Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps.

We experienced a case of successful nasotracheal intubation using the X-Blade of the McGrath MAC in a 28-year-old woman with a 2.5-cm mouth opening. She had no teeth on the right side, her neck movement was limited, her mandibular protrusion was grade C, and her Mallampati could not be evaluated. Her tongue was fixed to the left wall during a previous surgery. We evaluated the awake glottic view using the McGrath MAC X-Blade and topical oral anesthesia. We obtained a Cormack-Lehane grade II view and then decided to administer general anesthesia. Intubation was attempted with a Macintosh laryngoscope, but we could not insert the scope deeply enough and there was no area in which to insert the Magill forceps or endotracheal tube. We then used the X-Blade 3 of the McGrath MAC and obtained a sufficient area in which to insert the tube and manipulate the Magill forceps. A laryngoscopic view was achieved in 7 s and nasotracheal intubation was performed in 16 s with a 7.0-mm spiral tube using the Magill forceps. McGrath MAC X-Blade can be used with the Magill forceps in patients with restricted mouth opening with careful patient selection, in experienced hands.

Comparison of ProSeal LMA with Supreme LMA in paediatric patients.

BACKGROUND AND OBJECTIVE: Supreme laryngeal mask airway (S-LMA) has been improved in recent years, but comparative studies with a sizeable number of paediatric patients are limited in number. In this study, oropharyngeal leak pressures (OLPs) were compared between S-LMA and ProSeal laryngeal mask airway (P-LMA) in paediatric patients. METHODS: After obtaining approval from the ethics committee and written informed consent from the relatives of the patients, 60 patients, from 9 months to 5 years of age and 10-20 kg in weight, who were recommended for elective surgery were included in this prospective and randomised study. The patients were assigned to the S-LMA and P-LMA groups. OLP, insertion times, success rates, ease of airway device placement, fibre optical assessment, success rates and insertion times of an orogastric tube (OGT) were compared. RESULTS: P-LMA was placed successfully in all the patients. One patient was intubated in the S-LMA group. The outcomes of a total of 59 patients were analysed. The insertion times of the airway devices were shorter in the S-LMA group than in the P-LMA group (S-LMA; 12.2 ± 2.9, P-LMA; 15.4 ± 3.7 s) (P = 0.001). The first insertion attempts of airway device placement were similar. The OLPs were similar (P-LMA; 17.2 ± 2.3, S-LMA; 16.4 ± 1.7 cm H2 O). The fibre-optically determined anatomic position was better in the P-LMA group (P = 0.02). The insertion time of the OGT was shorter with S-LMA than with P-LMA (P = 0.01). CONCLUSION: Our findings suggest that S-LMA has OLPs similar to those of P-LMA in paediatric patients and that S-LMA provides successful positive pressure ventilation.

Tracheal intubation in morbidly obese patients: a comparison of the Intubating Laryngeal Mask Airway™ and Laryngeal Mask Airway CTrach™.

The aim of this study was to evaluate the efficacy of the Intubating Laryngeal Mask Airway™ (ILMA) and Laryngeal Mask Airway CTrach™ (LMA CTrach) in facilitating tracheal intubation in morbidly obese patients. Eighty patients (body mass index >40 kg x m(-2)) were randomly allocated to the ILMA or the LMA CTrach. The median (IQR [range]) total time taken for tracheal intubation was shorter with the ILMA than with the LMA CTrach (78 (63-105 [40-265]) s vs 128 (98-221 [60-423]) s, respectively; p<0.001). Significantly more manoeuvres were applied for the satisfactory ventilation and viewing of the glottis with the LMA CTrach (25% vs 55% with the ILMA; p=0.006). During the postoperative period, there was more sore throat with the LMA CTrach (p<0.02). We conclude that the ILMA results in shorter intubation times with fewer manoeuvres and sore throat compared with the LMA CTrach in the morbidly obese.

Comparison of the effect of LMA and ETT on ventilation and intragastric pressure in pediatric laparoscopic procedures.

BACKGROUND: The aim of our study was to compare classic laryngeal mask airway (LMA-C) with the endotracheal tube (ETT) in pediatric laparoscopic surgery to evaluate the intragastric pressures (IGP) using intragastric pressure monitoring. We also sought to investigate the related influence on respiratory parameters. METHODS: The Ethics Committee of the Health Institution approved the study protocol. A total of 40 patients, ASA I-II, three and a half months to 12 years old were included in this randomized study. Two study groups were formed: the ETT group and the LMA-C group. A nasogastric tube was inserted following induction to evacuate any intragastric gas and fluid before application of either LMA-C or ETT. The change in IGP was measured with a transducer, which was attached to the nasogastric tube. IGP, peak airway pressures (PAP), SPO2 and ETCO2 were recorded. Repeated ANOVA measures were used to evaluate the change in IGP, PAP, SPO2 and ETCO2 times in both groups. RESULTS: The change in IGP was not significant among the groups except at 15 and 30 minutes (P<0.05). The changes in PAP, SPO2, and ETCO2 levels were not significant. CONCLUSION: The perioperative intragastric pressure evaluation failed to show any significant change in intragastric pressures and ventilation parameters due to the application of LMA-C in this study. We advocate LMA-C application as a feasible anesthetic device in pediatric laparoscopic surgery.

Prospective case control comparison of fetal intrapartum oxygen saturations during epidural analgesia.

BACKGROUND: The purpose of this study was to compare fetal oxygen saturation by fetal pulse oximetry in parturients with and without epidural labor analgesia in a prospective case control study. METHODS: Fetal oxygen saturation values were compared in term pregnant women who received epidural analgesia (epidural group) with those in women who did not (control group). Mode of delivery, Apgar score, fetal oxygen saturation, cord blood gas analysis and fetal outcomes were also compared. RESULTS: A total of 150 pregnant women (75 in each group) gave written consent and were enrolled. The average fetal oxygen saturation during the first stage of labor (active phase) was 45.6 +/- 8.1% for the epidural group and 45.9 +/- 7.4% for the control group (NS); saturations for the second stage of labor were 44.9 +/- 8.8% and 45.3 +/- 6.7%, respectively (NS). In the epidural group, the duration of the first stage of labor was significantly longer (565 +/- 217 min) than the control group (434 +/- 222 min; P= 0.001). Cesarean delivery rates, neonatal cord blood gas analysis, Apgar scores, and neonatal outcomes were similar in the two groups. CONCLUSIONS: Fetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia.

A new supraglottic airway device: LMA-supreme, comparison with LMA-Proseal.

BACKGROUND AND OBJECTIVE: The LMA-Supreme() (S-LMA()) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Proseal() (P-LMA()) and S-LMA(). METHODS: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMA() (n=30) or S-LMA() (n=30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H(2)O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. RESULTS: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMA(), n=1; S-LMA(), n=1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMA(), n=1) due to failed OGT placement. OLPs were similar (P-LMA(); 26.9+/-6.6 S-LMA(); 26.1+/-5.2). ICP increased significantly in the P-LMA() at the 30 and 60 min during anesthesia (P-LMA(); 80.1+/-12.8, 92.9+/-14.4, S-LMA(); 68.3+/-10.9, 73.7+/-15.6). OGT placement was successful in all patients in the S-LMA(), but failed in five patients in the P-LMA() (P=0.02). Fiberoptically determined anatomic position was better with the P-LMA() (P=0.03). CONCLUSION: Our findings suggest that S-LMA() had leak pressures similar to the P-LMA(), and this new airway device proved to be successful during both spontaneous and positive pressure ventilation.

Spinal anesthesia for arthroscopic knee surgery.

BACKGROUND AND OBJECTIVE: The purpose of the study was to compare the effects of adding 50 microg of morphine, 25 microg of fentanyl or saline to 6 mg of hyperbaric bupivacaine on postoperative analgesia and time to urination in patients undergoing arthroscopic knee surgery under spinal anesthesia. METHODS: The study was designed in a prospective, randomized, double-blinded and placebo-controlled manner. Sixty ASA I-II patients were randomized into the following three groups: Group BM: 6 mg of bupivacaine and 50 microg of morphine, Group BF: 6 mg of bupivacaine and 25 microg of fentanyl, and Group BS: 6 mg of bupivacaine and saline. Selective spinal anesthesia was performed in a lateral decubitus position, with the operative knee dependent for 10 min. RESULTS: In all groups satisfactory anesthesia was provided during the operation. There was a statistically significant difference between all the groups in times to voiding [Group BM 422 +/- 161 min; Group BF 244 +/- 163 min; Group BS 183 +/- 54 min (mean +/- SD)]. The incidence of pruritus was significantly greater in Group BM (80%) and BF (65%) in comparison with Group BS (no pruritus) (P < 0.05). The incidence of nausea was significantly increased in Group BM (35%) in comparison with Group BF (10%) and Group BS (P < 0.05). Analgesic consumption was significantly greater in Group BS in comparison with Groups BM and BF (P < 0.01). CONCLUSIONS: We conclude that during spinal anesthesia even mini-dose intrathecal morphine is not acceptable for outpatient surgery due to side-effects, especially severely prolonged time to urination.