Various Uses of Laryngeal Mask Airway during Tracheal Surgery

2021 ◽  
Author(s):  
Ali Celik ◽  
Muhammet Sayan ◽  
Aykut Kankoc ◽  
Ismail Tombul ◽  
Ismail Cüneyt Kurul ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Laryngeal Mask Airway ◽  
Tracheal Stenosis ◽  
Laryngeal Mask ◽  
Tracheal Resection ◽  
Tracheal Surgery ◽  
The Mean ◽  
End Tidal ◽  
End Tidal Co2

Abstract Background The use of laryngeal mask airway (LMA) ventilation in surgeries to be performed in upper tracheal stenosis has been reported in the case series. However, there is no generally accepted standardized approach for the use of LMA. In this study, LMA usage areas and advantages of trachea surgery were examined. Methods The records of 21 patients who underwent tracheal surgery using LMA ventilation between March 2016 and May 2020 were evaluated retrospectively. The patient data were analyzed according to age, gender, mean follow-up time, surgical indication, mean tracheal resection length, anastomosis duration, mean oxygen saturation, mean end-tidal CO2 levels, and postoperative complications. Results Four patients were female and 17 were male, their median age was 43 (11–72 range) and the mean follow-up time was 17.6 months. The most common surgical indication was postintubation tracheal stenosis. The mean tracheal resection length was 26.6 mm and the mean anastomosis duration was 11.3 minutes. The mean pulse oximetry and mean end-tidal CO2 during laryngeal mask ventilation was 97.6% ± 2.1 and 38.1 ± 2.8 mm Hg, respectively. Postoperative complications were higher in patients with comorbidities. Conclusion LMA-assisted tracheal surgery is a method that can be used safely as a standard technique in the surgery of benign and malignant diseases of both the upper and lower airway performed on pediatric patients, patients with tracheostomy, and suitable patients with tracheoesophageal fistula.

The evolution of the pulmonary arterial sling syndrome, with particular reference to the need for reoperations because of untreated tracheal stenosis

2009 ◽  
Vol 19 (5) ◽  
pp. 446-450 ◽  
Author(s):  
Tsvetomir S. Loukanov ◽  
Christian Sebening ◽  
Wolfgang Springer ◽  
Siegfried Hagl ◽  
Matthias Karck ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Tracheal Stenosis ◽  
Left Pulmonary Artery ◽  
Tracheobronchial Tree ◽  
Tracheal Resection ◽  
Computer Tomography Angiography ◽  
Pulmonary Arterial ◽  
The Mean

AbstractBackgroundWe present a group of infants and children with pulmonary arterial sling and tracheal stenosis. In some of the patients, the anomalously located pulmonary artery had previously been reimplanted, but without simultaneous repair of the trachea.MethodsFrom 1992 to 2007, we reimplanted the left pulmonary artery in 13 children with a pulmonary arterial sling. Their median age was 8 months, with a range from 1 to 72 months. We also performed tracheal resection with end-to-end anastomosis, or complex tracheal reconstructions. In 5 patients, the reoperation was indicated because of persistent tracheal stenosis not treated initially at first correction of the arterial sling. All patients presented with stridor and respiratory distress. Cardiac catheterization, bronchoscopy and multidetecting computer tomography angiography were performed in all cases prior to the operation. All operations were performed under cardiopulmonary bypass.ResultsThere was no operative or late mortality. The patients were extubated under bronchoscopic control. The mean period of intubation was 18 plus or minus 8 days, and the average follow-up was 8 plus or minus 4 years. The patients showed no signs of tracheal re-stenosis clinically or on bronchoscopy. The group of the patients under reoperations, however, required longer periods of intubation and hospitalization.ConclusionOur experience demonstrates that, in patients with a pulmonary arterial sling, any associated tracheal stenosis should be explored at the initial operation, since decompression of the trachea by reimplanting the anomalously located pulmonary artery fails to provide relief. The funnel trachea, if present, undergoes progressive stenosis, and will require surgical repair. The use of cardiopulmonary bypass permitted extensive mobilization of the tracheobronchial tree, and allowed us to perform a tension-free anastomotic reconstruction of the trachea.

scholarly journals The haemodynamic and ventilatory responses with I-gel, laryngeal mask airway and tracheal intubation during laparoscopic cholecystectomy

2013 ◽  
Vol 1 (2) ◽  
pp. 84-90 ◽  
Author(s):  
SK Maharjan
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Tidal Volume ◽  
Tracheal Tube ◽  
Minute Volume ◽  
Laryngeal Mask ◽  
Haemodynamic Stress ◽  
Airway Devices ◽  
End Tidal ◽  
End Tidal Co2

Background: Despite use of adequate medications and techniques, tracheal intubation induces haemodynamic stress response, which can be minimized by using supraglottic airway devices instead of tracheal tube in elective surgical cases with adequate oxygenation and ventilation. Objectives: To compare haemodynamic variables and ventilation parameters of I-gel and laryngeal mask airway with tracheal intubation during laparoscopic surgery. Methods: This is a prospective randomized comparative study among 90 cases of American Society of Anesthesiologists physical status class I and II, undergoing laparoscopic cholecystectomy, who were equally divided into three groups of 30 patients each: I-gel group, Laryngeal mask airway group and Tracheal tube group. Randomization was done with pick up of cards from sealed envelope. Basal readings of heart rate, systolic, diastolic and mean arterial pressure were recorded and these parameters were measured again before airway device placement, one, three and five minutes after airway manipulation, during carboperitoneum creation and before and after extubation. Oxygen saturation, end tidal CO2, airway pressure and inhaled and exhaled tidal volume and minute volume were monitored before, during and after carboperitoneum creation. Leak volume was calculated by deducing exhaled tidal volume from inhaled tidal volume. Statistical analysis (Analysis of variance test) was done to see the differences among the groups. Results: Haemodynamic perturbations were maximum with tracheal intubation and moderate with laryngeal mask airway while stable haemodynamics was observed with I-gel. Intra and inter-group comparison revealed significant differences after use of airway devices and after removal as well. Regarding ventilatory response, oxygenation and ventilation was well maintained with maximum airway pressure of mean ± SD: 20.11 ±3.46, 20.24 ±4.42, 19.05±4.82 cmH2O during carboperitoneum creation in I-gel, laryngeal mask airway and tracheal tube group respectively and oxygen saturation of 98 to 100% and end tidal CO2 level of 31-35 mmHg. In all groups, minute volume was well maintained and leak volume of 18.88±12.40, 17.13±13.32 and 20.89±12.20 ml were recorded in I-gel, laryngeal mask airway and tracheal tube group respectively during carboperitoneum creation. There was no statistically significant difference among the groups at any time regarding the monitored parameters. Conclusion: Among the three airway management devices used during general anaesthesia with positive pressure ventilation, I-gel produced least haemodynamic stress response, both supraglottic devices can be used with proper size and placement with acceptable haemodynamics and ventilation during laparoscopic surgery. DOI: http://dx.doi.org/10.3126/jkmc.v1i2.8143 Journal of Kathmandu Medical College, Vol. 1, No. 2, Oct.-Dec., 2012: 84-90

Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask

2019 ◽  
Vol 68 (05) ◽  
pp. 450-456 ◽  
Author(s):  
Zhengcheng Liu ◽  
Rusong Yang ◽  
Yang Sun
Keyword(s):  
Thoracoscopic Surgery ◽  
Anterior Mediastinum ◽  
Laryngeal Mask ◽  
Double Lumen Tube ◽  
Perioperative Outcomes ◽  
Video Assisted ◽  
Incision Size ◽  
The Mean ◽  
End Tidal ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy. Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared. Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention. Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.

Proseal Laryngeal Mask Airway for the Resection of a High Grade Upper Tracheal Stenosis: A case report

2005 ◽  
Vol 48 (3) ◽  
pp. 315
Author(s):  
Chan Hong Park ◽  
Ho Seung Hyun ◽  
Jin Yong Chung ◽  
Woon Seok Roh ◽  
Bong Il Kim ◽  
...  
Keyword(s):  
Case Report ◽  
Laryngeal Mask Airway ◽  
Tracheal Stenosis ◽  
Proseal Laryngeal Mask Airway ◽  
Laryngeal Mask ◽  
High Grade

Alteration by hyperoxia of ventilatory dynamics during sinusoidal work

1980 ◽  
Vol 48 (6) ◽  
pp. 1083-1091 ◽  
Author(s):  
R. Casaburi ◽  
R. W. Stremel ◽  
B. J. Whipp ◽  
W. L. Beaver ◽  
K. Wasserman
Keyword(s):  
Gas Exchange ◽  
Work Load ◽  
Cycle Ergometer ◽  
Work Rate ◽  
Phase Lag ◽  
Ventilatory Responses ◽  
Load Tests ◽  
The Mean ◽  
End Tidal ◽  
End Tidal Co2

The effects of hyperoxia on ventilatory and gas exchange dynamics were studied utilizing sinusoidal work rate forcings. Five subjects exercised on 14 occasions on a cycle ergometer for 30 min with a sinusoidally varying work load. Tests were performed at seven frequencies of work load during air or 100% O2 inspiration. From the breath-by-breath responses to these tests, dynamic characteristics were analyzed by extracting the mean level, amplitude of oscillation, and phase lag for each six variables with digital computer techniques. Calculation of the time constant (tau) of the ventilatory responses demonstrated that ventilatory kinetics were slower during hyperoxia than during normoxia (P less than 0.025; avg 1.56 and 1.13 min, respectively). Further, for identical work rate fluctuations, end-tidal CO2 tension fluctuations were increased by hyperpoxia. Ventilation during hyperoxia is slower to respond to variations in the level of metabolically produced CO2, presumably because hyperoxia attenuates carotid body output; the arterial CO2 tension is consequently less tightly regulated.

scholarly journals Effect of inhaled carbon dioxide on laryngeal abduction

2015 ◽  
Vol 118 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Jonathan Cheetham ◽  
Amanda Jones ◽  
Manuel Martin-Flores
Keyword(s):  
Laryngeal Mask Airway ◽  
High Speed ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Maximal Response ◽  
High Temporal Resolution ◽  
Respiratory Drive ◽  
Laryngeal Function ◽  
Airway Patency ◽  
End Tidal

Hypercapnia produces a profound effect on respiratory drive and upper airway function to maintain airway patency. Previous work has evaluated the effects of hypercapnia on the sole arytenoid abductor, the posterior cricoarytenoid (PCA), using indirect measures of function, such as electromyography and direct nerve recording. Here we describe a novel method to evaluate PCA function in anesthetized animals and use this method to determine the effects of hypercapnia on PCA function. Eight dogs were anesthetized, and a laryngeal mask airway was used, in combination with high-speed videoendoscopy, to evaluate laryngeal function. A stepwise increase in inspired partial pressure of CO2 produced marked arytenoid abduction above 70-mmHg end-tidal CO2 (ETCO2) ( P < 0.001). Glottic length increased above 80-mmHg ETCO2 ( P < 0.02), and this lead to underrepresentation of changes in glottic area, if standard measures of glottic area (normalized glottic gap area) were used. Use of a known scale to determine absolute glottic area demonstrated no plateau with increasing ETCO2 up to 120 mmHg. Ventilatory parameters also continued to increase with no evidence of a maximal response. In a second anesthetic episode, repeated bursts of transient hypercapnia for 60 s with an ETCO2 of 90 mmHg produced a 43–55% increase in glottic area ( P < 0.001) at or shortly after the end of the hypercapnic burst. A laryngeal mask airway can be used in combination with videoendoscopy to precisely determine changes in laryngeal dimensions with high temporal resolution. Absolute glottic area more precisely represents PCA function than normalized glottic gap area at moderate levels of hypercapnia.

scholarly journals Anaesthetic Management of Tracheal Surgery Using the Laryngeal Mask Airway

1994 ◽  
Vol 22 (1) ◽  
pp. 69-73 ◽  
Author(s):  
J. V. Divatia ◽  
R. Sareen ◽  
S. M. Upadhye ◽  
K. S. Sharma ◽  
J. R. Shelgaonkar
Keyword(s):  
Laryngeal Mask Airway ◽  
Anaesthetic Management ◽  
Laryngeal Mask ◽  
Tracheal Surgery

Management of Severe Congenital Tracheal Stenosis

1994 ◽  
Vol 103 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Michael E. Dunham ◽  
Lauren D. Holinger ◽  
Carl L. Backer ◽  
Constantine Mavroudis
Keyword(s):  
Cardiopulmonary Bypass ◽  
Tracheal Stenosis ◽  
Preoperative Diagnosis ◽  
Surgical Repair ◽  
Pericardial Patch ◽  
Congenital Tracheal Stenosis ◽  
Life Threatening ◽  
The Mean

We have managed 23 infants and children with severe tracheal stenosis due to congenital complete tracheal rings producing a long-segment stenosis of the trachea. Nineteen (83%) have survived this life-threatening cause of airway obstruction, 7 of whom also had pulmonary artery slings. Pericardial patch tracheoplasty facilitated by partial cardiopulmonary bypass is currently our preferred technique for surgical repair. Eighteen patients (78%) underwent operative intervention, 3 of whom (17%) have died since surgery. The mean follow-up is 4.5 years. Bronchoscopy is essential for preoperative diagnosis and accurate intraoperative incision of the trachea, and is critical for long-term postoperative airway management. The more distal lesions are associated with increased complications and a higher mortality rate.

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