Comparison of I-gel and laryngeal mask airway classic in terms of ease of insertion and hemodynamic response: a randomised observational study

Background: The gold standard technique for preserving a patent airway throughout anaesthesia is tracheal intubation. I-gel is a relatively new addition to the SADs. I-gel has combined the concept of the non-cuffed SADs like the SLIPA and gastric tube of the proseal LMA yet retaining the shape of laryngeal mask. Hence, we have compared ease of insertion, number and duration of insertion attempts among the two devices. Methods: This study was conducted on patients undergoing elective surgery under GA in Pacific Medical College and Hospital, Udaipur. Patients were divided into two groups: group A= LMA classic, a variant of supraglottic airway device and group B= I-gel, a variant of supraglottic airway device. The two devices were than compared with respect to success rate of insertion, time taken for insertion and ease of gastric tube placement (number of attempts) and post-operative airway morbidity. Results: Mean insertion time was 8.66±3.21 seconds in C-LMA and 6.49±1.92 seconds in I-gel (p<0.001). 97.14% was the success rate of single time attempt insertion with I-gel as compared to 88.57% in C-LMA. There was a failure rate of 11.43% in single attempt insertion with CLMA as compared to 2.86% with I-gel (p>0.05). Conclusions: We hereby concluded with our study that successful and shorter duration of insertion, with less hemodynamic response, makes I-gel™ a suitable alternative to LMA classic™ during general anesthesia.

Confiabilidad interevaluador del K-SADS-PL-2009/trastornos del espectro autista (TEA) / K-SADS-PL-2009/Autism spectrum disorders (ASD) inter-rater reliability

El incremento en la prevalencia de los trastornos del espectro autista (TEA) provocó que dejaran de considerarse como poco frecuentes. La Entrevista Diagnóstica de Autismo Revisada (ADI-R; Autism Diagnostic Interview-Revised) y la Cédula de Observación General para el Diagnóstico del Autismo (ADOS-G, Autism Diagnostic Observation Schedule-Generic) se consideran estándares de oro para diagnósticar TEA. Sin embargo, ninguno de estos instrumentos evalúa la comorbilidad asociada. La nueva versión de la Entrevista de Diagnóstico Psiquiátrico para Niños y Adolescentes, K-SADS-PL-2009, agregó un apartado para el diagnóstico de los TEA. Objetivo El propósito de este estudio fue traducir, adaptar y analizar la confiabilidad interevaluadora del K-SADS-PL-2009/TEA. Método La muestra se conformó por 40 niños y adolescentes, de ambos sexos, con un rango de edad de cuatro a 17 años, con un diagnóstico presuntivo de trastorno del espectro autista. La versión original del K-SADS-PL-2009/TEA fue traducida al español por dos de los autores y retraducida al inglés por un traductor certificado ciego al estudio. Resultados Confiabilidad interevaluador. Los coeficientes de correlación intraclase fueron de buenos a excelentes para los siguientes diagnósticos en el presente y pasado: autismo 0.79 y 0.74; trastorno de Asperger 0.85 y 1.0; trastorno generalizado del desarrollo no especificado (TGDNE) 0.72 y 0.41. Los coeficientes kappa para las evaluaciones realizadas por los expertos fueron de buenos a excelentes para los siguientes diagnósticos en el presente y en el pasado: autismo 0.89 y 0.87; Asperger 0.77 y 1.00; TGDNE 0.69 y 0.64. La concordancia entre el diagnóstico realizado en el servicio de urgencias y el corroborado posteriormente por medio del instrumento diagnóstico fue de 37.5%, con un índice de error diagnóstico de 67.5%. Conclusiones El K-SADS-PL-2009/TEA mostró una buena confiabilidad interevaluador y puede usarse en niños y adolescentes mexicanos para propósitos clínicos y de investigación...

Autism spectrum disorders (ASD) have demonstrated an increase in prevalence and are no longer considered a rare condition. The Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule-Generic (ADOS-G) have been gold standard instruments to diagnose ASD, but neither of these tools identifies associated comorbidity. The new Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Present and Life time version (K-SADS-PL-2009) added a supplement for assessing ASD. Objective The purpose of this study was to translate, adapt and analyze the interrater reliability of the KIDDIE SADS-PL-2009/ASD. Method The sample consisted of 40 children and adolescents, both male and female, with an age range between four and 17 years old, and presumptive ASD diagnosis. The original ASD screen and supplement interview was translated in to Spanish by two of the authors and retranslated by a certified translator blind to the study. Results Inter-rater reliability: Intraclass correlation coefficients varied from moderate to excellent for the following diagnosis both in the present and the past: Autism 0.79, 0.74; Asperger 0.85, 1.0; PDDNOS 0.72, 0.41. Kappa coefficients for expert evaluations in the present and the past were as following: Autism 0.89, 0.87; Asperger 0.77, 1.00; PDDNOS 0.69, 0.64. Diagnostic concordance between the initial clinical diagnosis and the following diagnosis through the interview was: 37.5%, with a 67.5% error margin. Conclusions In this study, the K-SADS-PL-2009/ASD showed moderate inter-rater reliability indicating that it can be used for clinical or research purposes in Mexican children and adolescents...

The Reliability and Validity of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version (K-SADS-PL-K)

In order to develop a structured and objective diagnostic instrument, authors completed: (1) the translation and back translation of the Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (K-SADS-PL) and (2) the examination of its validity and reliability of the K-SADS-PL-Korean version (K-SADS- PL) when used with Korean children. A total of 91 study subjects were recruited from child and adolescent psychiatry outpatient clinics. Clinical diagnoses were used as a gold standard for the examination of validity of K-SADS-PL-K. Consensual validity of threshold and sub-threshold diagnoses were good to excellent for attention-deficit/hyperactivity disorder (ADHD), fair for tic and oppositional defiant disorders, and poor to fair for anxiety and depressive disorders. Inter-rater and test-retest reliabilities were fair to excellent for ADHD and tic disorder. The significant correlations between the K-SADS-PL-K and Korean Child Behavior Checklist (K-CBCL) were found, which provided additional support for the concurrent validity of the K-SADS-PL-K. Sensitivities varied according to the diagnostic categories, but specificities remained high over all diagnoses, suggesting that the K-SADS-PL-K is a desirable confirmatory diagnostic tool. The results of this study suggest that the K-SADS-PL-K is an effective instrument for diagnosing major child psychiatric disorders, including ADHD, behavioral disorders and tic disorders in Korean children. Future studies will examine the validity and reliability of the K-SADS-PL-K in larger samples, including adolescents and community samples on a variety of child and adolescent psychiatric disorders.