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Minerva Anestesiologica Feb 2017Second-generation laryngeal masks with gastric access are increasingly used in daily practice and expand the indications for laryngeal masks in the OR. Only limited data... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Second-generation laryngeal masks with gastric access are increasingly used in daily practice and expand the indications for laryngeal masks in the OR. Only limited data exist comparing different types of laryngeal masks. We investigated the second-generation laryngeal masks LMA Supreme™ and Ambu® AuraGain™ in a clinical setting. We hypothesized that the two devices would be comparable in terms of success rate and airway complications.
METHODS
After approval from the local ethics committee, data were collected in a prospective trial. Endpoints were success rate, time to insertion and airway morbidity. Anesthesiologists used either the Supreme (Teleflex Medical GmbH) or Gain (Ambu GmbH) laryngeal mask. Patients <18 years and those with a possible risk of regurgitation were excluded.
RESULTS
Data from 351 adult patients were documented (Supreme N.=177; Gain N.=174). Success rate for first attempt was 80% (Supreme) and 72% (Gain; P=0.08). Overall success rate was 89% and 92%, respectively (P=0.38). Providers with minimal experience were more successful at first attempt using Supreme (95%), compared to Gain (67%; P=0.01). The median insertion time was shorter in Supreme at 18 s [interquartile range (IQR), 14-25 s] compared to 30 s for Gain [18-41s] (P<0.0001). A higher incidence of airway complications was observed after device removal for Gain (P=0.009).
CONCLUSIONS
Supreme was superior to Gain in terms of insertion time and airway morbidity. Novices were more successful at first attempt using Supreme. These differences between supraglottic airway devices might be due to the different shapes and materials of the masks.
Topics: Aged; Airway Management; Anesthesia; Equipment Design; Female; Humans; Laryngeal Masks; Male; Middle Aged; Prospective Studies
PubMed: 27676414
DOI: 10.23736/S0375-9393.16.11112-5 -
Anaesthesia Jan 2006
Topics: Equipment Design; Humans; Laryngeal Masks; Pneumonia, Aspiration; Positive-Pressure Respiration
PubMed: 16409351
DOI: 10.1111/j.1365-2044.2005.04482.x -
Anaesthesia Sep 2016
Topics: Cricoid Cartilage; Intubation, Intratracheal; Laryngeal Masks; Pressure
PubMed: 27523049
DOI: 10.1111/anae.13594 -
Minerva Anestesiologica Mar 2018
Topics: Contraindications; Intubation, Intratracheal; Laryngeal Masks
PubMed: 29469549
DOI: 10.23736/S0375-9393.18.12680-0 -
British Journal of Anaesthesia Jun 2021
Topics: Airway Management; Computer Simulation; Humans; Laryngeal Masks
PubMed: 33836852
DOI: 10.1016/j.bja.2021.03.003 -
Medicine Dec 2023Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations... (Review)
Review
RATIONALE
Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations such as "cannot ventilate" or "cannot ventilate and cannot intubate" during anesthesia induction. Inappropriate airway management in such scenarios can have catastrophic consequences for an anesthetized patient. Here we report a case of sudden, unanticipated difficult mask ventilation caused by an asymptomatic supraglottic mass during sedative induction, which was quickly and effectively relieved by the Heimlich maneuver and chest compression.
PATIENT CONCERNS
We report a rare case of airway crisis occurred during sedative induction in a 63-year-old patient scheduled for a routine flexible bronchoscopy, and no evidence of respiratory difficulty or signs of obstruction was found in preoperative evaluation.
DIAGNOSES
A detailed examination of laryngopharyngeal structure under bronchoscopy revealed a supraglottic soft-tissue mass with a size of 1.6 × 0.8 cm covering the membranous part of the glottic area, which was the true cause of difficult mask ventilation in this patient during sedative induction.
INTERVENTIONS
As the unanticipated difficult mask ventilation occurred, 2-handed mask ventilation was initiated immediately for 9 attempts but failed. Fortunately, the airway crisis was successfully relieved with 2 Heimlich attempts and 3 chest compressions, and no need for a laryngeal mask airway.
OUTCOMES
Once the airway crisis was relieved and the supraglottic mass was confirmed, the patient underwent a second sedative anesthesia and a successful laryngeal mask airway-assisted bronchoscopy, with no post-bronchoscopy adverse events.
LESSONS
Asymptomatic supraglottic masses can cause valve-like upper airway obstruction and lead to unanticipated difficult mask ventilation. The Heimlich maneuver and chest compression may be effective in such critical situations and can serve as an emergency intervention.
Topics: Humans; Middle Aged; Intubation, Intratracheal; Heimlich Maneuver; Laryngeal Masks; Anesthesia, General; Hypnotics and Sedatives
PubMed: 38050299
DOI: 10.1097/MD.0000000000036362 -
Acta Veterinaria Scandinavica Mar 2023Endotracheal intubation in rabbits is challenging and supraglottic airway devices, such as laryngeal masks (LMA), represent an alternative as they are easy to insert,...
Retrospective comparison of the effects of laryngeal mask and endotracheal tube on some cardio-respiratory variables in pet rabbits undergoing anaesthesia for elective gonadectomy.
BACKGROUND
Endotracheal intubation in rabbits is challenging and supraglottic airway devices, such as laryngeal masks (LMA), represent an alternative as they are easy to insert, and do not stimulate the larynx requiring therefore a lighter plane of anaesthesia for their insertion and positioning than the endotracheal tubes. We investigated whether, compared to an endotracheal tube, the LMA can reduce the negative effects of general anaesthetics on some cardiovascular and respiratory parameters routinely monitored in rabbits anaesthetized for elective gonadectomy. The records of 21 adult mixed breed pet rabbits were collected retrospectively. Rabbits were divided in two groups based on the type of airway device used. A laryngeal mask secured the airway in group LMA (n = 11), and in group ETT (n = 10) an endotracheal tube was used. The amount of propofol used before successful insertion of the airway device was recorded. A pitot-based spirometer was connected and ventilatory variables were measured immediately after insertion. Pulse rate, non-invasive arterial blood pressure, haemoglobin oxygen saturation, respiratory rate, end-tidal carbon dioxide and volatile anaesthetic consumption were also monitored during the surgical procedure; extubation time was noted as well.
RESULTS
The use of LMA required significantly less propofol (0.8 to 4 mg/kg) for insertion than the ETT (1.2 to 5.6 mg/kg), and the difference was statistically significant (P < 0.01). No differences were observed in ventilatory variables measured immediately after airway positioning. Intraoperatively, there were no differences between groups for respiratory and cardiovascular variables, and amount of isoflurane administered. In all rabbits mean and diastolic blood pressure progressively decreased during surgery. Mean extubation time was shorter in group LMA (6 ± 2 min) than group ETT (8 ± 3 min, P < 0.01).
CONCLUSION
The airway device did not clinically affect the cardiovascular and respiratory variables during anaesthesia. Intraoperative hypoventilation was observed in most rabbits regardless of the device being used; therefore ventilatory support may be required. Rabbits with the laryngeal masks were extubated earlier.
Topics: Animals; Rabbits; Laryngeal Masks; Retrospective Studies; Propofol; Respiratory Rate; Intubation, Intratracheal; Anesthesia
PubMed: 36859294
DOI: 10.1186/s13028-023-00673-2 -
Anaesthesia Aug 2015
Topics: Disposable Equipment; Equipment Failure; Humans; Intubation, Intratracheal; Laryngeal Masks; Magnetic Resonance Imaging
PubMed: 26152261
DOI: 10.1111/anae.13147 -
The Journal of International Medical... Jun 2016A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSeal™... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSeal™ (Teleflex® Inc., Wayne, PA, USA) and i-gel® (Intersurgical Ltd, Wokingham, UK) in adults undergoing general anesthesia.
METHODS
Searches of MEDLINE®, EMBASE®, CENTRAL, KoreaMed and Google Scholar® were performed. The primary objective was to compare OLP; secondary objectives included comparison of clinical performance and complications.
RESULTS
Fourteen RCTs were included. OLP was significantly higher with LMA ProSeal™ than with i-gel® (mean difference [MD] -2.95 cmH2O; 95% confidence interval [CI] -4.30, -1.60). The i-gel® had shorter device insertion time (MD -3.01 s; 95% CI -5.80, -0.21), and lower incidences of blood on device after removal (risk ratio [RR] 0.32; 95% CI 0.18, 0.56) and sore throat (RR 0.56; 95% CI 0.35, 0.89) than LMA ProSeal™.
CONCLUSION
LMA ProSeal™ provides superior airway sealing compared to i-gel®.
Topics: Adult; Device Removal; Humans; Laryngeal Masks; Pressure; Publication Bias; Randomized Controlled Trials as Topic
PubMed: 27009026
DOI: 10.1177/0300060515607386 -
Anesthesiology Dec 2013
Topics: Female; Humans; Laryngeal Masks; Male
PubMed: 24113647
DOI: 10.1097/ALN.0000000000000016