-
Anaesthesia Jun 2016Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age,... (Review)
Review
Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.
Topics: Airway Management; Anti-Inflammatory Agents, Non-Steroidal; Humans; Intubation, Intratracheal; Laryngeal Masks; Lidocaine; Pharyngitis; Postoperative Complications; Risk Factors
PubMed: 27158989
DOI: 10.1111/anae.13438 -
Anesthesia Progress 2018Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With...
Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2-13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8-9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10-18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.
Topics: Adolescent; Adolescent Behavior; Anesthesia Recovery Period; Anesthesia, General; Child; Child Behavior; Child, Preschool; Cooperative Behavior; Dental Care; Female; Humans; Infant; Intubation, Intratracheal; Laryngeal Masks; Male; Pediatric Dentistry; Respiration, Artificial; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30715931
DOI: 10.2344/anpr-65-03-04 -
The New England Journal of Medicine Feb 2019Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial.
METHODS
In a multicenter, randomized trial conducted in seven intensive care units in the United States, we randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. The secondary outcome was the incidence of severe hypoxemia, defined as an oxygen saturation of less than 80%.
RESULTS
Among the 401 patients enrolled, the median lowest oxygen saturation was 96% (interquartile range, 87 to 99) in the bag-mask ventilation group and 93% (interquartile range, 81 to 99) in the no-ventilation group (P = 0.01). A total of 21 patients (10.9%) in the bag-mask ventilation group had severe hypoxemia, as compared with 45 patients (22.8%) in the no-ventilation group (relative risk, 0.48; 95% confidence interval [CI], 0.30 to 0.77). Operator-reported aspiration occurred during 2.5% of intubations in the bag-mask ventilation group and during 4.0% in the no-ventilation group (P = 0.41). The incidence of new opacity on chest radiography in the 48 hours after tracheal intubation was 16.4% and 14.8%, respectively (P = 0.73).
CONCLUSIONS
Among critically ill adults undergoing tracheal intubation, patients receiving bag-mask ventilation had higher oxygen saturations and a lower incidence of severe hypoxemia than those receiving no ventilation. (Funded by Vanderbilt Institute for Clinical and Translational Research and others; PreVent ClinicalTrials.gov number, NCT03026322.).
Topics: Adult; Aged; Critical Illness; Female; Humans; Hypoxia; Intensive Care Units; Intubation, Intratracheal; Laryngeal Masks; Male; Middle Aged; Oxygen; Respiration, Artificial
PubMed: 30779528
DOI: 10.1056/NEJMoa1812405 -
Anaesthesia Nov 2015The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and...
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.
Topics: Airway Management; Algorithms; Anesthesiology; Female; Humans; Intubation, Intratracheal; Laryngeal Masks; Obstetrics; Pregnancy; Societies, Medical
PubMed: 26449292
DOI: 10.1111/anae.13260 -
Respiratory Care Jun 2014Manual ventilation is a basic skill that involves airway assessment, maneuvers to open the airway, and application of simple and complex airway support devices and... (Review)
Review
Manual ventilation is a basic skill that involves airway assessment, maneuvers to open the airway, and application of simple and complex airway support devices and effective positive-pressure ventilation using a bag and mask. An important part of manual ventilation is recognizing its success and when it is difficult or impossible and a higher level of support is necessary to sustain life. Careful airway assessment will help clinicians identify what and when the next step needs to be taken. Often simple airway maneuvers such as the head tilt/chin lift and jaw thrust can achieve a patent airway. Appropriate use of airway adjuncts can further aid the clinician in situations in which airway maneuvers may not be sufficient. Bag-mask ventilation (BMV) plays a vital role in effective manual ventilation, improving both oxygenation and ventilation as well as buying time while preparations are made for endotracheal intubation. There are, however, situations in which BMV may be difficult or impossible. Anticipation and early recognition of these situations allows clinicians to quickly make adjustments to the method of BMV or to employ a more advanced intervention to avoid delays in establishing adequate oxygenation and ventilation.
Topics: Airway Management; Humans; Immobilization; Intubation, Intratracheal; Laryngeal Masks; Life Support Care; Patient Positioning
PubMed: 24891193
DOI: 10.4187/respcare.03060 -
Anaesthesia Oct 2019
Topics: Cohort Studies; Humans; Laryngeal Masks; Masks; Respiration
PubMed: 31106854
DOI: 10.1111/anae.14703 -
Pneumologie (Stuttgart, Germany) Nov 2019
Topics: Humans; Laryngeal Masks; Practice Guidelines as Topic
PubMed: 31715637
DOI: 10.1055/a-0947-3446 -
Drug Design, Development and Therapy 2023This study aimed to evaluate the efficacy and safety of remazolam compared with propofol in patients who underwent laryngeal mask airway (LMA) insertion without the use...
PURPOSE
This study aimed to evaluate the efficacy and safety of remazolam compared with propofol in patients who underwent laryngeal mask airway (LMA) insertion without the use of muscle relaxant agents during hysteroscopic surgery.
PATIENTS AND METHODS
A total of 72 patients undergoing hysteroscopy with LMA insertion were assigned to two groups. The patients in the remazolam group received 0.3 μg/kg sufentanil, 0.3 mg/kg remazolam and 1.2 mg/kg remifentanil, whereas the patients in the propofol group received 0.3 μg/kg sufentanil, 2.0 mg/kg propofol and 1.2 mg/kg remifentanil for insertion of the LMA. The primary endpoint was the summed score of the insertion conditions. The secondary endpoints included hemodynamics, the duration of induction, the duration of insertion, tidal volume, plateau pressure and adverse events.
RESULTS
No difference was identified between the propofol group and remazolam group in the median summed score [18.0 (18.0, 18.0), 18.0 (17.0, 18.0), respectively, > 0.05]. The induction duration was significantly longer ( < 0.05) in the remazolam group than propofol group. The cost of dopamine ( < 0.05) was significantly lower in the remazolam group compared with the patients in the propofol group, while the plateau pressure ( < 0.05) and the incidence of transient mild laryngospasm ( < 0.05) were significantly higher in the remazolam group. No differences were identified between the two groups in terms of heart rate, tidal volume, injection pain or hiccups ( > 0.05).
CONCLUSION
Remazolam provided similar insertion conditions and better hemodynamic stability than propofol during LMA insertion without the use of muscle relaxant agents. However, a higher incidence of transient mild laryngospasm was found in the remazolam group, which should be considered.
Topics: Female; Pregnancy; Humans; Propofol; Anesthetics, Intravenous; Laryngeal Masks; Remifentanil; Hysteroscopy; Sufentanil; Laryngismus; Feasibility Studies; Vasodilator Agents; Muscles
PubMed: 37152102
DOI: 10.2147/DDDT.S408584 -
Journal of Feline Medicine and Surgery Aug 2022Airway management during anaesthesia in cats is always a demanding task and is associated with several complications. The aim of this study was to evaluate the...
OBJECTIVES
Airway management during anaesthesia in cats is always a demanding task and is associated with several complications. The aim of this study was to evaluate the practicability and complications during feline-specific laryngeal mask placement in anaesthetised cats as an alternative to endotracheal intubation.
METHODS
In this prospective clinical study, laryngeal masks were placed in 148 anaesthetised cats. Success of placement was evaluated by capnography.
RESULTS
Placement was possible at the first attempt in 136 cats, at the second attempt in eight cats and at the third attempt in one cat. In one cat, placement was not possible. Two cats were excluded. Failure to position the laryngeal mask at the first attempt was not different between laryngeal mask sizes ( = 0.313) or positioning during placement ( = 0.406). In nine cats, the laryngeal mask dislocated during the procedure. Dislocation occurred more often in the dorsal position than in the sternal ( = 0.018) and right lateral positions ( = 0.046). Mucous obstruction of the laryngeal mask occurred in one of these cats and regurgitation in another. Material-related issues, such as disconnection of the parts of the laryngeal mask and leakage of the balloon, were observed in 2/8 laryngeal masks.
CONCLUSIONS AND RELEVANCE
The placement of a feline-specific laryngeal mask was easy to perform. In about 7% of the cases, replacement of the device was required due to mispositioning or dislocation. Full monitoring, including capnography, should be provided to uncover dislocation and airway obstruction immediately.
Topics: Anesthesia; Animals; Cats; Intubation, Intratracheal; Laryngeal Masks; Prospective Studies
PubMed: 34663126
DOI: 10.1177/1098612X211050612 -
BioMed Research International 2015Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences... (Review)
Review
Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.
Topics: Airway Management; Anesthesia, General; Child; Evidence-Based Medicine; Humans; Intubation, Intratracheal; Laryngeal Masks; Pediatrics; Perioperative Care
PubMed: 26759809
DOI: 10.1155/2015/368761