#Without loss of laryngeal function, the survival of DRT is comparable to that of S + RT in supraglottic and hypopharyngeal carcinoma.

A feasibility study of jaw thrust as an indicator assessing adequate depth of anesthesia for insertion of supraglottic airway device in morbidly obese patients / 中华医学杂志(英文版)

Background@#Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction. This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction.@*Methods@#Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study. After adequate pre-oxygenation, 5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min. After motor responses to jaw thrust disappeared, a SAD was inserted and insertion conditions were graded. The anatomic position of SAD was assessed using a fiberoptic bronchoscope.@*Results@#The SAD was successfully inserted at the first attempt in all patients. Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%), respectively. The fiberoptic views of SAD position were adequate in 28 patients (93%).@*Conclusions@#Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.@*Clinical trial registration@#ChiCTR1800016868; http://www.chictr.org.cn/showproj.aspx?proj=28646.

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.

Efetividade de técnicas de suporte ventilatório em cenários simulados de emergências e desastres químicos, biológicos, radiológicos e nucleares: metanálise / Effectiveness of ventilatory support techniques in simulated scenarios of chemical, biological, radiological and nuclear emergencies and disasters: meta-analysis

Introdução: certas situações de emergências e desastres são desencadeadas pelo uso acidental ou intencional de agentes químicos, biológicos, radiológicos ou nucleares (QBRN), o que pode resultar em quadros clínicos de insuficiência respiratória às vítimas. Técnicas de suporte ventilatório avançado, tais como inserção de dispositivos supraglóticos e intubação orotraqueal, são fundamentais neste contexto, pois tendem a garantir a sobrevida das vítimas contaminadas por agentes QBRN. Em tais situações recomenda-se, pelo menos, a utilização de equipamento de proteção individual (EPI) nível C, que é composto basicamente por um macacão com gorro impermeável, luvas, botas, proteção ocular e máscara. A efetividade do emprego dessas técncias carece de análise em termos de tempo de execução e de êxito na primeira tentativa, uma vez que possibilidades de ações retardatárias devem ser minoradas na resposta assistencial a situações de emergência e desastres. Objetivo: comparar o tempo médio e o êxito na primeira tentativa de inserção de dispositivos supraglóticos em relação ao tubo orotraqueal, considerando a paramentação de profissionais de saúde com equipamento de proteção individual nível C na resposta assistencial a quadros de insuficiência respirtatória, em situações de emergências e desastres. Metodologia: foram acessadas as bases de dados LILACS, MEDLINE, CINAHL, COCHRANE, SCOPUS, WEB OF SCIENCE e, complementarmente, o Google Acadêmico, no período de 08 de março a 30 de agosto de 2019. A estratégia de busca utilizou a seleção de termos MeSH e estabelecimento de interseções com eles; a pesquisa na lista de artigos relacionados a cada artigo incluído na plataforma PubMed; e a pesquisa manual na lista de referências dos artigos selecionados. A seleção estudos ocorreu por dois pesquisadores independentes (coeficiente Kappa = 0,74). As metanálises foram desenvolvidas no software RevMan 5.3 da Cochrane. Resultados: a Revisão Sistemática (RS) contou com nove estudos para as metanálises. Para o desfecho 'redução de tempo' em cada procedimento, obteve-se o resultado heterogêneo -22,11 [IC 95% : -27,43; -16,79]; (P < 0,00001); I2= 97%, favorecendo os dispositivos supraglóticos. Sequencialmente, subgrupos foram criados os quais mostraram menor ou nenhum grau de heterogeneidade. No subgrupo 'dispositivos supraglóticos de 1a geração', obteve-se o resultado de -28,31 [IC 95% : -37,99; -18,64]; (P < 0,00001); I2= 98%). O subgrupo 'ILMA' resultou em -10,99 [IC 95% : -16,08; -5,90]; (P < 0,00001); I2= 74%. O subgrupo 'dispositivos supraglóticos de 2a geração' gerou o resultado -15,42 [IC 95% : -16,77; -14,06]; (P < 0,00001); I2 = 0%. O subgrupo dos 'emergencistas' resultou em -12,96 [IC 95% : -16,10; -9,82]; (P < 0,00001); I 2= 64%; e subgrupo dos 'anestesistas' apresentou o resultado de - 14,94 [IC 95% : -18,44; -11,45]; (P < 0,00001); I 2= 71%. Nos subgrupos de 'metodologia reprodutível', os estudos de Castle et al (2009 e 2010) tiveram como resultado -39,29 [IC 95% : -41,88; -36,70]; (P < 0,00001); I2 = 12%. No subgrupo 'dispositivos supraglóticos' de Ophir et al (2014) resultou em -15,70 [IC 95% : -17,04; -14,37]; (P < 0,00001); I2 = 0%. No subgrupo 'dispositivos supraglóticos' de Plazikowski et al (2018), obteve-se o resultado - 14,55 [IC 95% : -16,45; -12,64]; (P < 0,00001); I2 = 0%. Concernente ao desfecho 'êxito na primeira tentativa', o resultado foi de 0,06 [IC 95% : 0,03; 0,10]; (P= 0,0008); I2 = 52%. Conclusão: em cenários simulados de emergências e desastres, com risco de contaminação por agentes QBRN, a inserção de dispositivos supraglóticos em comparação à intubação endotraqueal demonstrou ser mais rápida e com maior chance de acerto em manequins, inclusive em seres humanos, com nível de evidência moderado. Registro PROSPERO (CRD42019136139).

Introduction: Certain emergencies are triggered by malicious or accidental use of chemical, biological, radiological or nuclear (CBRN) agents, sometimes resulting in respiratory failure for victims. For example, the action of nerve agents; viral hemorrhagic fever; and acute radiation syndrome. Advanced ventilatory support techniques such as orotracheal intubation and insertion of supraglottic devices are critical in this context. Considering the victim contaminated by a CBRN agent, health providers should wear at least a level C personal protective equipment (PPE), which means a chemical-resistant splash suit, butyl rubber gloves, boots, and a respirator. Objective: To compare the mean time and success in the first attempt at orotracheal tube insertion as well as supraglottic devices, considering health professionals paired with level C personal protective equipment. Methodology: The checked databases were LILACS, MEDLINE, CINAHL, COCHRANE, SCOPUS, WEB OF SCIENCE and, as complementary resource, the Google Scholar, from 08th March to 30th August 2019. The search strategy used the selection of MeSH terms and establishment of intersections with them; searching the list of related articles to each article included, through the PubMed platform; and hand search on the reference list of the selected articles. The selection took place by two independent researchers (Kappa coefficient = 0.74). The meta- analyzes were developed by Cochrane RevMan 5.3 software. Results: the Systematic Review captured nine studies to make meta-analysis. For the outcome mean time in each procedure, the heterogeneous result was obtained -22.11 [95% CI: -27.43; -16.79]; (P <0.00001); I2 = 97%, in favor of supraglottic airway device. Subsequently, subgroups were created to decrease the degree of heterogeneity. In 1st Generation Supraglottic Devices subgroup, the result was -28.31 [95% CI: -37.99; -18.64]; (P <0.00001); I2 = 98%). The ILMA subgroup resulted in -10.99 [95% CI: -16.08; -5.90]; (P <0.00001); I2 = 74%. The 2nd Generation Supraglottic Devices subgroup generated the result -15.42 [95% CI: -16.77; -14.06]; (P <0.00001); I2 = 0%. The emergency caregivers subgroup resulted in -12.96 [95% CI: -16.10; -9.82]; (P <0.00001); I 2 = 64%. The anesthetists' subgroup presented the result of -14.94 [95% CI: -18.44; -11.45]; (P <0.00001); I 2 = 71%. Concern reproducible methodology subgroups, the studies by Castle et al (2009 and 2010) resulted in -39.29 [95% CI: -41.88; -36.70]; (P <0.00001); I2 = 12%. The subgroup supraglottic devices of Ophir et al (2014) resulted in -15.70 [95% CI: -17.04; - 14.37]; (P <0.00001); I2 = 0%. The subgroup supraglottic devices of Plazikowski et al (2018) resulted -14.55 [95% CI: -16.45; -12.64]; (P <0.00001); I2 = 0%. Concerning the outcome success rate in the first attempt, the result was 0.06 [95% CI: 0.03; 0.10]; (P = 0.0008); I2 = 52%. Conclusion: In the context of an environment with risk of CBRN contamination, insertion of a supraglottic device compared to endotracheal intubation was shown to be faster and more likely to obtain success in manikins and humans with moderate level of evidence. Prosperous Registration (CRD42019136139).

Introducción: Ciertas emergencias se desencadenan por el uso intencional o accidental de agentes químicos, biológicos, radiológicos o nucleares (QBRN), que a veces resultan en insuficiencia respiratoria para las víctimas. Se puede citar la acción de los agentes neurotóxicos; fiebre hemorrágica viral; y síndrome de radiación aguda. Las técnicas avanzadas de soporte ventilatorio como la intubación orotraqueal y la inserción de dispositivos supraglóticos son críticas en este contexto. Durante los primeros auxilios de los profesionales de la salud, considerando a la víctima contaminada por un agente QBRN, se recomienda al menos el nivel C de equipo de protección personal (EPP), que consiste en un traje con gorro impermeable, guantes, botas, protección. ocular y máscara. Objetivo:Comparar el tiempo medio y el éxito en el primer intento de inserción del tubo orotraqueal, así como los dispositivos supraglóticos, considerando a los profesionales de la salud emparejados con equipos de protección personal de nivel C. Metodología: Utilizamos las bases de datos LILACS, MEDLINE, CINAHL, COCHRANE, SCOPUS, WEB OF SCIENCE y, además, Google Académica, del 8 de marzo al 30 de agosto de 2019. La estrategia de búsqueda utilizó la selección de términos MeSH y el establecimiento de intersecciones con ellos; buscar en la lista de artículos relacionados con cada artículo incluido en la plataforma PubMed; y búsqueda manual en la lista de referencias de artículos seleccionados. Los estudios de selección fueron realizados por dos investigadores independientes (coeficiente Kappa = 0,74). Los metanálisis se desarrollaron utilizando el software Cochrane RevMan 5.3. Resultados: La Revisión Sistemática capturó nueve estúdios para hacer metanálisis. Para el tiempo de resultado empleado en cada procedimiento, se obtuvo el resultado heterogéneo -22,11 [IC 95%: -27,43; -16,79]; (P <0,00001); I2 = 97%, favoreciendo el dispositivo supraglótico. Posteriormente, se crearon subgrupos donde mostraron menor o ningún grado de heterogeneidad. En el subgrupo de dispositivos supraglóticos de primera generación, el resultado fue -28.31 [95% CI: -37.99; -18.64]; (P <0,00001); I2 = 98%). El subgrupo ILMA resultó en -10.99 [IC 95%: -16.08; -5,90]; (P <0,00001); I2 = 74%. El subgrupo 2 Supr Generation Supraglottic Devices generó el resultado -15.42 [IC 95%: -16.77; -14,06]; (P <0,00001); I2 = 0%. El subgrupo de la sala de emergencias resultó en -12.96 [IC 95%: -16.10; -9,82]; (P <0,00001); I 2 = 64%. El subgrupo de anestesistas presentó el resultado de -14,94 [IC 95%: -18,44; -11,45]; (P <0,00001); I 2 = 71%. En los subgrupos de metodología reproducible, los estudios de Castle et al (2009 y 2010) dieron como resultado -39.29 [IC 95%: -41.88; -36,70]; (P <0,00001); I2 = 12%. En el subgrupo, los dispositivos supraglóticos de Ophir et al (2014) resultaron en -15.70 [IC 95%: -17.04; -14,37]; (P <0,00001); I2 = 0%. En el subgrupo de dispositivos supraglóticos de Plazikowski et al (2018), el resultado fue -14.55 [IC 95%: -16.45; -12,64]; (P <0,00001); I2 = 0%. Con respecto a la tasa de éxito del resultado en el primer intento, el resultado fue 0.06 [IC 95%: 0.03; 0,10]; (P = 0,0008); I2 = 52%. Conclusión: en el contexto de un entorno con riesgo de contaminación QBRN, se demostró que la inserción de un dispositivo supraglótico en comparación con la intubación endotraqueal fue más rápida y más probable que golpee a maniquíes y humanos con un nivel de evidencia moderado. Registro PROSPERO (CRD42019136139).

Influence of Supraglottic Swallow on Swallowing Kinematics: Comparison between the Young and the Elderly / 대한연하장애학회지

OBJECTIVE: This study was conducted to evaluate the influence of supraglottic swallowing maneuver on swallowing kinematics using kinematic analysis of a videofluoroscopic swallowing study (VFSS). METHOD: Twenty healthy volunteers (10 in a young group ( < 40 years) and 10 in an elderly group (≥60 years)), participated in this study. After structured instruction by a skilled physician, the subjects swallowed 5 ml of diluted barium in the neutral position without any swallowing maneuvers, as well as with supraglottic swallow maneuver under digital videofluoroscopy, three times each. Kinematic analysis was conducted by digitization of video files for movements of hyolaryngeal structures, including the hyoid bone, larynx, arytenoid, and epiglottis. We measured the maximum displacements and velocities of the hyolaryngeal structures during swallowing. RESULT: The most remarkable change in supraglottic swallow was the maximum vertical displacement (mm) of the hyoid bone during swallowing in both groups (11.5±3.34–19.7±6.88 in the young group, P=0.009; 13.4±2.13–22.8±5.35 in the elderly group, P < 0.001). For velocity variables, patterns of change differed between the young and elderly groups. In the young group, the maximum vertical velocities of the larynx and arytenoid were decreased (P < 0.05), but in the elderly group, the maximum 2D velocity of hyoid bone, maximum horizontal and 2D velocity of the larynx and maximum horizontal velocity of the arytenoid were increased (P < 0.05). There were no significant differences in changes between the young and elderly groups. CONCLUSION: This study showed that supraglottic swallow could affect hyolaryngeal movements, particularly vertical hyoid movement, during swallowing. Beneficial kinematic changes in supraglottic swallow were more pronounced in the elderly group. Therefore, supraglottic swallow may contribute to swallowing improvement by enhancing hyolaryngeal movements during swallowing, in addition to laryngeal closure.

Preliminary Study on the Effect of Supraglottic Laryngeal Carcinoma and Hypopharyngeal Carcinoma on Swallowing Function / 听力学及言语疾病杂志

Objective To explore the effects of supraglottic laryngeal carcinoma and hypopharyngeal carcino-ma on swallowing functions .Methods The data of 32 patients with supraglottic laryngeal carcinoma (laryngeal car-cinoma group) ,20 patients with hypopharyngeal carcinoma (hypopharyngeal carcinoma group) and 81 cases of nor-mal persons of the same age (50～79) as a control (normal control group) who were diagnosed and treated in our department from 2015 December to 2017 February were evaluated by repeated saliva swallowing test ,watian drink-ing water test ,and endoscopic examination of swallowing .Results In the laryngeal carcinoma group ,we found swallowing dysfunctions in 17 cases(53 .13％ ,17/32) .In the hypopharyngeal carcinoma group ,we found swallo-wing dysfunctions in 15 cases(75 .00％ ,15/20) .For 81 cases of normal persons (normal control group) ,there were swallowing dysfunctions in 11 cases(13 .58％ ,11/81) .The statistical analysis of the laryngeal carcinoma and hypo-pharyngeal carcinoma groups with abnormal swallowing functions were significantly higher than the normal control group (P<0 .001) .In the laryngeal carcinoma group ,according to the anatomic site ,the tumors were divided into two groups :from 21 cases of epiglottis and fringe group ,we found swallowing dysfunctions in 14 cases (66 .67％ , 14/21);out of 11 cases of ventricular bands + laryngeal ventricle group , swallowing dysfunctions in 3 cases(27 .27％ ,3/11) .The differences between the two groups were significant (P<0 .05) .In the hypopharyngeal carci-noma group ,out of 14 cases of pyriform sinus ,swallowing dysfunctions were in 10 cases(71 .43％ ,10/14);out of 6 cases of posterior hypopharyngeal wall carcinoma ,swallowing dysfunctions in 5 cases(83 .33％ ,5/6) .The differ-ences between the two groups were insignificant (P>0 .05) .Conclusion Supraglottic laryngeal carcinoma and hypo-pharyngeal carcinoma all have effects on swallowing functions and increase the incidence of dysphagia .In the supra-glottic laryngeal carcinoma ,the primary tumor location has influence on the swallowing functions .

Comparison of three different insertion techniques with LMA-UniqueTM in adults: results of a randomized trial / Comparação de três técnicas diferentes de inserção com a máscara laríngea LMA-UniqueTM em adultos: resultados de um estudo randômico

Abstract Background The triple airway maneuver insertion technique allowed faster insertion of the LMA. This study compared three different insertion techniques of the laryngeal mask airway-UniqueTM. Methods One hundred and eighty ASA I-II patients aged 18-65 years were included into the study. Patients were randomly allocated to the standard, rotational and triple airway maneuver (triple) group. In the standard group (n = 60), the LMA (Laryngeal Mask Airway) was inserted with digital intraoral manipulation. In the triple group (n = 60), the LMA was inserted with triple airway maneuver (mouth opening, head extension and jaw thrust). In the rotational group (n = 60), LMA was inserted back-to-front, like a Guedel airway. Successful insertion at first attempt, time for successful insertion, fiber optic assessment, airway morbidity and hemodynamic responses were assessed. Results Successful insertion at the first attempt was 88.3% for the standard, 78.3% for the rotational and 88.3% for the triple group. Overall success rate (defined as successful insertion at first and second attempt) was 93% for the standard, 90% for the rotational and 95% for the triple group. Time for successful insertion was significantly shorter in the triple group (mean [range] 8.63 [5-19]s) compared with the standard (11.78 [6-24]s) and rotational group (11.57 [5-31]s). Fiber optic assessment, airway morbidity and hemodynamic responses were similar in all groups. Conclusions Rotational and triple airway maneuver insertion techniques are acceptable alternatives. Triple airway maneuver technique shows higher overall success rates and allows shorter insertion time for LMA insertion and should therefore be kept in mind for emergent situations.

Resumo Justificativa A técnica de inserção com a manobra tripla das vias aéreas permitiu a inserção mais rápida da ML. Este estudo comparou três técnicas de inserção da máscara laríngea UniqueTM. Métodos Foram incluídos no estudo 180 pacientes ASA I-II, entre 18-65 anos. Os pacientes foram aleatoriamente designados para grupos de manobra das vias aéreas padrão, rotacional e tripla. No grupo padrão (n = 60), a máscara laríngea (ML) foi inserida com a técnica digital intraoral. No grupo tripla (n = 60), a ML foi inserida com a técnica de manobra tripla das vias aéreas (abertura bucal, extensão da cabeça e elevação da mandíbula). No grupo rotacional (n = 60), a ML foi inserida com a técnica de inserção de trás para frente, como uma cânula de Guedel. Inserção bem-sucedida na primeira tentativa, tempo de inserção bem-sucedida, avaliação por fibra óptica, morbidade das vias aéreas e respostas hemodinâmicas foram avaliados. Resultados O sucesso da inserção na primeira tentativa foi de 88,3% para o grupo padrão, 78,3% para o grupo rotacional e 88,3% para o grupo tripla. A taxa de sucesso global (definida como inserção bem-sucedida na primeira e segunda tentativas) foi de 93% para o grupo padrão, 90% para o grupo rotacional e 95% para o grupo tripla. O tempo de inserção bem-sucedida foi significativamente menor no grupo tripla (média [intervalo] 8,63 [5-19]s), em comparação com o grupo padrão (11,78 [6-24]s) e o grupo rotacional (11,57 [5-31]s). A avaliação por fibra óptica, a morbidade das vias aéreas e as respostas hemodinâmicas foram semelhantes em todos os grupos. Conclusões As técnicas de inserção rotacional e de manobra tripla das vias aéreas são opções aceitáveis. A técnica de manobra tripla das vias aéreas apresenta taxas mais altas de sucesso global e permite um tempo menor de inserção da ML e, portanto, deve ser considerada em situações de emergência.

Laryngeal tube suction for airway management during in-hospital emergencies

OBJECTIVE: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. METHODS: During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded. RESULTS: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. CONCLUSIONS: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.

A comparison of various supraglottic airway devices for fiberoptical guided tracheal intubation / Uma comparação de vários dispositivos supraglóticos para intubação traqueal guiada por fibra óptica

Abstract Background: Fiberoptical assisted intubation via placed supraglottic airway devices has been described as safe and easy procedure to manage difficult airways. However visualization of the glottis aperture is essential for fiberoptical assisted intubation. Various different supraglottic airway devices are commercially available and might offer different conditions for fiberoptical assisted intubation. The aim of this study was to compare the best obtainable view of the glottic aperture using different supraglottic airway devices. Methods: With approval of the local ethics committee 52 adult patients undergoing elective anesthesia were randomly assigned to a supraglottic airway device (Laryngeal Tube, Laryngeal Mask Airway I-Gel, Laryngeal Mask Airway Unique, Laryngeal Mask Airway Supreme, Laryngeal Mask Airway Aura-once). After standardized induction of anesthesia the supraglottic airway device was placed according to the manufacturers recommendations. After successful ventilation the position of the supraglottic airway device in regard to the glottic opening was examined with a flexible fiberscope. A fully or partially visible glottic aperture was considered as suitable for fiberoptical assisted intubation. Suitability for fiberoptical assisted intubation was compared between the groups (H-test, U-test; p < 0.05). Results: Demographic data was not different between the groups. Placement of the supraglottic airway device and adequate ventilation was successful in all attempts. Glottic view suitable for fiberoptical assisted intubation differed between the devices ranging from 40% for the laringeal tube (LT), 66% for the laryngeal mask airway Supreme, 70% for the Laryngeal Mask Airway I-Gel and 90% for both the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once. Conclusion: None of the used supraglottic airway devices offered a full or partial glottic view in all cases. However the Laryngeal Mask Airway Unique and the Laryngeal Mask Airway Aura-once seem to be more suitable for fiberoptical assisted intubation compared to other devices.

Resumo Justificativa: A intubação guiada por fibra óptica (IGFO) através de dispositivo supraglótico (DSG) tem sido descrita como um procedimento seguro e fácil para o manejo de via aérea difícil. No entanto, a visibilização da abertura da glote é essencial para a IGFO. Vários DSGs diferentes estão comercialmente disponíveis e podem oferecer diferentes condições para a IGFO. O objetivo deste estudo foi comparar a melhor visão obtida da abertura da glote com o uso de diferentes DSGs. Métodos: Com a aprovação do Comitê de Ética local, 52 pacientes adultos submetidos à anestesia eletiva foram randomicamente designados para um dos DSGs: tubo laríngeo (TL), máscara laríngea (ML) I-Gel, ML Unique, ML Supreme, ML AuraOnce. Após a indução padronizada da anestesia, o DSG foi colocado de acordo com as recomendações do fabricante. Após ventilação bem-sucedida, a posição do DSG em relação à abertura da glote foi examinada com um endoscópio flexível. Uma abertura da glote total ou parcialmente visível foi considerada como adequada para a IGFO. A adequação para a IGFO foi comparada entre os grupos (teste-H, teste-U; p < 0,05). Resultados: Os dados demográficos não foram diferentes entre os grupos. A colocação do DSG e a ventilação adequada foram bem-sucedidas em todas as tentativas. A visão da glote adequada para a IGFO diferiu entre os dispositivos, variou de 40% para o TL, 66% para a ML Supreme, 70% para a ML I-Gel e 90% para ambas as máscaras laríngeas Unique e AuraOnce. Conclusão: Nenhum dos DSG usados ofereceu uma visão total ou parcial da glote em todos os casos. Porém, as máscaras laríngeas Unique e AuraOnce pareceram mais adequadas para a IGFO em comparação com os outros dispositivos.

Laryngeal cancer neck node metastases: Patterns of spread

OBJECTIVE: To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.METHODS:Design: Chart ReviewSetting: Tertiary Public HospitalParticipants: Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.RESULTS: Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI.CONCLUSION: Our findings show that neck node levels II, III and IV are most frequently affected in laryngeal carcinoma patients in our sample and may guide recommendations for neck dissection in our institution.

Laryngeal cancer neck node metastasis: Patterns of spread

OBJECTIVE: To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.METHODS:Design:            Chart Review Setting:            Tertiary Public HospitalSubjects:         Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.RESULTS: Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis, with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. CONCLUSION: Our findings show that neck node levels II, III, and IV are most frequently affected in laryngeal carcinoma patients in our sample, and may guide recommendations for neck dissection in our institution.

Laryngeal cancer neck node metastases: Patterns of spread

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Chart Review<br /><strong>Setting:</strong> Tertiary Public Hospital<br /><strong>Participants:</strong> Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.<br /><strong>RESULTS:</strong> Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI.<br /><strong>CONCLUSION:</strong> Our findings show that neck node levels II, III and IV are most frequently affected in laryngeal carcinoma patients in our sample and may guide recommendations for neck dissection in our institution.</p>

Standard versus Rotation Technique for Insertion of Supraglottic Airway Devices: Systematic Review and Meta-Analysis

PURPOSE: Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated. MATERIALS AND METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways. RESULTS: Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique. CONCLUSION: The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.