Unilateral lingual nerve and hypoglossal nerve injury caused by a novel laryngeal mask airway: a case report

Abstract Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.

Dispositivos supraglóticos con acceso gástrico en colecistectomía laparoscópica / Supraglottic Devices with Gastric Access in Laparoscopic Cholecystectomy

Introducción: El abordaje de la vía aérea del paciente bajo cirugía laparoscópica representa múltiples retos para el anestesiólogo. Objetivo: Evaluar la efectividad y seguridad de tres dispositivos supraglóticos con acceso gástrico en el abordaje de la vía aérea de pacientes bajo colecistectomía laparoscópica. Métodos: Se realizó un estudio cuasiexperimental, prospectivo, longitudinal en el Hospital Universitario "General Calixto García", entre el 2017 y 2019. Se constituyeron tres grupos de 40 pacientes, según dispositivo: máscara laríngea proseal, máscara laríngea supreme y máscara I-gel. Se estudió: tiempo de inserción, número de intentos para colocación, facilidad de inserción de la sonda nasogástrica, presión y suficiencia de sellado orofaríngeo, presión pico con neumoperitoneo y complicaciones. Las variables cualitativas se analizaron con frecuencias absolutas y relativas, y las cuantitativas con medias y desviación estándar. Para la asociación entre variables cualitativas, se utilizó la prueba de chi-cuadrado, y el análisis de varianza para la asociación entre cuantitativas y cualitativas. Se consideró significativo valor de p < 0,05. Resultados: La máscara laríngea supreme se insertó con éxito al primer intento en la mayoría de los pacientes (p = 0,004). La I-gel registró el menor tiempo de inserción (10,05 ± 1,75 seg) y la Supreme mayor facilidad para la sonda nasogástrica (p < 0,001). La mayor presión de sellado fue con la máscara laríngea proseal (30,87 ± 2,60 cmH2O). Las complicaciones fueron pocas y similares con cada uno. Conclusiones: La utilización de dispositivos supraglóticos con acceso gástrico demostró seguridad y efectividad en pacientes intervenidos por colecistectomía laparoscópica(AU)

Introduction: Airway management in the patient undergoing laparoscopic surgery presents multiple challenges for the anesthesiologist. Objective: To assess the effectiveness and safety of three supraglottic devices with gastric access in the airway management in patients undergoing laparoscopic cholecystectomy. Methods: A quasiexperimental, prospective and longitudinal study was carried out, between 2017 and 2019, at General Calixto García University Hospital. Three groups of forty patients were made up, according to the usage of each device: ProSeal laryngeal mask, Supreme laryngeal mask, and I-gel mask. The following variables were studied: insertion time, number of placement attempts, ease of insertion of nasogastric tube, pressure and sufficiency of oropharyngeal sealing, peak pressure with pneumoperitoneum, and complications. Qualitative variables were analyzed with absolute and relative frequencies; and quantitative variables, with means and standard deviation. For the association between qualitative variables, the chi-square test was used, while variance analysis was used for the association between quantitative and qualitative variables. A value of P< 0.05 was considered significant. Results: The Supreme laryngeal mask was successfully inserted on the first attempt in most patients (P=0.004). The I-gel mask had the shortest insertion time (10.05±1.75 seconds), while the Supreme was the easiest for the nasogastric tube (P< 0.001). The highest sealing pressure was obtained with the ProSeal laryngeal mask (30.87±2.60 cmH2O). The complications were few and similar with each device. Conclusions: The use of supraglottic devices with gastric access showed safety and effectiveness in patients who underwent laparoscopic cholecystectomy(AU)

Comparison of two supraglottic airway devices on postoperative sore throat in children: a prospective randomized controlled trial / Comparação entre dois dispositivos supraglóticos de vias aéreas na dor de garganta pós-operatória em crianças: estudo controlado prospectivo randomizado

Abstract Background and objective: Sore throat is well recognized complaint after receiving general anesthesia. This study is conducted to compare the severity and frequency of postoperative sore throat in children undergoing elective surgery, following the use of Ambu laryngeal mask airway or I-gel®, who are able to self-report postoperative sore throat. Method: Seventy children, 6 to 16 years-old, undergoing elective surgery randomly allocated to either Ambu laryngeal mask (Ambu Group) or I-gel® (I-gel Group). After the procedure, patients were interviewed in the recovery room immediately, after one hour, 6 and 24 hours postoperatively by an independent observer blinded to the device used intra-operatively. Results: On arrival in the recovery room 17.1% (n = 6) of children of the Ambu Group complained of postoperative sore throat, against 5.7% in I-gel Group (n = 2). After one hour, the results were similar. After 6 hours, postoperative sore throat was found in 8.6% (n = 3) of the children in Ambu group vs. 2.9% (n = 1) in I-gel Group. After 24 hours, 2.9% (n = 1) of the children in Ambu Group complained of postoperative sore throat compared to none in I-gel Group. There was no significant difference found in the incidence of postoperative sore throat in both devices on arrival (p = 0.28); after 1 hour (p = 0.28); after 6 hours (p = 0.30); and after 24 hours (p = 0.31). The duration of the insertion of Ambu laryngeal mask was shorter and it was easier to insert than I-gel® (p = 0.029). Oropharyngeal seal pressure of I-gel® was higher than that of Ambu laryngeal mask (p = 0.001). Conclusion: The severity and frequency of postoperative sore throat in children is not statistically significant in the I-gel Group compared to Ambu Group.

Resumo Justificativa e objetivo: Dor de garganta é uma queixa bem conhecida após anestesia geral. O presente estudo comparou a gravidade e a frequência da queixa de dor de garganta pós-operatória associada ao uso de máscara laríngea Ambu ou máscara laríngea I-gel® durante cirurgia eletiva, em crianças capazes de autoreferir a queixa no pós-operatória. Método: Setenta crianças, de 6 a 16 anos submetidas à cirurgia eletiva foram alocadas aleatoriamente para o emprego da máscara laríngea Ambu (Grupo Ambu) ou para o emprego da máscara laríngea I-gel® (Grupo I-gel). Após o procedimento, os pacientes foram entrevistados imediatamente após admissão na sala de recuperação pós-anestésica-SRPA, uma hora, 6 e 24 horas após a cirurgia por um observador independente e cego ao dispositivo de vias aéreas utilizado no intraoperatório. Resultados: Na admissão à SRPA, 17,1% das crianças no Grupo Ambu (n = 6) se queixaram de dor de garganta pós-operatória, contra 5,7% no Grupo I-gel (n = 2). Após uma hora, os resultados foram similares. Após 6 horas, houve dor de garganta pós-operatória em 8,6% (n = 3) das crianças no Grupo Ambu vs. 2,9% (n = 1) no Grupo I-gel. Após 24 horas, 2,9% (n = 1) das crianças no Grupo Ambu versus nenhuma criança no Grupo I-gel. Não houve diferença significante na incidência de dor de garganta pós-operatória nos dois dispositivos na admissão na SRPA (p = 0,28); após 1 hora (p = 0,28); após 6 horas (p = 0,30); e após 24 horas (p = 0,31). A duração da inserção foi menor no grupo da máscara laríngea Ambu, e a I-gel® foi mais fácil de inserir (p = 0,029). A pressão de selagem orofaríngea do I-gel® foi maior do que a da máscara laríngea Ambu (p = 0,001). Conclusão: A gravidade e a frequência da dor de garganta pós-operatória em crianças não foram estatisticamente significantes no grupo com máscara laríngea I-gel® em comparação ao grupo com máscara laríngea Ambu.

Efectividad de la máscara laríngea Ambu® Aura40TM para anestesia general en cirugía ortopédica pediátrica / Effectiveness of Ambu® Aura40TM laryngeal mask for general anesthetic in pediatric orthopedic surgery

RESUMEN Introducción: las máscaras laríngeas son dispositivos supraglóticos utilizadas ampliamente en anestesia para el abordaje y mantenimiento de la vía respiratoria. Una de ellas, la Ambu® Aura 40TM, tiene un diseño que le permite ajustarse al entorno de la hipofaringe con su lumen dirigido a la apertura laríngea. Ha demostrado ser adecuada para procedimientos quirúrgicos donde no es necesaria la intubación endotraqueal. Objetivo: determinar la efectividad dicha máscara laríngea para anestesia general en cirugía ortopédica pediátrica. Materiales y métodos: se realizó un estudio descriptivo, prospectivo, transversal, en 135 pacientes intervenidos quirúrgicamente de forma electiva en el Hospital Pediátrico Eliseo Noel Caamaño, de Matanzas, en el periodo enero de 2015- junio 2017. Se tuvo en cuenta el número de intentos y el tiempo para insertar la máscara laríngea, la necesidad de reemplazarla por un tubo endotraqueal y las complicaciones relacionadas con su uso. Resultados: la ML Ambu® Aura 40TM fue efectiva en la mayoría de los pacientes ya que permitió realizar la cirugía sin necesidad de sustituirla por el tubo endotraqueal y la aparición de complicaciones relacionada con su uso fue baja. Conclusiones: la ML Ambu® Aura 40TM fue efectiva ya que en la mayoría de los pacientes fue insertada correctamente en el primer intento y un tiempo inferior a los 20 segundos. Solo una minoría necesitó que fuera reemplazada por el tubo endotraqueal, y la aparición de complicaciones relacionada con su uso fue baja (AU).

ABSTRACT Introduction: laryngeal mask are supra glottal devices widely used in anesthetics for approaching and maintaining the airway. One of them, the Ambu® Aura 40TM, has a design allowing to adjust to the surroundings of hypo-pharynx with its lumen directed to the pharyngeal opening. It has demonstrated to be adequate for surgical procedures when there is no need of endotracheal intubation. Objective: to determine the effectiveness of that laryngeal mask for general anesthetic in pediatric orthopedic surgery. Materials and methods: a cross-sectional, prospective, descriptive study was carried out in 135 patients who underwent elective surgical intervention in the Pediatric Hospital ?Eliseo Noel Caamaño?, of Matanzas, in the period January 2015- June 2017. The number of attempts and the time needed to insert laryngeal mask, the necessity of changing it for an endotracheal tube, and complications related to its usage were taking into account. Results: Ambu® Aura 40TM laryngeal mask was effective in most patients, due to it allowed to perform the surgery without need of changing it for an endotracheal tube, and the low appearance of complications related to its use. Conclusions: Ambu® Aura 40TM laryngeal mask was effective because it was inserted correctly at the first attempt, in a time less than 20 seconds. Only a minority needed to replace it by endotracheal tube, and the appearance of complications related to its use were low (AU).

Edema pulmonar por presión negativa con máscara laríngea clásica. Presentación de un caso pediátrico / Pulmonary edema due to negative pressure with classical laryngeal mask. Presentation of a pediatric case

RESUMEN El edema pulmonar por presión negativa es una complicación rara y dramática en la anestesia general. Habitualmente ocurre como consecuencia de un laringoespasmo u otra causa de obstrucción de la vía aérea. Se presentó un caso con el objetivo de mostrar los elementos usados para el diagnóstico y tratamiento del edema pulmonar por presión negativa. Paciente de 7 años de edad, femenina, ASA I, operada de metatarso varo funcional con anestesia general balanceada y máscara laríngea clásica # 3. Desarrolló dicho evento adverso durante la recuperación anestésica. El diagnóstico se basó en la disociación toraco abdominal al restablecer la ventilación espontanea, crepitantes en ambos hemitórax, cianosis central, hipoxemia y la presencia de infiltrado difuso bilateral alveolar. Se intubó la tráquea, se controló la ventilación con presión positiva al final de la espiración y se administró furosemida. La paciente fue trasladada a la Unidad de Cuidados Intensivos donde evolucionó satisfactoriamente. Este es un síndrome cuya verdadera incidencia se desconoce debido a la escasa familiarización con el mismo. La evolución de los pacientes es favorable siempre que se establezca el diagnóstico y el tratamiento oportuno (AU).

ABSTRACT Pulmonary edema due to negative pressure is a rare and dramatic complication in general anesthetic. It usually occurs as a consequence of a laryngeal spasm or another cause of respiratory tract obstruction.A case was presented with the aim of showing the elements used for the diagnosis and treatment of the pulmonary edema due to negative pressure. An ASA I, 7-year-old female patient, was operated on a functional metatarsus varus with balanced general anesthetic and classical laryngeal mask number 3. She developed this adverse event during the anesthetic recovery. The diagnosis was based on the thoracoabdominal dissociation when recovering spontaneous ventilation, crepitation in hemithoraxes, central cyanosis, hypoxemia, and alveolar bilateral diffused infiltrate. The trachea was intubated, ventilation was controlled with positive pressure at the end of the expiration and furosemide was administered. The patient was transferred to the Intensive Care Unit where she evolved satisfactorily. This is a syndrome whose true incidence is unknown as a result of the lack of familiarization with it. Patients' evolution is favorable whenever the right diagnosis and treatment are timely established (AU).

Impact of the practising anesthesiologist team member on the laryngeal mask cuff pressures and adverse event rate / Impacto do anestesiologista em treinamento sobre as pressões do manguito de máscara laríngea e incidência de eventos adversos

OBJECTIVE: We have planned to evaluate the laryngeal mask cuff pressures (LMcp) inflated by anesthesia workers of several seniority, without using manometer. METHODS: 180 patients scheduled to have short duration surgery with laryngeal mask were included in the study. Five anesthesia specialists (Group S), 10 residents (Group R) and 6 technicians (Group T) inflated the LMc; thereafter LMcp were measured with pressure manometer. Participants have repeated this practice in at least five different cases. LMcp higher than 60 cm H2O at the initial placement or intraoperative period were adjusted to normal range. Sore throat was questioned postoperatively. Groups were compared in terms of mean LMcp and occupational experience. RESULTS: At the settlement of LM, LMcp pressures within the normal range were determined in 26 (14.4%) cases. Mean LMcp after LM placement in Group S, R and T were 101.2 ± 14.0, 104.3 ± 20.5 cm H2O and 105.2 ± 18.4 cm H2O respectively (p > 0.05). Mean LMcp values in all measurement time periods within the groups were above the normal limit (60 cm H2O). When groups were compared in terms of LMcp, no difference has been found among pressure values. Occupational experience was 14.2 ± 3.9; 3.3 ± 1.1 and 6.6 ± 3.8 years for specialists, residents and technicians respectively and measured pressure values were not different in regard of occupational experience. Seven (3.9%) patients had sore throat at the 24th hour interview. CONCLUSION: Considering lower possibility of normal adjustment of LMcp and ineffectiveness of occupational experience to obtain normal pressure values, it is suitable that all anesthesia practitioners should adjust LMcp with manometer.

OBJETIVO: Planejamos avaliar as pressões do manguito de máscara laríngea (PMML) inflado por profissionais da área de anestesiologia com tempos de serviço variados, sem o uso de manômetro. MÉTODOS: 180 pacientes agendados para cirurgia de curta duração com máscara laríngea foram incluídos no estudo. Cinco especialistas em anestesia (Grupo E), 10 residentes (Grupo R) e seis técnicos (Grupo T) inflaram os manguitos das máscaras laríngeas; subsequentemente, as PMML foram medidas com manômetro de pressão. Os participantes repetiram essa prática em pelo menos cinco casos diferentes. As PMML superiores a 60 cm H2O na colocação inicial ou no intraoperatório foram ajustadas para valores normais. Os pacientes foram questionados sobre a presença de dor de garganta no período pós-operatório. Os grupos foram comparados quanto à média das PMML e experiência profissional. RESULTADOS: Ao inserirem a ML, as pressões do manguito dentro da faixa normal foram determinadas em 26 (14,4%) casos. As médias das PMML após a inserção da ML pelos grupos E, R e T foram 101,2 ± 14,0, 104,3 ± 20,5 cm e 105,2 ± 18,4 cm H2O, respectivamente, (p > 0,05). A média dos valores das PMML em todos os períodos de mensuração entre os grupos estava acima do limite normal (60 cm H2O). Quando os grupos foram comparados quanto às PMML, nenhuma diferença foi encontrada entre os valores das pressões. A experiência profissional era de 14,2 ± 3,9; 3,3 ± 1,1 e 6,6 ± 3,8 anos para especialistas, residentes e técnicos, respectivamente, e os valores das pressões mensuradas não foram diferentes em relação à experiência profissional. Sete pacientes (3,9%) apresentaram dor de garganta durante a entrevista realizada na 24a hora. CONCLUSÃO: Levando-se em consideração uma possibilidade menor de ajuste da pressão do manguito da máscara laríngea (PMML) e da ineficácia da experiência profissional para a obtenção de valores normais das pressões, é adequado que todos os profissionais de anestesia ajustem as PMML com manômetro.

Reducing sore throat following laryngeal mask airway insertion: comparing lidocaine gel, saline, and washing mouth with the control group / Redução da dor de garganta após a inserção de máscara laríngea: comparação de gel de lidocaína, salina e lavagem da boca com o grupo controle

BACKGROUND: Laryngeal mask airway is still accompanied by complications such as sore throat. In this study, effects of three methods of reducing postoperative sore throat were compared with the control group. METHODS: 240 patients with ASA I, II candidates for cataract surgery were randomly divided into four same groups. No supplementary method was used in the control group. In the second, third and fourth groups, lidocaine gel, washing cuff before insertion, and washing mouth before removing laryngeal mask airway were applied, respectively. Anesthesia induction was done with fentanyl, atracurium, and propofol and maintained with propofol infusion. The incidence of sore throat was evaluated during the recovery, 3-4 h later and after 24 h using verbal analog scale. The data were analyzed by t-test, analysis of variance and chi-square using SPSS V11.5. RESULTS: Age, gender, duration of surgery and cuff pressure were the same in all the four groups. Incidence of sore throat at recovery room was highest in the control group (43.3%) and lowest in the washing mouth group (25%). However, no significant statistical difference was observed between these four groups (recovery, p = 0.30; discharge, p = 0.31; examination, p = 0.52). In this study, increased duration of operation had a significant relationship with the incidence of sore throat (p = 0.041). CONCLUSION: Sore throat is a common postoperative problem, but no special method has been found completely efficient yet. In this study, cuff washing, lidocaine gel, and mouth washing before removing laryngeal mask airway were not helpful for sore throat.

JUSTIFICATIVA: A máscara laríngea ainda é relacionada a complicações como a dor de garganta. Neste estudo, os efeitos de três métodos para reduzir a dor de garganta, no período pós-operatório, foram comparados com o grupo controle. MÉTODOS: Duzentos e quarenta candidatos,com estado físico ASA I-II, foram aleatoriamente divididos em quatro grupos iguais para a cirurgia de catarata.com estado físico ASA I-II, candidatos para a cirurgia de catarata foram aleatoriamente divididos em quatro grupos iguais. Nenhum método complementar foi usado no grupo controle. No segundo, terceiro e quarto grupos, os métodos utilizados foram: Aplicação de gel de lidocaína, lavagem do manguito antes da inserção e lavagem da boca antes de remover a máscara laríngea, respectivamente. A anestesia foi induzida com fentanil, atracúrio e propofol e mantida com propofol. A incidência de dor de garganta foi avaliada durante a recuperação, 3-4 h depois e após 24 h usando uma escala verbal analógica. Teste-t, análise de variância e teste do qui-quadrado foram usados para a análise dos dados por meio do programa estatístico SPSS V11.5. RESULTADOS: Idade, gênero, tempo de cirurgia e pressão do manguito foram semelhantes em todos os quatro grupos. Na sala de recuperação, a incidência de dor de garganta foi maior no grupo controle (43,3%) e mais baixa no grupo lavagem da boca (25%). No entanto, não houve diferença estatisticamente significante entre os quatro grupos (recuperação, p = 0,30; alta, p = 0,31; exame, p = 0,52). Neste estudo, o tempo mais longo de cirurgia apresentou relação significativa com a incidência de dor de garganta (p = 0,041). CONCLUSÃO: Dor de garganta é um problema pós-operatório comum, mas nenhum método em especial foi considerado totalmente eficiente. Neste estudo, a lavagem do manguito, a aplicação de gel de lidocaína e a lavagem de boca antes de remover a máscara laríngea não foram úteis para evitar a dor de garganta.

Comparison of the i-gelTM and the Laryngeal Mask Airway ClassicTM in terms of clinical performance / Comparação da máscara laríngea i-gel (i-gelTM) com a máscara laríngea clássica (LMA-ClassicTM) em relação ao desempenho clínico

ABSTRACTPURPOSE: The i-gelTM is one of the second generation supraglottic airway devices. Our study was designed to compare the i-gel and the Laryngeal Mask Airway ClassicTM with respect to the clinical performance.METHODS: We compared the performance of the i-gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation.RESULTS: There was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p = 0.951). The laryngeal mask insertion time for the i-gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6 ± 2.4 s versus 13.1 ± 1.8 s [p = 0.001]). The fiberoptic glottic view scores for the i-gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p = 0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24 h after the procedure (p = 0.752).CONCLUSION: Both devices had good performance with low postoperative complications and without occurrence of regurgitation. The i-gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.

RESUMOJUSTIFICATIVA E OBJETIVO: A i-gel é um dos dispositivos supraglóticos de segunda geração para o manejo das vias aéreas. Nosso estudo foi projetado para comparar a i-gelTM e a máscara laríngea clássica (Laryngeal Mask Airway ClassicTM, LMA-C) em relação ao desempenho clínico.MÉTODOS: Avaliamos os desempenhos de i-gel e LMA-C em 120 pacientes submetidos à cirurgia urológica sob anestesia geral sem relaxante muscular. Comparamos o número de tentativas de inserção bem-sucedidas, o tempo de inserção, a pressão de pico das vias aéreas, a incidência de regurgitação, a visibilidade da glote com o uso de fibra óptica e as complicações no pós-operatório. Os dispositivos supraglóticos de segunda geração foram inseridos pelo mesmo anestesiologista com experiência na aplicação de ambos os dispositivos (> 200 aplicações e taxa de falha na primeira tentativa < 5%). O corante azul de metileno foi usado para detectar regurgitação gástrica.RESULTADOS: Não houve diferença estatística entre os dois grupos em relação ao sucesso da inserção do dispositivo supraglótico de segunda geração (p = 0,951). O tempo de inserção da máscara laríngea no grupo i-gel foi significativamente menor do que no grupo LMA-C (11,6 ± 2,4 segundos vs. 13,1 ± 1,8 segundos, p = 0,001). O escore de visibilidade da glote via fibra óptica do grupo i-gel foi significativamente melhor do que o do grupo LMA-C (p = 0,001). Na visão via fibra ótica, sinais do corante azul de metileno não foram observados em qualquer momento em ambos os grupos. Além disso, não houve diferença entre as respostas dos grupos quando perguntados sobre a presença de dor de garganta 24 horas após o procedimento (p = 0,752).CONCLUSÃO: Ambos os dispositivos apresentaram bom desempenho, com poucas complicações no pós-operatório e sem ocorrência de regurgitação. A máscara laríngea i-gel proporcionou um tempo de inserção mais curto e uma visão via fibra óptica melhor do que a LMA-C.

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

Comparação de via aérea por máscara laríngea Supreme e via aérea por máscara laríngea ProSeal para trauma laringofaríngeo e morbidade pós-operatória em crianças / Comparison of laryngeal mask airway supreme and laryngeal mask airway proseal for laryngopharyngeal trauma and postoperative morbidity in children / Comparación de vía aérea por mascarilla laríngea Supreme y vía aírea por mascarilla laríngea ProSeal para el trauma laringofaríngeo y la morbilidad postoperatoria en niños

EXPERIÊNCIA E OBJETIVOS: A via aérea por máscara laríngea (LMA), que tem sido utilizada frequentemente no tratamento das vias aéreas, pode causar lesão e morbidade na área laringofaríngea. Nesse estudo, comparamos as alterações macroscópicas nas estruturas laringofaríngeas e a morbidade laringofaríngea pós-operatória pelo uso da LMA Supreme® versus LMA ProSeal® em crianças. MÉTODOS: Dividimos os pacientes em dois grupos. Inserimos LMA ProSeal #3 no primeiro grupo e LMA Supreme #3 no segundo grupo. Antes da inserção da LMA e em seguida à sua remoção, fizemos laringoscopia direta nos pacientes. Comparamos entre os dois grupos: hiperemia, lesão de mucosa e as manchas de sangue por ocasião da remoção da LMA, e também o tempo de inserção, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito e dor de garganta. RESULTADOS: Não foram observadas diferenças significativas entre os dois grupos para tempo médio de operação, gênero, idade, peso, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito, dor de garganta e lesão de mucosa. O tempo médio de inserção para o grupo LMA ProSeal foi significativamente maior versus grupo LMA Supreme (p = 0,0001). O índice de manchas de sangue na remoção da LMA foi significativamente mais alto no grupo LMA ProSeal versus LMA Supreme (p = 0,034). Os pacientes que apresentaram manchas de sangue por ocasião da remoção da LMA exibiram hiperemia e lesão de mucosa significativamente mais expressivas versus pacientes com LMA limpa (p = 0,0001, p = 0,020). CONCLUSÃO: Em crianças, a inserção da LMA Supreme é mais rápida e fácil do que a inserção da LMA ProSeal; e, em comparação com LMA ProSeal, causa menos lesão laringofaríngea.

BACKGROUND AND OBJECTIVES: Laryngeal mask airway (LMA), which has been used frequently in airway management, can cause laryngopharyngeal injury and morbidity. In this trial, we compare the macroscopic changes on laryngopharyngeal structures and the postoperative laryngopharyngeal morbidity by using LMA supreme with LMA proseal in children. METHODS: We divided patients into two groups. We inserted size three LMA proseal into the first group and size three LMA supreme into the second group. Before LMA insertion and after LMA removal, we performed direct laryngoscopy on the patients. We compared hyperemia, mucosal injury and blood staining on LMA removal, as well as insertion time, rate of success in gastric tube insertion on the first attempt, nausea, vomiting, and sore throat between the two groups. RESULTS: We recorded no significant differences between the two groups for mean operation time, sex, age, weight, rate of success in gastric tube insertion on first attempt, nausea, vomiting, sore throat and mucosal injury. Mean insertion time for the LMA proseal group was significantly longer than the LMA supreme group (p = 0.0001). The ratio of blood staining on LMA removal was significantly higher in the LMA proseal group than the LMA supreme group (p = 0.034). The patients with blood staining on LMA removal exhibited significantly more mucosal hyperemia and injury than the patients with clear LMA (p = 0.0001, p = 0.020). CONCLUSION: LMA supreme insertion is faster and easier than LMA proseal and causes less laryngopharyngeal injury than LMA proseal in children.

EXPERIENCIA Y OBJETIVOS: La vía aérea por mascarilla laríngea (LMA), que ha sido utilizada a menudo en el tratamiento de las vías aéreas, puede causar lesión y morbilidad en el área laringofaríngea. En ese estudio, comparamos las alteraciones macroscópicas en las estructuras laringofaríngeas y la morbilidad laringofaríngea postoperatoria por el uso de la LMA Supreme® versus LMA ProSeal® en niños. MÉTODOS: Dividimos los pacientes en dos grupos. Insertamos LMA ProSeal #3 en el primer grupo y LMA Supreme #3 en el segundo grupo. Antes de la inserción de la LMA e inmediatamente después de su retirada, hicimos una laringoscopia directa en los pacientes. Comparamos entre los dos grupos: hiperemia, lesión de mucosa y las manchas de sangre en razón de la retirada de la LMA, y también el tiempo de inserción, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito y dolor de garganta. RESULTADOS: No fueron observadas diferencias significativas entre los dos grupos para tiempo promedio de operación, sexo, edad, peso, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito, dolor de garganta y lesión de mucosa. El tiempo promedio de inserción para el grupo LMA ProSeal fue significativamente mayor versus grupo LMA Supreme (p = 0,0001). El índice de manchas de sangre en la retirada de la LMA fue significativamente más alto en el grupo LMA ProSeal versus LMA Supreme (p = 0,034). Los pacientes que tenían manchas de sangre en razón de la retirada de la LMA tenían hiperemia y una lesión de la mucosa significativamente más expresivas versus pacientes con LMA limpia (p = 0,0001, p = 0,020). CONCLUSIONES: En los niños, la inserción de la LMA Supreme es más rápida y fácil que la inserción de la LMA ProSeal; y en comparación con LMA ProSeal, causa menos lesión laringofaríngea.

Estudo clínico prospectivo aleatório sobre o uso da máscara laríngea Supreme® em pacientes submetidos a anestesia geral / Prospective, randomized clinical trial of laryngeal mask airway Supreme® used in patients undergoing general anesthesia / Estudio clínico prospectivo aleatorio sobre el uso de la mascarilla laríngea Supreme® en pacientes sometidos a la anestesia general

JUSTIFICATIVA E OBJETIVOS: Dispositivos supraglóticos são cada vez mais usados como opção à intubação traqueal durante procedimentos eletivos de complexidade variável. O objetivo deste estudo foi avaliar prospectivamente o uso clínico da máscara laríngea Supreme® (MLS) em pacientes submetidas a procedimentos cirúrgicos eletivos na mama e compará-la ao tubo endotraqueal (TE). MÉTODO: 60 pacientes submetidas a procedimentos cirúrgicos da mama sob anestesia geral foram distribuídas aleatoriamente em dois grupos de acordo com o dispositivo usado (MLS ou TE). Foram avaliados: tempo de inserção, número de tentativas para inserção, resposta hemodinâmica à inserção, presença de sangue no dispositivo usado e incidência de dor de garganta, disfagia, náuseas e vômitos no pós-operatório. RESULTADOS: Não houve diferença entre os grupos com relação ao tempo de inserção, ao número de tentativas para inserção bem-sucedida e à presença de sangue no dispositivo. A frequência cardíaca e a pressão arterial após a inserção foram maiores no grupo TE. A incidência de dor de garganta e disfagia após duas horas de pós-operatório também foi maior no grupo TE. Não houve diferença na incidência e na intensidade das complicações avaliadas após seis horas de pós-operatório. CONCLUSÕES: O uso da MLS como técnica de acesso à via aérea durante a anestesia geral em procedimentos cirúrgicos eletivos na mama é tão seguro e eficiente quanto a intubação traqueal, com a vantagem de desencadear menor resposta hemodinâmica durante a sua execução e menor incidência de dor de garganta e disfagia nas primeiras horas de pós-operatório.

BACKGROUND AND OBJECTIVES: Supraglottic airway devices are increasingly used as an option to tracheal intubation for elective procedures of varying complexity. The aim of this study was to prospectively evaluate the clinical use of the laryngeal mask airway Supreme® (LMAS) in patients undergoing elective breast surgery and compare it with endotracheal tube (ETT). METHODS: Sixty patients undergoing breast procedures under general anesthesia were randomly divided into two groups according to the device used (LMAS or ETT). Time of insertion, number of insertion attempts, hemodynamic response to insertion, presence of blood on the device used; and incidence of sore throat, dysphagia, nausea and vomiting were assessed postoperatively. RESULTS: There was no difference between groups regarding time of insertion, number of attempts for successful insertion, and presence of blood on the device. Heart rate and blood pressure after insertion were higher in ETT group. Incidence of sore throat and dysphagia was also higher in ETT group after two hours in the postoperative period. There was no difference regarding incidence and severity of complications evaluated after six hours postoperatively. CONCLUSIONS: The use of the LMAS technique to access airway during general anesthesia for elective breast surgery is as safe and effective as tracheal intubation, with the advantage of promoting smaller hemodynamic response during its management and lower incidence of sore throat and dysphagia in the first hours after surgery.

JUSTIFICATIVA Y OBJETIVOS: Los dispositivos supraglóticos son cada vez más usados como una opción a la intubación traqueal durante los procedimientos electivos de complejidad variable. El objetivo de este estudio, fue evaluar prospectivamente el uso clínico de la mascarilla laríngea Supreme® (MLS) en pacientes sometidas a procedimientos quirúrgicos electivos en la mama y compararlo con el tubo endotraqueal (TE). MÉTODO: Sesenta pacientes fueron sometidas a procedimientos quirúrgicos de la mama bajo anestesia general, y distribuidas aleatoriamente en dos grupos de acuerdo con el dispositivo usado (MLS o TE). Se evaluaron: tiempo de inserción, número de intentos para la inserción, respuesta hemodinámica a la inserción, presencia de sangre en el dispositivo usado, e incidencia de dolor de garganta, disfagia, náuseas y vómitos en el postoperatorio. RESULTADOS: No hubo diferencia entre los grupos con relación al tiempo de inserción, al número de intentos para la inserción exitosa y a la presencia de sangre en el dispositivo. La frecuencia cardíaca y la presión arterial después de la inserción fueron más elevadas en el grupo TE. La incidencia de dolor de garganta y disfagia después de dos horas de postoperatorio, también fue mayor en el grupo TE. No hubo diferencia en la incidencia y en la intensidad de las complicaciones evaluadas después de seis horas del postoperatorio. CONCLUSIONES: El uso de la MLS como técnica de acceso a la vía aérea durante la anestesia general en procedimientos quirúrgicos electivos en la mama, es tan seguro y eficiente como la intubación traqueal, con la ventaja de que desencadena una menor respuesta hemodinámica durante su ejecución y una menor incidencia de dolor de garganta y disfagia en las primeras horas del postoperatorio.

Uso da máscara laríngea em pacientes com parada cardiorrespiratória: revisão sistemática / Laryngeal mask utilization in patients with cardiopulmonary arrest: a systematic review / Uso de mascarilla laríngea en pacientes con paro cardiorrespiratorio: revisión sistemática

O estudo teve como objetivo analisar a sobrevida, a efetividade da ventilação e a ocorrência de regurgitação associadas ao uso da máscara laríngea em paciente com parada cardiorrespiratória. Trata-se de revisão sistemática realizada nas bases de dados LILACS, Embase, CINAHL, MEDLINE e Cochrane. O total de estudos selecionados foi treze, sendo dois ensaios clínicos, um randomizado controlado e outro não randomizado, e onze estudos descritivos. No ensaio clínico randomizado controlado, a sobrevida dos pacientes que utilizaram a máscara laríngea foi de 7%, mas não houve diferença estatística quando comparada aos outros dispositivos para via aérea. A ventilação pulmonar foi efetiva tanto na avaliação subjetiva quanto na objetiva. A regurgitação foi observada em três casos, mas a frequência não foi estatisticamente diferente dos demais grupos. Os resultados dos estudos desta revisão sistemática indicam a necessidade de realizar estudos controlados e randomizados para analisar os benefícios do uso da máscara laríngea na ressuscitação cardiorrespiratória...

The objective of this study was to analyze the survival, ventilation effectiveness and the occurrence of regurgitation associated to the utilization of the laryngeal mask in patients with cardiopulmonary arrest. This systematic review was performed using the LILACS, Embase, CINAHL, MEDLINE and Cochrane databases. Thirteen studies were selected: two clinical trials, being one randomized controlled trial and one not controlled; and eleven descriptive studies. The randomized controlled trial showed a 7% survival rate for patients who utilized the laryngeal mask, but no statistical difference was found compared to other airway devices. Pulmonary ventilation was effective in both the subjective and the objective evaluations. Regurgitation was observed in three cases, but the frequency showed no statistical differences between groups. The results of this systematic review indicate the need to perform randomized controlled studies to analyze the benefits of using the laryngeal mask in cardiopulmonary resuscitation...

Se objetivó analizar la sobrevida, efectividad de ventilación y ocurrencia de regurgitación asociadas al uso de mascarilla laríngea en pacientes con paro cardiorrespiratorio. Revisión sistemática en las bases LILACS, Embase, CINAHL, MEDLINE y Cochrane. Fueron seleccionados trece estudios, dos de ellos ensayos clínicos, uno randomizado controlado y el otro no randomizado, y once estudios descriptivos. En el ensayo clínico randomizado controlado, la sobrevida de pacientes que utilizaron mascarilla laríngea fue 7%, sin diferencia estadística en comparación con otros dispositivos para vías aéreas. La ventilación pulmonar fue efectiva tanto en la evaluación subjetiva como en la objetiva. Se observó regurgitación en tres casos, sin diferencia estadística de los otros grupos. Los resultados de los estudios de esta revisión indican la necesidad de realizar estudios controlados y randomizados para analizar los beneficios del uso de la mascarilla laríngea en la resucitación cardiorrespiratoria...

Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

Laryngeal Mask Airway Insertion in Adults: Comparison between Fully Deflated and Partially Inflated Technique

PURPOSE: The laryngeal mask airway (LMA) is a supraglottic airway device designed to seal around the laryngeal inlet. A controlled study was designed to compare the effectiveness and complications in inserting the LMA when the cuff is fully deflated and partially inflated. MATERIALS AND METHODS: American Society of Anesthesiologists physical status I or II 172 female patients scheduled for gynecologic procedures were included in this study. Patients were randomly allocated into one of the two groups; fully deflated (n=86) and partially inflated group (n=86). A size #4 LMA was inserted. The number of attempts, time taken for successful insertion, grade of leak, grade of fiberoptic view, and complications were evaluated. RESULTS: All 172 patients completed the study protocol. The number of attempts, time taken for successful insertion, and grade of leak were not significantly different between the two groups. The grade of fiberoptic view and complications were lower in the fully deflated group. CONCLUSION: The fully deflated method is more accurate and safe because of better fiberoptic view and lesser complications than the partially inflated group.

Uso da máscara laríngea descartável em adenotonsilectomias / The use of disposable laryngeal mask airway for adenotonsillectomies / Uso de la mascarilla laríngea desechable en adenotonsilectomías

JUSTIFICATIVA E OBJETIVOS: A intubação traqueal associada a operações das vias aéreas faz com que complicações como laringoespasmo, broncoespasmo e períodos de redução da saturação de oxigênio sejam frequentemente relatados em adenotonsilectomias, procedimento que, por sua natureza, eleva a incidência de tais complicações. O objetivo deste estudo foi analisar a ocorrência de problemas respiratórios comparando-se o uso da máscara laríngea (ML) descartável com a intubação orotraqueal em adenotonsilectomias. MÉTODOS: Foram avaliados 204 pacientes pediátricos submetidos a anestesia geral para adenotonsilectomias e alocados em dois grupos, aleatoriamente: grupo Cânula Traqueal (CT, n = 100) e grupo Máscara Laríngea (ML, n = 104). Foram observados os níveis de saturação de pulso de oxigênio (SpO2) após a indução anestésica (SpO2-1), após o estabelecimento de campo operatório (SpO2-2), ao término do procedimento cirúrgico (SpO2-3), três minutos após a retirada do dispositivo respiratório (SpO2-4) e na admissão da sala de recuperação anestésica (SpO2-5). As complicações respiratórias foram relatadas. RESULTADOS: Os valores médios e os desvios padrão de SpO2 nos grupos CT e ML foram, respectivamente: SpO2-1: 98,9 ± 1,0 e 98,7 ± 0,8 (p > 0,25); SpO2-2: 97,4 ± 1,0 e 94,9 ± 4,3 (p < 0,001); SpO2-3: 96,9 ± 1,1 e 97,2 ± 1,1 (p = 0,037); SpO2-4: 91,7 ± 9,0 e 95,2 ± 2,2 (p < 0,001); SpO2-5: 94,0 ± 2,1 e 95,8 ± 2,6 (p < 0,001). No grupo ML, em 12 pacientes, foi necessária alguma manobra para ajuste do dispositivo e correção de vazamento durante o ato operatório. A ML foi substituída pela CT em quatro pacientes. As complicações respiratórias foram similares entre os grupos. CONCLUSÕES: Adenotonsilectomias em pacientes pediátricos com o emprego da ML, em comparação com a CT, resulta em menores valores de SpO2 intraoperatórios e, eventualmente, necessidade de substituição da ML pela CT. Apesar de a ML viabilizar a cirurgia, pela segurança, o uso da CT é preferível.

BACKGROUND AND OBJECTIVES: Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT). METHODS: We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n = 100) or the laryngeal mask airway group (LMA, n = 104). It was measured the level of oxygen saturation by pulse oximetry (SpO2) after the induction of anesthesia (SpO2-1), after establishing the operative field (SpO2-2), at the end of the surgical procedure (SpO2-3), three minutes after the removal of the contained breathing apparatus (SpO2-4) and upon admission to the post-anesthesia care unit (SpO2-5). All respiratory complications were recorded. RESULTS: The mean SpO2 values and standard deviations for the TT and LMA groups were as follows: SpO2-1: 98.9 ± 1.0 and 98.7 ± 0.8 (p > 0.25), SpO2-2: 97.4 ± 1.0 and 94.9 ± 4.3 (p < 0.001), SpO2-3: 96.9 ± 1.1 and 97.2 ± 1.1 (p = 0.037), SpO2-4: 91.7 ± 9.0 and 95.2 ± 2.2 (p < 0.001) and SpO2-5: 94.0 ± 2.1 and 95.8 ± 2.6 (p < 0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a TT. Respiratory complications were similar between groups. CONCLUSIONS: Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO2, compared to using a TT. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a TT is preferred for safety.

JUSTIFICATIVA Y OBJETIVOS: La intubación traqueal asociada con las operaciones de las vías aéreas hace con que complicaciones como el laringoespasmo, el broncoespasmo y los períodos de reducción de la saturación de oxígeno sean a menudo relatados en adenotonsilectomías, procedimiento que, por su naturaleza, eleva la incidencia de tales complicaciones. El objetivo de este estudio, fue analizar la aparición de problemas respiratorios comparándose el uso de la mascarilla laríngea (ML) desechable con la intubación orotraqueal en adenotonsilectomías. MÉTODOS: Se evaluaron 204 pacientes pediátricos sometidos a la anestesia general para las adenotonsilectomías que se dividieron en dos grupos aleatoriamente: grupo Cánula Traqueal (CT, n = 100) y grupo Mascarilla Laríngea (ML, n = 104). Se observaron los niveles de saturación de pulso de oxígeno (SpO2) después de la inducción anestésica (SpO2-1), posteriormente al establecimiento del campo operatorio (SpO2-2), al término del procedimiento quirúrgico (SpO2-3), tres minutos después de la retirada del dispositivo respiratorio (SpO2-4) y a la llegada a la sala de recuperación anestésica (SpO2-5). Las complicaciones respiratorias se relataron. RESULTADOS: Los valores promedios y las desviaciones estándar de SpO2 en los grupos CT y ML fueron, respectivamente: SpO2-1: 98,9 ± 1,0 y 98,7 ± 0,8 (p > 0,25); SpO2-2: 97,4 ± 1,0 y 94,9 ± 4,3 (p < 0,001); SpO2-3: 96,9 ± 1,1 y 97,2 ± 1,1 (p = 0,037); SpO2-4: 91,7 ± 9,0 y 95,2 ± 2,2 (p < 0,001); SpO2-5: 94,0 ± 2,1 y 95,8 ± 2,6 (p < 0,001). En el grupo ML, en 12 pacientes, se necesitó alguna maniobra para el ajuste del dispositivo y para la corrección del escape durante la operación. La ML se remplazó por la CT en cuatro pacientes. Las complicaciones respiratorias fueron similares entre los grupos. CONCLUSIONES: La realización de adenotonsilectomías en pacientes pediátricos con el uso de la ML, en comparación con la CT, acarrea menores valores de SpO2 intraoperatorios y eventualmente la necesidad de sustitución de la ML por la CT. A pesar de que la ML viabiliza la realización de la cirugía, en razón de la seguridad, se prefiere el uso de la CT.

Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

Comparison of intraocular pressure and hemodynamic response subsequent to tracheal tube versus laryngeal tube insertion during general anesthesia

It is well accepted that intraocular pressure should be controlled during general anesthesia [G/A] for intraocular procedures. This study was performed to compare the effects of the laryngeal and tracheal tubes on intraocular pressure [IOP], mean arterial pressure [MAP] and heart rate [HR] during the course of G/A. Eighty adult patients were randomly allocated to two groups for cataract surgery. Group A [n=40] underwent laryngeal tube [LT] placement and group B [n=40] had tracheal tube [TT] insertion. Anesthesia was induced by midazolam, fentanyl, propofol and atracurium and was maintained by propofol and 50% nitrous oxide in oxygen. IOP, MAP and HR were measured before and 3 minutes after induction of G/A, 1 and 5 minutes after tube placement, at the end of the operation, and 1 minute after extubation. The IOP at 1 minute after removal of the tubes was significantly higher in the TT group than the LT group. The MAP at 1 minute and heart rate at 1 and 5 minutes after placement of the tubes were significantly higher in TT group than the LT group. In the course of G/A, using the same anesthetic agents such as propofol, and atracurium, LT had better control than TT on IOP, MAP and HR

hemodynamic effects and complications of tracheal intubation with intubating laryngeal mask airway: a comparison with direct laryngoscopy

The intubating laryngeal mask airway [ILMA] is designed to facilitate blind tracheal intubation. Direct laryngoscopy, to facilitate tracheal intubation, produces a marked pressor response. This randomized, controlled study -was undertaken to compare the complications of insertion and hemodynamic effects following tracheal intubation through intubating laryngeal mask airway [ILMA] with that of conventional Macintosh laryngoscope. One hundred adult patients undergoing elective surgery were randomly allocated into two equal-sized groups. All patients received general anesthesia using a standard balanced anesthesia technique. Tracheal intubation was performed using either intubating laryngeal mask airway or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, the problems encountered during intubation, hemodynamic changes and postoperative pharyngolaryngeal complications were recorded. Time to intubation was comparatively longer in ILM.4 group than laryngoscopy group [58.6 +/- 8.2 sec. versus 29.2 +/- 5.6 sec. p <0.001]. The overall intubation success rate was comparable among the two study groups. The changes-in mean blood pressure were significantly less in ILMA group as compared to laryngoscope group [p <0.05]. The incidence of postoperative sore throat and hoarseness of voice was comparable among groups. Our results suggest that ILMA offers advantage over laryngoscope in minimizing the hemodynamic effects to intubation. Therefore, it can be used as a suitable alternative to laryngoscopy for tracheal intubation