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).

Comparison between the streamlined liner of pharyngeal airway TM [slipa] and the laryngeal mask airway unique TM for spontaneous ventilation anaesthesia

The newly developed disposable streamlined of pharyngeal airway [SLIPATM] has recently been introduced into clinical practice. It has no inflatable cuff, because the shape of the SLIPATM closely resembles anatomy of the pharynx. The current study compared the SLIPATM and the LMA Unique TM with respect to insertion success rate, ease of insertion and insertion time, maximum air way sealing pressure, respiratory variables during spontaneous ventilation, haemodynamic response to the insertion of study devices, and postoperative adverse events related to these devices in 80 adult patients [ASA I-II] undergoing routine general surgery, orthopedic, urologic and gynecologic of short, moderate duration under general anaesthesia and through spontaneous ventilation. There was significant rise in MAP from the baseline value [73.8 +/- 12.0 mmHg] at all five minutes interval following insertion of the SLIPA with maximum rise [87.1 +/- 14.9 mmHg] seen at two minutes. There was significant rise in mean arterial blood pressure [MAP] from the baseline value [74.1 +/- 10.3 mmHg] at one and two minutes following insertion of the LMA Unique with maximum rise [81.1 +/- 11.2 mmHg] seen at one minute. MAP was significantly higher with SLIPA than with LMA Unique at two, three, four, and five minutes. There was no significant difference between the two groups with respect to oxygen saturation, inspired and expired tidal volume [TV ins, TV exp], and end-tidal carbon dioxide concentration throughout the surgical procedure. There was no statistical significant difference between the study groups with respect to the rate of successful insertion [96% and 98% in the SLIPATM and LMA Unique TM groups, respectively], and its scale. In the SLIPATM group, insertion was rated straight forward in 87%, slightly difficult in 10%, obviously difficult in 0%, and failure in 2% of patients. In the LMATM Unique group, insertion was rated straightforward in 89%, slightly difficult in 8%, obviously difficult in 2%, and failure in 0% of patients. Regarding to insertion time and peak airway sealing pressure there was no significant difference between the two SGA. With respect to adverse events related to the study air way devices, no regurgitation of gastric contents was observed in any patients, there was a significantly higher incidence of blood on the device with the SLIPA [11/40 versus 4/40 with LMA unique]. Also complaints of sore throat were noticed at significantly higher rate in the LMATM unique group than in SLIPATM group [19%, 3% respectively], 30 minutes after arrival in the post-anesthetic care unit. No cases of sore throat reported at the 24[th] hour postoperatively in both groups. Both the SLIPA and the LMA unique appear to be effective in establishing a clinically patent airway in patients who are spontaneously breathing under general anesthesia during operations of short or intermediate duration. They have similar insertion and functional characteristics. The SLIPA has significant haemodynamic effects on the study patients with frequent blood traces on the device in comparison with the LMA Unique. Fewer patients in the SLIPA group complained of a sore throat suggesting that the SLIPA might increase patients comfort after minor surgery

LMA-proseal versus endotracheal intubation for elective laparosgopic cholecystectomy

The aim of this study was to evaluate the effectiveness of laryngeal mask airway -ProSeal as compared to endotracheal intubation during laparoscopic cholecystectomy as regards pulmonary ventilation and respiratory events at emergence. Forty patients aged 18 years or above, ASA 1 or 2 subjected to laparoscoeic cholecystectomy under general anesthesia were included. Patients with a history of hiatus hernia, gastroesophagcal reflux or diabetes mellitus were excluded Patients were randomized into two groups: Group 1 [LMA-PS] [Laryngeal mask airway ProSeal]: LMA-PS size 3 for female and size 4 for male patient were used. The cuff was inflated with air in 2-3ml increments until effective airway was obtained. Group 2[ETT][Endotracheal tube]: Cuffed ETT size 7mm for female and 8mm for male patient were used and inflated the cuff until no leak was audible. After preoxygenation with 100% oxygen for 3 minutes, anesthesia was induced with 20mg lidocaine, 2-2.5mg.kg[-1] propofol, 1-2micro g. Kg[1] fentanyl and vecuronium 0.05mg .kg[-1]. Positive pressure ventilation [PPV] was not used until after insertion of LMA-PS or ETT. Anesthesia was maintained with 50%nitrous oxide in oxygen, sevoflurare 1 -3%. We started with 6L.min[-1] fresh gasflow to be reduced to 3L.min[1] closed circuit. Incremental doses of vecuronium and fentanyl was given as required. Minute volume and Fio2 were adjusted to maintain SpO2 > 94% and PETCO2 < 45mmHg. If effective airway could not be maintained for 90 seconds or SpO2 /= 45mmHg at any time of the procedure, the LMA-PS will be shifted to ETT. Insufflation time, total anesthetic time, regurgitation [clear or bile stained fluid] and respiratory events at extubation cough, laryngeal spasm, the need for PPV, tracheal intubation] were recorded and compared in both groups. Our study showed that the incidence of respiratory events at extubation were significantly less in group 1 [LMA-PS] as compared to group 2. There was insignificant difference as regard ventilation parameters in both groups and was within normal physiological range. The use of Laryngeal mask airway ProSeal is associated with less incidence of respiratory events at recovery compared to endotra-cheal intubation and both were effective as regard pulmonary ventilation during laparoscopic cholecystectomy

proseal LMA as an aid to endotracheal intubation

The Proseal laryngeal mask airway [PLMA] is a new laryngeal mask device with a modified cuff to improve seal and a drainage tube to provide a channel for regurgitated fluid and gastric tube placement. In the present randomized study, the PLMA was tested as an aid to endotracheal intubation. Sixty paralyzed, anesthetized adult patients were studied. Group I [n=20], the gum elastic bougie was passed into PLMA through a self-sealing port in the elbow connector aiming at insertion into the trachea. After insertion of the gum-elastic bougie, the PLMA was withdrawn and a proper size endotracheal tube [ETT] was railroaded over the bougie into the trachea. Group II [n=20], the light-guided bougie was passed into PLMA the same way as in Group I When the light-guided bougie entered the glottic opening, a circumscribed glow was seen in the anterior neck. Again, the PLMA was withdrawn and a proper size ETT was railroaded over the lighted-bougie into the trachea Group III [n=20], the fiberoptic bronchoscope [FOB] was passed through a tube exchanger and the combination was passed into PLMA through a self-sealing port in the elbow connector which allows ventilation during the procedure. The FOB-tube exchanger combination was passed through the larynx into the trachea under direct vision and when it reached the carina, the FOB and the PLMA were carefully withdrawn leaving the tube exchanger in the trachea. Proper size endoiracheal tube [ETT] was railroaded over the tube exchanger into the trachea Hemodynamic changes, success rate and the time taken between initial disconnection of the PLMA from the anesthesia breathing system to final successful tracheal intubation were recorded. Finally, any complications that occurred during the procedure were documented. Successful intubation using the -gum elastic bougie [Group I] was 75% at the first attempt and 20% at the second attempt Successful intubation using the light-guided bougie [Group II] was 25% at both the first and the second attempts. Failure of intubation was 5% and 50% in group I and group II, respectively. Successful intubation was 100% in Group III [FOB-tube exchanger combination], Time required for successful intubation after initial disconnection of the PLMA from the anesthesia breathing system was significantly shorter in Group I [18 +/- 2.5 s] compared to Group II [24.5 +/- 3.7 s] and Group III [22.5 +/- 2.6 s][P<0.05]. Intubation through PLMA was 100% successful using FOB-tube exchanger combination. The gum elastic bougie had a higher success rate of intubation than the light-guided bougie. Finally, the gum elastic bougie had the shortest intubation time

Experience with laryngeal mask airway in Pakistani patients

One hundred and thirty seven adult patients undergoing peripheral surgery were studied regarding ease of larangeal mask airway [LMA] insertion, airway maintenance during surgery and complication encountered during insertion, maintenance and in the postoperative period. In a majority [84%] of patients, the airway was positioned correctly at the first attempt, 3% patients had mild laryngospasm at insertion and in 85% a good airway was obtained. No airway related problems were encountered intraoperatively. Two percent patients had laryngospasm on removal of LMA. Postoperatively, the complaint of sore throat and uvular trauma was seen in 4% cases