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

A comparative study of supraglottic airway devices Baska mask and ProSeal-laryngeal mask airway in short gynaecological procedures

Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.

Comparative Evaluation of Effective Dose 50 (ED 50) of Propofol in Adult Patients with Saline-Propofol, Dexmedetomidine-Propofol and Fentanyl - Propofol for Laryngeal Mask Airway Insertion

Introduction: Propofol a short acting intravenous anaestheticis widely used with various adjuncts to facilitate improvedinsertion conditions of Proseal Laryneal Mask Airway(PLMA). We compared the median effective dose (ED 50)propofol requirement and insertion conditions of PLMA withsaline - propofol, dexmedetomidine - propofol and fentanyl -propofol.Material and Methods: This was a prospective randomizeddouble blind study conducted in 100 adult patients of AmericanSociety of Anaesthesiology (ASA) class I/II scheduled toundergo elective surgical procedures. They were randomlyallocated into four groups of 25 each - Group N normal saline,Group F1 fentanyl 1 mcg/kg, Group F2 fentanyl 2mcg/kg andGroup D dexmedetomidine 1mcg/kg. The study drug wasdiluted in 50ml saline and infused over 10 minutes followedby a predetermined dose of propofol as per Dixon’s up anddown method. The ease of PLMA insertion was assessed asper Muzi mouth opening score. Hemodynamic parameterswere observed starting from baseline (T0), at 10 min post testdrug infusion (T1), post propofol injection (T2), 1min postLMA insertion (T3) and till 3 minutes post LMA insertion(T4).Results: The ED50 of propofol for the insertion of PLMAwith normal saline, fentanyl (1mcg/kg), fentanyl (2 mcg/kg)and dexmedetomidine (1mcg/kg) as adjuncts were found outto be 3.25mg/kg, 2mg/kg, and 1.67mg/kg and 1.92mg/kgrespectively. PLMA insertion conditions and hemodynamicparameters were comparable between the four groups. Leastincidence of apnoea was noted in group D with only 8 patientsrequiring assisted ventilation.Conclusion: Dexmedetomidine significantly reduces therequirement of induction dose propofol for PLMA insertionwhile providing stable hemodynamic and excellent insertionconditions

Related factors for ProSeal™ laryngeal mask airway failure / Factores relacionados con insuficiencia de las vías respiratorias con el uso de ProSeal™ laryngeal mask

Abstract Introduction: The laryngeal mask airway (LMA) is a device for airway management that is easy to insert, safe, and efficient. However, there are associated complications that can lead to important patient morbidity and mortality, as ventilator failure, can occur with reported incidence between 0.2% and 4.7%. Male gender, advanced age, obesity, short thyromental distance, and poor dentition are known related factors to LMA failure. Objective: Determine the incidence of ProSeal™ LMA ventilatory failure and identify clinical related conditions. Materials and methods: Observational analytic study a group of adult patients with ProSealTM laryngeal mask for airway management. Statistical analysis was performed using STATA 12.1 software. Bivariate analysis was done using Fisher's exact test or Chi2 as it corresponded with statistical significance defined as P value <0.05. Skewed logistic regression for multivariate analysis was performed for estimating adjusted odd ratios (ORs). Results: Incidence of ProSealTM LMA ventilatory failure was 5.2%. In the group of patients that presented failure, 69 were older than 75 years (OR=1.06, 95% confidence interval [CI] 1.03-1.09, P < 0.001), 6 (23.1%) thyromental distance less than 6 x0200A;cm (OR = 2.48, 95% CI 0.93-6.62, P = 0.069), 5 (19.2%), inadequate anesthetic depth and/or laryngospasm (OR=5.78, 95% CI 2.23-14.96, P< 0.001) and 9 (34.6%) vintraoperative use of neuromuscular blockers (NMB) (OR=2.35, 95% CI 1.06-5.21, P=0.035). Conclusion: In patients with LMA management, the age, intraoperative use of NMB and inadequate anesthetic depth and/ or laryngospasm are clinical related conditions for ProSealTMLMA ventilatory failure.

Resumen Introducción: La mascarilla laríngea de vía aérea (LMA) es un dispositivo para el manejo de la vía aérea fácil de insertar, seguro y eficiente. Sin embargo, hay complicaciones asociadas que pueden llevar a morbilidad y mortalidad del paciente, como la falla del respirador, con una incidencia reportada de entre el 0.2% y el 4.7%. El sexo masculino, la edad avanzada, la obesidad, la corta distancia tiromentoniana y la mala dentición son factores conocidos relacionados con el fracaso de la LMA. Objetivo: Determinar la incidencia de la insuficiencia respiratoria con ProSeal™ LMA e identificar las condiciones clínicas relacionadas. Materiales y métodos: Estudio analítico observacional de un grupo de pacientes adultos con uso de ProSeal™ Laryngeal Mask para el manejo de las vías respiratorias. El análisis estadístico se realizó utilizando el software STATA 12.1©. El análisis bivariado se realizó utilizando la prueba exacta de Fisher o Chi2, ya que correspondía a la significación estadística definida como valor de p < 0.05. Se realizó una regresión logística sesgada para el análisis multivariado, con el fin de estimar las proporciones impares ajustadas (OR). Resultados: La incidencia de fallo ventilatorio de ProSeal™ LMA fue del 5.2%. En el grupo de pacientes que presentaron fracaso, 69 eran mayores de 75 años (OR = 1.06; IC del 95%: 1.03 a 1.09; p < 0.001), 6 pacientes (23.1%) tenían distancia tiromentoniana inferior a 6 cm (OR = 2.48; IC del 95%: 0.93 a 6.62, p = 0.069), 5 (19.2%) presentaron profundidad inadecuada del anestésico y/o laringoespasmo (OR = 5.78; IC del 95%: 2.23 a 14.96; p < 0.001) y en 9 (34.6%) hubo uso intraoperatorio de NMB (OR = 2.35; IC del 95%: 1.06 a 5.21; p = 0.035). Conclusión: En pacientes con manejo de la LMA, la edad, el uso intraoperatorio de la NMB y la profundidad anestésica inadecuada y/o laringoespasmo son condiciones clínicas relacionadas con la insuficiencia respiratoria de la LMA ProSeal™.

Comparison of ProSeal laryngeal mask airway, classical laryngeal mask airway with endotracheal tube in gynecological laparoscopy under controlled ventilation

Background: PLMA is a recent, complex, and ingenious development with some added feature of classic LMA like modified dual cuff, drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of classical laryngeal mask airway, ProSeal laryngeal mask airway, and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure.Methods: About 150 patients, ASA risk I and II, posted for elective gynecological laparoscopy were recruited in the study. All the patients between 18 to 45years of age were randomly divided in three groups, group PLMA, group CLMA, group ETT (50 patients each). Attempt of insertion of airway device, leaks pressure, pulmonary ventilation, hemodynamic; heart and MAP, gastric distention was recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in all the groups.Results: Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia. Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before and after pneumoperitonium were comparable in all three groups. After head low position peak airway pressure is slightly raised in group PLMA, group CLMA. Gastric distension was noted higher in group 10 % as compare to group PLMA (8%) and group (2%). Incidence of sore throat (22%), nausea vomiting (14%) and airway trauma (14%) was higher in group ETT.Conclusions: Hemodynamic stability was better in and CLMA group at time of induction and comparable in all three groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post-operative sore throat, nausea vomiting was higher with

A comparative study of Baska mask vs proseal LMA in elective sterilization surgeries

Introduction: Baska mask is a 3rd generation Supraglottic Airway Device (SGA). One of the major limitations of the SGA device is the risk of aspiration. Aim of the study: Evaluate the advantages of Baska mask over Proseal LMA in providing adequate laryngeal seal and ease of insertion. Materials and methods: A Randomized prospective single-blinded study. A study group of 40 female patients recruited and divided into 2 groups. Group I (BM-Baska Mask) with 20 patients and Group II (PLM- Proseal LMA) with 20 patients. All patients received general anesthesia with control ventilation. SGA device insertion was done once patients were anesthetized. Baseline intraoperative hemodynamic parameters and capnography were monitored. The ease of insertion was assessed by a number of attempts, time of insertion and any extra maneuver required. The airway pressure calculated as the plateau pressure with fresh gas flow at 6L and APL valve at 70cm H20. In Proseal LMA it was calculated using a handheld manometer. Results: The success rate of insertion was comparable in 2 groups. The mean time for insertion was 13.3 s while it was 19.7s for PLMA (Pvalue of 0`001). The mean airway sealing pressure was significantly higher in the BM group (p= 0.000). The seal pressure ranged from 20 -29 and 24 -37 in group I and II respectively with P value of 0.001 which makes it significant. There was no significant post-operative laryngopharyngeal morbidity in both groups. Conclusion: Baska mask provides an adequate seal with better ease of insertion when compared to Proseal LMA.

Comparison of I-gel and ProSeal laryngeal mask airway during volume controlled ventilation

Introduction: I-gel and the ProSeal laryngeal mask airway (PLMA) are two supra-glottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of I-gel compared with PLMA for airway maintenance in patients under general anesthesia with controlled ventilation. The aim of the study: To compare the supra-glottic airway devices, I-Gel and ProSeal Laryngeal mask airway with respect to Ease of insertion, Time taken for insertion, Airway leak pressure, Hemodynamic response during intubation. Materials and methods: A total number of, 40 patients were randomized into two groups of 20 each. After induction of anesthesia using a standardized protocol for all the patients, one of the supra-glottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion, airway leak pressure, hemodynamic changes, were noted. Results: There was no significant difference in the incidence of adverse effects in both the groups. One incidence of airway trauma was noted in I-gel group. No gastric insufflations and laryngo or bronchospasm in both groups. Conclusion: Based on the result of our study we conclude that I-gel had an acceptable airway leak pressure of 23 cm H2O when compared to ProSeal whose airway leak pressure is significantly higher i-e 29 cm H2O.Both the devices provided optimal oxygenation and no fall in saturation was observed in both the groups.

Simple method for determining the size of the ProSeal laryngeal mask airway in children: a prospective observational study / Método simples para determinar o tamanho da máscara laríngea ProSeal em crianças: um estudo observacional, prospectivo

Abstract Background and objectives: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children. Methods: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics. Results: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics. Conclusions: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations.

Resumo Justificativa e objetivos: O tamanho da máscara laríngea ProSeal (MLPS) em crianças é determinado com base no peso do paciente. No entanto, em alguns casos, pode ser necessário um método opcional. Este estudo teve como objetivo comparar o tamanho da MLPS convencional pela orelha e pelo peso em crianças. Métodos: Após aprovação do Comitê de Ética institucional e receber o consentimento informado assinado pelos pais, 197 crianças com estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), programadas para uma operação geniturinária de rotina, foram incluídas no estudo. O tamanho correto da MLPS foi determinado de acordo com o tamanho da orelha em crianças. Os resultados foram comparados com os do método padrão, baseado no peso, recomendado pelas diretrizes do fabricante. Os pacientes foram classificados em diferentes grupos, a depender dos tamanhos das MLPS, conforme determinado por ambos os métodos. A concordância entre as duas técnicas foi avaliada com as estatísticas do coeficiente kappa (k). Resultados: Inserção e ventilação adequada foram obtidas em 185 pacientes na primeira tentativa e 12 pacientes precisaram de uma segunda tentativa. Três pacientes precisaram ser intubados. A concordância entre os dois métodos de seleção do tamanho da MLPS foi moderada com a estatística κ. Conclusões: A escolha do tamanho da MLPS em crianças de acordo com a orelha da criança é válida e prática. Em particular, é um método opcional em situações nas quais o peso do paciente é desconhecido, como em situações de emergência.

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS) / Comparação da concentração de sevoflurano para a inserção de ML proseal e intubação traqueal em crianças (correlação com BIS)

BACKGROUND: Sevoflurane is an inhalational agent of choice in paediatric anaesthesia. For management of airways in children a suitable alternative to ETT is a paediatric proseal laryngeal mask airway (benchmark second generation SAD). Various studies have shown that less sevoflurane concentration is required for LMA insertion in comparison to TI. BIS is a useful monitor of depth of anaesthesia. AIMS: To compare concentration of sevoflurane (end tidal and MAC value) required for proseal laryngeal mask airway insertion and tracheal intubation in correlation with BIS index. METHOD: The prospective randomised single blind study was done in children between 2 and 9 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation). No sedative premedication was given. Induction was done with 8% sevoflurane and then predetermined concentration was maintained for 10 min. Airway was secured either by proseal laryngeal mask airway or endotracheal tube without using muscle relaxant. End tidal sevoflurane concentration, MAC, BIS, and other vital parameters were monitored every minute till insertion of an airway device. Insertion conditions were observed. Statistical analysis was done by ANOVA and Students t test. RESULTS: Difference between ETLMI (2.49 ± 0.44) and ETTI (2.81 ± 0.65) as well as MACLMI (1.67 ± 0.13) and MACTI (1.77 ± 0.43) was statistically very significant, while BISLMI (49.05 ± 10.76) and BISTI (41.25 ± 3.25) was significant. Insertion conditions were comparable in both the groups. CONCLUSION: We can conclude that in children airway can be secured safely with proseal laryngeal mask airway using less sevoflurane concentration in comparison to tracheal intubation and this was supported by BIS index.

JUSTIFICATIVA: Sevoflurano é um agente inalatório de escolha em anestesia pediátrica. Para o manejo de vias aéreas em crianças, uma opção adequada para o TET é uma MLP pediátrica (referência de segunda geração SAD). Vários estudos mostraram que uma menor concentração do sevoflurano é necessária para a inserção da ML em comparação com a IT. O BIS é um monitor útil da profundidade da anestesia. OBJETIVOS: Comparar a concentração de sevoflurano (valores no fim da expiração e da CAM) necessária para a inserção de MLP e intubação traqueal em correlação com o BIS. MÉTODO: Estudo prospectivo, randômico e cego conduzido com crianças entre 2-9 anos, estado físico ASA I-II, randomicamente alocados nos grupos P (inserção de MLP) e IT (intubação traqueal). Pré-medicação sedativa não foi administrada. A indução foi feita com sevoflurano a 8% e, em seguida, a concentração predeterminada foi mantida durante 10 minutos. A via aérea foi garantida por MLP ou tubo endotraqueal, sem o uso de relaxante muscular. A concentração de sevoflurano no fim da expiração, CAM, BIS e outros parâmetros vitais foram monitorados a cada minuto até a inserção do dispositivo respiratório. As condições de inserção foram observadas. A análise estatística foi feita com o teste t de Student e Anova. RESULTADOS: As diferenças entre TEIML (2,49 ± 0,44) e TEIT (2,81 ± 0,65), bem como CAMIML (1,67 ± 0,13) e CAMIT (1,77 ± 0,43), foram estatisticamente muito significativas; enquanto BISIML (49,05 ± 10,76) e BISIT (41,25 ± 3,25) foram significativos. As condições de inserção foram comparáveis em ambos os grupos. CONCLUSÃO: Podermos concluir que a MLP em comparação com a intubação traqueal pode ser segura para a via aérea de crianças com o uso de menos concentração de sevoflurano, o que foi confirmado pelo BIS.

Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery

<p><b>INTRODUCTION</b>The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.</p><p><b>METHODS</b>150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.</p><p><b>RESULTS</b>Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.</p><p><b>CONCLUSION</b>The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.</p>

Máscara laríngea I Gel vs ProSeal en cirugía oncológica de mama / Larynx mask I Gel vs ProSeal in breast oncological surgery

Introducción: los dispositivos supraglóticos inicialmente, sólo se utilizaron para el abordaje de la vía respiratoria anatómicamente difícil. En la actualidad, los anestesiólogos disponen de varios dispositivos supraglóticos para el abordaje de la vía respiratoria. Objetivos: caracterizar comparativamente los desempeños de las máscaras laríngeas I Gel y ProSeal en el abordaje de la vía aérea, en pacientes sujetos a procedimientos de cirugía oncológica de mama. Métodos: se realizó un estudio prospectivo caso-control simple ciego, aplicado, y de evaluación, en el Hospital "Hermanos Ameijeiras", en el período de septiembre del 2009 y abril del 2012. se estudiaron 200 sujetos intervenidos por procedimientos de cirugía oncológica de mama bajo anestesia general balanceada, asignados al azar a partes iguales a cada grupo. Resultados: los dos grupos investigados presentaron similitud estadística respecto a: edad, peso corporal, estado físico, y tiempo quirúrgico. El tiempo de inserción de la máscara en el grupo Estudio fue significativamente inferior que en el grupo Control. Los valores promedio de la P1 y del Volumen de fuga fueron significativamente superiores en el grupo Control en cada uno de los instantes analizados. Los valores promedio de la PAM y la FC pertenecientes a los grupos Estudio y Control se revelaron sin diferencias estadísticamente significativas. La única complicación postoperatoria inmediata con desenlaces significativamente diferentes para los grupos fue la Disfagia leve, la cual estuvo ausente en el grupo Estudio. Conclusiones: el desempeño de la máscara laríngea I Gel fue significativamente superior al de la máscara laríngea ProSeal.

Introduction: the supraglottic devises were initiallly used only for the respiratory via boarding anatomically diffcult. Today, anesthesiologists arrange different supraglottic for the respiratory via boarding. Objective: to characterize comparatively the performances of the larynx masks I Gel and ProSeal in the boarding of the air passage in patients subject to procedures of breast oncological surgery. Methods: a case control prospective control study blind was carried out at "Hermanos Ameijeiras" Hospital during the period from September 2009 to April 2012.200 subjects intervened were studied with procedures of ontological breast surgery under general balanced anesthesia at random with equal parts in each group. Results: both groups searched presented similar statistics as to age, body weight, physical condition and surgical time. The time of insertion of the mask in the study was significantly inferior to the control group. The average values of P1 and the volume of escape were significantly higher in the control group in each of the moments analyzed. The average values of the PAM and the FC belonging to study and control groups were revealed without significant statistical differences. The only postoperative immediate complication with significant difference outcome for the groups were light swallowing which was absent in the study group. Conclusion: the performance of the larynx mask I Gel was significantly higher than the larynx mask ProSeal.

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.

Laryngeal mask airway (LMA-ProSeal™) malfunction causing acute airway obstruction

The Laryngeal Mask Airway ProSeal™ (LMA-ProSeal™; Laryngeal Mask Company Limited) is a reusable supraglottic airway device developed to enhance supraglottic airway protection and extend the benefits of the classic LMA (Laryngeal Mask Airway) to greater number of patients. Added features include an additional drain tube to channel fluid away from the airway and a tighter seal against the glottic opening with no increase in mucosal pressure. Clinicians have extended the use of the LMA-ProSeal™ inside and outside the operating theatre including use for difficult airway management and airway rescue. However, even these new devices have their limitations. We report an unforeseen acute airway obstruction caused by LMA-ProSeal™ malfunction during ophthalmic surgery. The cuff of the device was deformed with herniation to one side upon insufflation of the balloon.

Safety and effectiveness of ProSeal laryngeal mask airway in posterior spinal surgery / 中国医师进修杂志

Objective To explore the effect iveness and safety of ProSeal laryngeal mask(PLMA)used in posterior spinal surgery. Methods Forty ASA Ⅰ - Ⅱ patients of thoracic-lumbar fracture were randomly divided into PLMA group and tracheal intubation (TI) group by systematic sampling with 20 cases each. PLMA or TI was inserted after intravenous anesthesia induction. The number of intubation, intubation time and time to surgery were recorded, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded induction (To), during intubation (T1), at 1 min (T2),3 min(T3), 5 min (T4), 10 min after intubation (T5), during extubation (T6). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage were recorded. Results All patients in PLMA group and TI group achieved satisfactory lung ventilation at the first attempt. There were no significant difference in the number of intubation, intubation time and time to surgery between two groups (P ＞ 0.05 ).SBP,DBP,HR at T1,T2,T3,T6 in TI group were significandy higher than To and those in PLMA group (P＜0.05). The intubation, extubation, and the maintain ventilation process of the respiratory and respiratory damage in TI group (5,25,36 cases) were more than those in PLMA group (0,1,6 cases)(P ＜0.05).Conclusion PLMA for posterior spinal surgery is safe and effective.

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.

Bilateral symmetric lacerations of the soft palate after general anesthesia using the laryngeal mask airway ProSeal(TM): A case report / 대한마취과학회지

ProSeal(TM) laryngeal mask airway (PLMA) was developed to be more effective especially with glottic airway sealing and is suppose to be an improved device over the classic laryngeal mask airway (cLMA). The PLMA's cuff is bulkier, softer, and more pliable than the cLMA. We reviewed a case were a patient had hand surgery under general anesthesia using the PLMA. After having the hand surgery, the patient suffered from dyspnea and had difficulty with their respirations at a supine position. The problems with dyspnea and respiration after surgery resulted because of difficulties from inserting PLMA No.5 into the patient. We suspect from this case that the problems in dyspnea and respiration were due to the folded cuff and incomplete placement of the PLMA, which resulted in lacerations of the mucosa in the soft palate of the patient. In this paper, we considered the probable causes for lacerations of the mucosa in the soft palate and reviewed all of the relevant literature, especially about the proper placement of the PLMA.

Comparison between the index finger insertion and catheter-guided insertion techniques for airway placement of a ProSeal(TM) laryngeal mask by inexperienced personnel / 대한마취과학회지

BACKGROUND: Insertion of a ProSeal(TM) laryngeal mask airway (PLMA(TM)) by experienced users was more successful with using a catheter-guided (CG) technique than a digital technique. The purpose of this study is to assess the efficacy of the CG insertion technique for a PLMA(TM) by inexperienced personnel. METHODS: Forty patients aged 18-65 yr and who were undergoing general anesthesia were randomly allocated to the index finger (IF) or CG insertion techniques for PLMA(TM) insertion. The IF technique was performed with the routine insertion technique. The CG technique was performed using a catheter inserted PLMA(TM), which was primed into the drain tube of the PLMA(TM) with using a soft flexible catheter. Successful insertion was primarily judged by the clinical function of the airway. The number of insertion attempts and the insertion time were recorded. Postoperative airway morbidity (sore throat, dysphonia, dysphagia) was assessed at 24 hr postoperatively. RESULTS: The success rate was similar between the groups (IF, 18/20; CG, 15/20). The successful insertion time (the time to provide an effective airway) was similar between the groups but the insertion time at the first attempt was shorter for the IF technique (IF, 21.6 +/- 5.3 s; CG, 27.4 +/- 10.3 s). There were no differences between the groups for the postoperative airway morbidity. CONCLUSIONS: This study suggests that the CG insertion technique is not a useful alternative technique for inexperienced personnel.

Tearing of the lingual frenulum caused by insertion of the proSeal LMA in a child: A case report / 대한마취과학회지

The laryngeal mask airway (LMA) is widely used as an adjunctive airway device composed of a tube with a cuffed mask-like projection on the distal end. The LMA is simple to use and less invasive to pharynx and larynx than endotracheal tube. The LMA is inserted blindly into the hypopharynx, forms a low pressure seal around the laryngeal inlet. It is minimally stimulating the airway. Microscopic mucosal injuries are common during laryngeal mask airway (LMA) insertion but macroscopic injuries are rare and few have been reported with the ProSeal LMA. This report describes a case of the tearing of the lingual frenulum incidentally caused by insertion of the ProSeal LMA in a child.

Median effective dose of remifentanil for ProSeal laryngeal mask airway tolerance in adult / 临床麻醉学杂志

Objective To determine the median effective dose of remifentanil for maintaining the tolerance to ProSeal laryngeal mask airway in awake and spontaneously breathing patients.Methods Sixty ASA Ⅰ orⅡpatients aged 20-55 years old were recruited.Sixty patients was randomized into six groups with 10 case each Remifentanil was infused in a dose of 0.061,0.048,0.039,0.03,0.025 or 0.02μg·kg~(-1) 5 minutes after inserting PLMA.Single dose of remifentanil 0.25/μg/kg was given before continuous intravenous infusion.Respiratory response subscore of comfort scale(CSRR)and Ramsay sedation scale(RSS)were recorded after 25 minutes.ED50 was calculated.Results The ED50 of remifentanil for ProSeal laryngeal mask airway tolerance was 0.027μg·kg~(-1)(95%CI:0.023-0.030μg·kg~(-1)·min~(-1)in awake and spontaneously breathing patients.Conclusion The patients tolerate stimulus of laryngeal mask with a low dose continuous intravenous infusion of remifentanil in awake.and can maintain the hemodynamics stable.

Role of LMA \u2013 Proseal in anesthesia for laparoscopic surgery

Background: Is Laryngeal Mask Airway (LMA) Proseal superior over Endo Tracheal Tube (ETT) in anesthesia for laparoscopic surgery? Objective: (1) To evaluate the effect of LMA Proseal on blood pressure, heart rate and respiration in laparoscopic surgery. (2) To evaluate the surgical condition and side effects of LMA Proseal. Subject and Method: A single blind control study was done for 60 patients at Viet Duc Hospital. Patients were divided into 2 groups: LMA Proseal group (30 patients) and control group (30 patients). Blood pressure, heart rate, SpO2, PetCO2, Pmax and Vh were monitored after laparoscopic surgery. Results: Compared with ETT, LMA Proseal attenuates the increase in blood pressure and heart rate; SpO2, PetCO2, Pmax and Vh are stable within safe limits like ETT. Conclusions: LMA Proseal provides stability for blood pressure, heart rate and respiration while facilitating surgical conditions and reducing postoperative side effects.