A comparative study of the Cobra perilaryngeal airway and Proseal laryngeal mask airway during laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: The Cobra Perilaryngeal Airway(TM) (Cobra PLA) and the Proseal Laryngeal Mask Airway(TM) (Proseal LMA) provide higher sealing pressures than the classic LMA. The authors compared the clinical effectiveness of these two airway types for controlled ventilation during laparoscopic cholecystectomy. METHODS: One hundred and twenty patients (ASA physical status I-II, aged 18-65 yrs) scheduled for laparoscopic cholecystectomy were randomly allocated for airway management with the Cobra PLA or the Proseal LMA. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion system. Insertion characteristics, anatomical positions, airway adequacies, ventilation efficacies, degrees of gastric distension, and postoperative adverse events (sore throat, dysphagia, and dysphonia) were noted. RESULTS: The number of insertion attempts, insertion times, airway sealing pressure, and airway positions were similar in the two groups. In one Cobra PLA patient, tracheal intubation was needed due to inadequate ventilation before pneumoperitoneum. During pneumoperitoneum, oxygenation and ventilation were optimal in all patients in both groups, and degrees of gastric distension were similar. Furthermore, no differences were found in terms of the incidences of adverse effects. CONCLUSIONS: Cobra PLA and Proseal LMA were found to have similar insertion characteristics and both provided adequate airways and effective ventilation during laparoscopic cholecystectomy.

Analysis for Failure and Immediate Complications of Subclavian Venous Catheterization

BACKGROUND: This study was to investigate success rate, immediate complications, and risk factors of failure and immediate complications of subclavian venous catheterization (SVC). METHODS: All patients requiring SVC, older than 18 years of age and without past history of operation, scar, and radiation therapy at puncture site were included. After general or regional anesthesia was induced, SVC was done via infraclavicular approach. Patient's age, gender, weight, height, the rank of operator, anesthesia method, the side of venipuncture, the number of puncture attempts, arterial puncture, and success or failure were recorded. After the operation, a chest radiography was evaluated to check the occurrence of pneumothorax, hemothorax and the location of the catheter tip. RESULTS: SVC was performed in 1092 patients. Thirty-nine patients were excluded because a chest radiography was not checked. Successful catheterization without immediate complications was performed in 939 patients (89.2%). Failure occurred in 65 patients (6.2%). Arterial puncture, pneumothorax and misplacement of the catheter tip were reported in 26 (2.5%), 5 (0.5%), and 35 (3.3%) patients, respectively. Misplacement of the catheter tip were observed in 26 patients (2.5%) at ipsilateral internal jugular vein, and in 9 (0.8%) at contralateral subclavian vein. Failure and immediate complications of SVC were associated with the number of puncture attempts. The number of puncture attempts were associated with age, puncture side and anesthetic method. CONCLUSIONS: Failure and immediate complications of SVC occurred in 10.8% of cases and were associated with the number of puncture attempts.