Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

Introduction: Supraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalization of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this trial is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications. Methods and analysis: This is a multicenter, prospective, interventional cohort study. The enrolment will take place in seven centers in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts, and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months. Ethics and dissemination: The trial has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences.

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Evaluation of the insertion parameters and complications of the i-gel Plus airway device for maintaining patent airway during planned procedures under general anaesthesia: a protocol for a prospective multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2021-053215 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053215

Author(s):

Olga Klementova ◽

Taranpreet Kaur Bhoday ◽

Jakub Werner ◽

Ana M Lopez ◽

Will Donaldson ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Complications ◽

Success Rate ◽

General Anaesthesia ◽

Airway Device ◽

University Hospital ◽

Supraglottic Airway ◽

Military Hospital ◽

Supraglottic Airway Device ◽

Supraglottic Airway Devices

IntroductionSupraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalisation of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this cohort study is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications.Methods and analysisThis is a multicentre, prospective, interventional cohort study. The enrolment will take place in seven centres in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months.Ethics and disseminationThe cohort study has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences.Trial registration numberISRCTN86233693;Pre-results.

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Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study

Anaesthesia ◽

10.1111/anae.15533 ◽

2021 ◽

Author(s):

N. Akhtar ◽

N. Ungureanu ◽

S. Cakir ◽

U. Ansari ◽

T.‐Y. Mohamed ◽

...

Keyword(s):

Observational Study ◽

Temporomandibular Joint ◽

General Anaesthesia ◽

Prospective Observational Study ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Temporomandibular Joint Dysfunction

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Airway Management in Children

10.2310/anes.18002 ◽

2019 ◽

Author(s):

James Peyton ◽

Raymond Park

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Fiberoptic Bronchoscopy ◽

Difficult Tracheal Intubation ◽

Airway Device ◽

Successful Outcome ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Factors Associated ◽

Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references. Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

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Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA in paediatric cases.

International Journal of Medical Research and Review ◽

10.17511/ijmrr.2021.i02.07 ◽

2021 ◽

Vol 9 (2) ◽

pp. 95-101

Author(s):

Dr. Nimish Jain ◽

◽

Dr. Susheela Taxak ◽

Dr. Karampal Singh ◽

◽

...

Keyword(s):

General Anaesthesia ◽

Elective Surgery ◽

Airway Device ◽

Blind Study ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Physical Status ◽

Aim Analysis ◽

American Society ◽

Single Blind

Aim: Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA inpaediatric cases. Methods: We did a prospective, randomised single-blind study on Eighty patientsof either sex belonging to American Society of Anaesthesiologists (ASA) physical status class I or II,between 6 months to 8 years of age, scheduled to undergo elective surgery for less than one andhalf hour duration under general anaesthesia. In this study we analysed the ease of insertion,attempts and time were taken to insert the supraglottic airway device. Results: The ease ofinsertion observed was easy in 39(97.5%) in the i-gel group and 35(87.5%) in cLMA group in ourstudy. The i-gel was placed successfully in 39 out of 40 (97.5%) patients in the first attempt, andachieved 100% insertion on the second attempt. Correct positioning of cLMA in the first attempt wasseen in 35 out of 40 (87.5%) patients. The remaining 5 patients (12.5%) required a secondattempt. The average insertion time of cLMA (12.88 ± 1.771 seconds) was longer than the averagetime of insertion of i-gel (9.48 ± 1.037 seconds), and these differences were highly significantstatistically (p= 0.000). Conclusion: To conclude, i-gel and cLMA is effective and safe devices foruse in children. Both are easy to insert and have insignificant morbidity, however, time taken andattempts of insertions for i-gel was lesser than cLMA. Also, the ease of insertion was relatively easyfor i-gel than cLMA in pediatric cases.

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Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: a retrospective cohort study

European Archives of Paediatric Dentistry ◽

10.1007/s40368-018-0332-1 ◽

2018 ◽

Vol 19 (2) ◽

pp. 99-105 ◽

Cited By ~ 1

Author(s):

M. Grindefjord ◽

J. Persson ◽

L. Jansson ◽

G. Tsilingaridis

Keyword(s):

Cohort Study ◽

Children And Adolescents ◽

General Anaesthesia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Dental Treatment ◽

Caries Prevention ◽

Healthy Children

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For horses undergoing general anaesthesia, are rope recoveries or free recoveries better?

Veterinary Evidence ◽

10.18849/ve.v6i3.451 ◽

2021 ◽

Vol 6 (3) ◽

Author(s):

Ffion Lloyd ◽

Pamela Murison

Keyword(s):

Cohort Study ◽

General Anaesthesia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Controlled Trial ◽

Research Question ◽

Individual Case ◽

Clinical Expertise ◽

Bottom Line ◽

Weak Evidence

PICO question In horses undergoing general anaesthesia, does assistance with ropes result in better recoveries when compared to no assistance (‘free’ recovery)? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed One randomised, non-blinded controlled trial and two retrospective cohort studies Strength of evidence Weak Outcomes reported The three studies reviewed arrive at different conclusions regarding the utility of rope assistance in recovery from general anaesthesia in horses, but examine very different populations. The randomised controlled trial provides weak evidence that rope assistance can shorten recovery and improve recovery quality in healthy (American Society of Anesthesiologists (ASA) I–II) horses. One retrospective cohort study provides weak evidence that rope assistance confers a reduction in fatality in both healthy and sick horses. The other retrospective cohort study provides weak evidence that rope assistance confers no benefit to horses undergoing emergency colic surgery. Both assisted and unassisted groups in each study had fatalities and all studies reported complications related to the rope recovery system Conclusion Insufficient evidence is available to permit a full recommendation regarding rope assistance during recovery from general anaesthesia in horses. Rope assistance may improve recovery time and quality in some horses. The decision to perform a rope-assisted recovery must be made considering individual patient, team and clinic factors. Rope assistance cannot prevent fatalities in recovery How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Faculty Opinions recommendation of Supraglottic airway devices in difficult airway management: a retrospective cohort study of 658,104 general anaesthetics registered in the Danish Anaesthesia Database.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734161864.793551429 ◽

2018 ◽

Author(s):

Andrea Vannucci

Keyword(s):

Cohort Study ◽

Airway Management ◽

Difficult Airway ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Supraglottic Airway ◽

Difficult Airway Management ◽

Supraglottic Airway Devices ◽

Airway Devices

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Intubating Through Supraglottic Airway Devices: A Narrative Review

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113719 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Say Yang Ong ◽

Vanessa Moll ◽

Berthold Moser ◽

Amit Prabhakar ◽

Elyse M. Cornett ◽

...

Keyword(s):

Tracheal Intubation ◽

Endotracheal Tube ◽

Airway Device ◽

Narrative Review ◽

Supraglottic Airway ◽

Successful Intubation ◽

Success Rates ◽

Supraglottic Airway Device ◽

Supraglottic Airway Devices ◽

Consistent Performance

Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.

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