RESUMEN
Background and Aims: The laryngeal mask airway ProSeal (PLMA) insertion should be easy, fast, and atraumatic. Most studies have been done on adults who cannot be considered as the reflection of pediatric patients. In this study, we compared the first attempt success rate of three techniques of PLMA insertion: introducer, 90° rotation, and pharyngoscopy technique in the pediatric population. Material and Methods: In this prospective comparative randomized study, a total of 135 patients of American Society of Anesthesiology grade I and II, aged three to eleven years, with normal airways scheduled for elective surgery, were randomly allocated into three groups: introducer, 90° rotation, and pharyngoscopy group. Parameters evaluated were: first attempt insertion success rate, insertion time, ease of insertion score, hemodynamic parameters, oropharyngeal seal pressure, manipulations, PLMA blood staining, postoperative sore throat, and hoarseness. Results: First attempt insertion success rate was higher in the 90° rotation (97.78%) and pharyngoscopy (97.78%) group as compared to the introducer group (93.33%). But the result was not statistically significant. PLMA insertion time was the least in the rotation group, followed by the pharyngoscopy and introducer group (P < 0.0001). Mean arterial pressure and heart rate were significantly raised in the pharyngoscopy versus rotation group and the introducer versus 90° rotation group after PLMA insertion. Oropharyngeal seal pressure was significantly higher in the introducer as compared to the rotation group (P = 0.007). Conclusion: All three techniques had a high first-attempt insertion success rate. As the rotation technique had the best result in insertion time and hemodynamic response, it may be considered a good alternative to pharyngoscopy and introducer technique in pediatric patients of age three to eleven years with a normal airway.
RESUMEN
BACKGROUND: Airway management is the most essential skill in Anesthesiology and the inability to secure the airway is one of the most common reasons for anesthesia-related morbidity and mortality. This study aimed to evaluate and compare the insertion characteristics of laryngeal mask airway (LMA) ProSeal insertion using the standard introducer technique, 90-degree rotation technique, and 180-degree rotation technique in adult patients undergoing elective surgery. MATERIAL AND METHOD: This prospective, interventional, randomized, comparative study was carried out in the Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, after obtaining hospital ethical committee approval for 18 months of duration. Patients in the age group 18-65 years, of either gender, fulfilling American Society of Anesthesiologists grade I or II criteria, scheduled for elective surgery under general anesthesia with controlled ventilation using the LMA ProSeal were included in the study. The patients were randomized into three groups: Group I - Standard Introducer technique (n=40); Group NR - 90-degree rotation technique (n=40); Group RR - 180-degree rotation technique or back to front (airway) technique (n=40). RESULT: In this study, the majority (73.3%) of the patients were females with 31 patients in group I, 29 patients in group NR, and 28 patients in group RR. A total of 26.67% of male patients were included in the study. No significant difference in the gender distribution of the three groups was seen in the study. There was no incidence of failure in ProSeal laryngeal mask airway (PLMA) insertion in the NR group, while it was 2.50% in group I and 7.50% in group RR but the difference was not statistically significant. A statistically significant difference was seen in the incidence of LMA ProSeal blood staining (p=0.013). In the post-anesthesia care unit at 1 hour, the incidence of sore throat was 10% in patients with the NR group, 30% in the I group, and 35.44% in the RR group which was statistically significant. CONCLUSION: The study concluded that the 90-degree rotation technique was superior to both the 180-degree rotation and the introducer technique in adult patients in terms of insertion time, ease of insertion score, manipulation requirement, blood staining of PLMA, and post-op sore throat.
RESUMEN
BACKGROUND: The present study was undertaken to compare and evaluate the efficacy of intravenous (IV) fentanyl and lignocaine airway nebulization and a combination of both in attenuating the hemodynamic response to laryngoscopy and tracheal intubation. MATERIALS AND METHODS: Ninety-six patients of either sex aged between 18 and 65 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included in the study. Patients were randomly divided into three groups. Group F received IV fentanyl 2 µg/kg, Group L received nebulization with 3 mg/kg of 4% lignocaine, and Group FL received both nebulization with 3 mg/kg of 4% lignocaine and IV fentanyl 2 µg/kg before intubation. Hemodynamic parameters were noted before and immediately after induction, 1 min after intubation, and every minute after intubation for 10 min. RESULTS: Hemodynamic response to laryngoscopy and intubation was not completely abolished in any of the groups. Nebulized lignocaine was least effective in attenuating hemodynamic response to intubation, and hemodynamic parameters were significantly high after intubation as compared to other groups. Fentanyl alone or in combination with nebulized lignocaine was most effective, and Group F and Group FL were comparable. The maximum increase in mean blood pressure after intubation from baseline in Groups F, L, and FL was 7.4%, 14.6%, and 5.4%, respectively. CONCLUSION: In our study, IV fentanyl 2 µg/kg administered 5 min before induction was found to be the most effective in attenuating the hemodynamic response. There was no advantage to the use of nebulized lignocaine in attenuating the hemodynamic response to laryngoscopy and intubation.
RESUMEN
AIM: To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications. STUDY DESIGN: This prospective, randomized study was conducted in 80 patients [Group I - I-gel insertion (n = 40) and Group P - LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications. MATERIALS AND METHODS: All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted. STATISTICAL ANALYSIS: Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used. RESULT: Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H2O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H2O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.