A Cost Analysis of the Laryngeal Mask Airway for Elective Surgery in Adult Outpatients

1995 ◽  
Vol 83 (2) ◽  
pp. 250-257. ◽  
Author(s):  
Alex Macario ◽  
Pearl C. Chang ◽  
Dan B. Stempel ◽  
John G. Brock-Utne
Keyword(s):  
Nitrous Oxide ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Neuromuscular Blockade ◽  
Face Mask ◽  
Spontaneous Ventilation ◽  
Nitrous Oxide Oxygen ◽  
Management Techniques ◽  
Cost Efficient ◽  
The Cost

Background Since the introduction of the laryngeal mask airway (LMA) into the United States in 1991, the device has become widely used in anesthesia practice. The purpose of this economic analysis was to use existing data to evaluate the costs of the LMA relative to three other common airway management techniques and to identify the variables that had the greatest effect on cost efficiency. Methods We evaluated four airway management techniques for healthy adults receiving an isoflurane-nitrous oxide-oxygen anesthetic for elective outpatient surgery: (1) LMA with spontaneous ventilation; (2) face mask with spontaneous ventilation; (3) tracheal intubation after succinylcholine with subsequent spontaneous ventilation; and (4) tracheal intubation after nondepolarizing neuromuscular blockade and controlled ventilation. We analyzed published clinical studies of the LMA and obtained cost data from Stanford University Medical Center. The best available estimates of the independent variables were incorporated into a baseline case. For each airway technique we derived cost equations that excluded costs common to all four techniques. Results Relative to airway management with an LMA, calculated values for the baseline analysis included additional isoflurane costs for use of a face mask ($ 0.12/min) and for tracheal intubation with ($ 0.043/min) and without neuromuscular blockade ($ 0.06/min). With a neuromuscular blocking drug cost of $ 0.21/min and an LMA cost per use of $ 20, the face mask with spontaneous ventilation was the cost-efficient airway choice for anesthetics lasting as long as 100 min. Increasing the LMA reuse rate from 10 to 25 made the LMA the least costly airway technique for cases lasting more than 70 min. Conclusions If the LMA is reused 40 times, the LMA is the cost-efficient airway choice for outpatients receiving an isoflurane-nitrous oxide-oxygen anesthetic lasting longer than 40 min. This finding does not change if the cost of neuromuscular blockade or the incidence of airway-related complications is varied over a clinically relevant range.

Doxacurium Chloride for Neuromuscular Blockade before Tracheal Intubation and Surgery during Nitrous Oxide-Oxygen-Narcotic-Enflurane Anesthesia

1989 ◽  
Vol 68 (3) ◽  
pp. 255???260 ◽  
Author(s):  
Robert L. Lennon ◽  
Michael P. Hosking ◽  
Peter C. Houck ◽  
Steven H. Rose ◽  
Denise J. Wedel ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Tracheal Intubation ◽  
Neuromuscular Blockade ◽  
Enflurane Anesthesia ◽  
Nitrous Oxide Oxygen ◽  
Doxacurium Chloride

Evaluation of 51W89 for Tracheal Intubation in Surgical Patients during Nitrous Oxide/Oxygen/Propofol Anesthesia

1994 ◽  
Vol 81 (SUPPLEMENT) ◽  
pp. A1082 ◽  
Author(s):  
E. Schmautz ◽  
H. Deriaz ◽  
M. Vrillon ◽  
A. Lienhart
Keyword(s):  
Nitrous Oxide ◽  
Tracheal Intubation ◽  
Surgical Patients ◽  
Nitrous Oxide Oxygen

Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy 

1999 ◽  
Vol 90 (3) ◽  
pp. 697-700 ◽  
Author(s):  
Ashwani K. Chhibber ◽  
Stewart J. Lustik ◽  
Rajbala Thakur ◽  
David R. Francisco ◽  
Kenneth B. Fickling
Keyword(s):  
Nitrous Oxide ◽  
Hospital Stay ◽  
Neuromuscular Blockade ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Postoperative Vomiting ◽  
Inhalation Induction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen

Background Nausea and vomiting are the most frequent problems after minor ambulatory surgical procedures. The agents used to induce and maintain anesthesia may modify the incidence of emesis. When neuromuscular blockade is antagonized with anticholinesterases, atropine or glycopyrrolate is used commonly to prevent bradycardia and excessive oral secretions. This study was designed to evaluate the effect of atropine and glycopyrrolate on postoperative vomiting in children. Methods Ninety-three patients undergoing tonsillectomy with or without adenoidectomy were studied. After inhalation induction of anesthesia with nitrous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were randomized to receive, in a double-blinded manner, either 15 microg/kg atropine or 10 microg/kg glycopyrrolate with 60 microg/kg neostigmine to reverse neuromuscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were assessed. Results There were no significant differences in age, gender, weight, or discharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate group (81%; P<0.05). There was no significant difference between the atropine and glycopyrrolate groups in the number of patients who required antiemetics or additional analgesics. Conclusions In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.

scholarly journals Novices Ventilate and Intubate Quicker and Safer via  Intubating Laryngeal Mask Than by Conventional Bag–Mask Ventilation and Laryngoscopy

2007 ◽  
Vol 107 (4) ◽  
pp. 570-576 ◽  
Author(s):  
Arnd Timmermann ◽  
Sebastian G. Russo ◽  
Thomas A. Crozier ◽  
Christoph Eich ◽  
Birgit Mundt ◽  
...  
Keyword(s):  
Medical Students ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Medical Personnel ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Success Rates ◽  
Management Techniques ◽  
Bag Mask Ventilation ◽  
Randomized Crossover Study

Background Because airway management plays a key role in emergency medical care, methods other than laryngoscopic tracheal intubation (LG-TI) are being sought for inadequately experienced personnel. This study compares success rates for ventilation and intubation via the intubating laryngeal mask (ILMA-V/ILMA-TI) with those via bag-mask ventilation and laryngoscopic intubation (BM-V/LG-TI). Methods In a prospective, randomized, crossover study, 30 final-year medical students, all with no experience in airway management, were requested to manage anesthetized patients who seemed normal on routine airway examination. Each participant was asked to intubate a total of six patients, three with each technique, in a randomly assigned order. A task not completed after two 60-s attempts was recorded as a failure, and the technique was switched. Results The success rate with ILMA-V was significantly higher (97.8% vs. 85.6%; P < 0.05), and ventilation was established more rapidly with ILMA-V (35.6 +/- 8.0 vs. 44.3 +/- 10.8 s; P < 0.01). Intubation was successful more often with ILMA-TI (92.2% vs. 40.0%; P < 0.01). The time needed to achieve tracheal intubation was significantly shorter with ILMA-TI (45.7 +/- 14.8 vs. 89.1 +/- 23.3 s; P < 0.01). After failed LG-TI, ILMA-V was successful in all patients, and ILMA-TI was successful in 28 of 33 patients. Conversely, after failed ILMA-TI, BM-V was possible in all patients, and LG-TI was possible in 1 of 5 patients. Conclusion Medical students were more successful with ILMA-V/ILMA-TI than with BM-V/LG-TI. ILMA-TI can be successfully used when LG-TI has failed, but not vice versa. These results suggest that training programs should extend the ILMA to conventional airway management techniques for paramedical and medical personnel with little experience in airway management.

Induction of Anesthesia and Tracheal Intubation with Sevoflurane in Adults

1996 ◽  
Vol 85 (3) ◽  
pp. 536-543. ◽  
Author(s):  
M. Muzi ◽  
B.J. Robinson ◽  
T.J. Ebert ◽  
T.J. O'Brien
Keyword(s):  
Nitrous Oxide ◽  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Gas Flow ◽  
Face Mask ◽  
Laryngeal Mask ◽  
Breath Holding ◽  
Laryngeal Mask Airway Insertion ◽  
Airway Responses ◽  
To Receive

Background The speed, quality, and cost of mask induction of anesthesia and laryngeal mask airway insertion or tracheal intubation were studied in young non-premedicated volunteers given high inspired concentrations of sevoflurane (6 to 7%). Methods Twenty healthy persons who were 19 to 32 years old participated three times, received 6 l/min fresh gas flow, and were randomized to receive 6 to 7% sevoflurane in 66% nitrous oxide/28% oxygen by face mask until tracheal intubation (treatment 1) or until laryngeal mask airway insertion (treatment 3), or 6 to 7% sevoflurane without nitrous oxide to tracheal intubation (treatment 2). Participants exhaled to residual volume and took three vital capacity breaths of the gas mixture; thereafter ventilation was manually assisted. The time of exposure to the inhaled gas was varied for consecutive participants. It was either increased or decreased by 30-sec increments based on the failure or success of the preceding volunteer's response to laryngoscopy and intubation after a preselected exposure time. Failure was defined as poor jaw relaxation, coughing or bucking, or inadequate vocal cord relaxation. Results Loss of the lid-lash reflex in unpremedicated young volunteers was achieved in 1 min and did not differ among groups. Average time (and 95% confidence interval) for acceptable conditions for LMA insertion was achieved in 1.7 (0.7 to 2.7) min, and all participants had an immediate return of spontaneous ventilation. The time for acceptable tracheal intubating conditions after manual hyperventilation by mask was 4.7 (3.7 to 5.7) min and 6.4 (5.1 to 7.7) min in treatments 1 and 2, respectively. There were no cases of increased secretions or laryngospasm. The incidence of breath holding and expiratory stridor ("crowing") was 7.5% and 25%, respectively, during treatment 1 and 15% and 40%, respectively, during treatment 2. Conclusions The induction of anesthesia to loss of lid reflex in young non-premedicated adults approaches the speed of intravenous induction techniques. No untoward airway responses were noted during mask induction of anesthesia with a three-breath technique. In response to intubation, no adverse airway responses, including jaw tightness, laryngospasm, and excessive coughing or bucking, occurred in participants whose duration of mask administration of sevoflurane met the appropriate times (as determined in this study).

A Dose-ranging Study of Rapacuronium in Pediatric Patients

2000 ◽  
Vol 92 (4) ◽  
pp. 1002-1009 ◽  
Author(s):  
George H. Meakin ◽  
Olli A. Meretoja ◽  
Johann Motsch ◽  
Tomi Taivainen ◽  
Kari Wirtavuori ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Tracheal Intubation ◽  
Rapid Onset ◽  
Neuromuscular Blocking ◽  
Infants And Children ◽  
Older Children ◽  
Duration Of Action ◽  
Intubating Conditions ◽  
Nitrous Oxide Oxygen ◽  
Train Of Four

Background The aim of this study was to determine the dose or doses of the new rapid-onset, short-acting, neuromuscular blocking drug rapacuronium that would provide satisfactory conditions for tracheal intubation at 60 s in infants and children. Methods Sixty-five infants (< 1 yr), 51 younger children (1-6 yr), and 49 older children (7-12 yr) were studied. Anesthesia was induced with thiopental-nitrous oxide-oxygen. Tracheal intubation was attempted 60 s after administration of one of five doses of rapacuronium (0.5, 1.0, 1.5, 2.0, or 2.5 mg/kg) and intubating conditions were assessed using a four-point scale. Following tracheal intubation, anesthesia was maintained with nitrous oxide-oxygen and alfentanil (12.5-50 microg/kg) as necessary. Neuromuscular transmission was monitored in an uncalibrated fashion using an acceleromyograph. Results Intubating conditions were good or excellent at 60 s in all infants after doses of 1.5 mg/kg or more and in all younger and older children after doses of 2.0 mg/kg or more. The duration of action of rapacuronium was dose- and age-dependent. Mean times to reappearance of the third twitch of the train-of-four (TOF; T3) were less than 10 min in infants at doses of 1.5 mg/kg or less and in younger and older children at doses of 2.0 mg/kg or less. Recovery of T3 after 1.0-2.0 mg/kg rapacuronium was significantly slower in infants compared with younger (P = 0.001) and older (P = 0.02) children. Five adverse experiences were related to rapacuronium administration: Bronchospasm (two instances), tachycardia (one instance), and increased salivation (two instances). None were serious. Conclusions Doses of 1.5 and 2.0 mg/kg rapacuronium can produce satisfactory intubating conditions at 60 s in anesthetized infants and children, respectively, and are associated with a short duration of action.

Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Carla Hipólito ◽  
Vicente Vieira ◽  
Virginia Antunes ◽  
Petra Alves ◽  
Adriana Rodrigues ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Airway Management ◽  
Inguinal Hernia Repair ◽  
Neuromuscular Blockade ◽  
Retrospective Review ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Laparoscopic Inguinal Hernia ◽  
Increased Risk ◽  
The Mean

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

scholarly journals Comparison of LPWAN Technologies: Cost Structure and Scalability

2021 ◽  
Author(s):  
Mohammad Istiak Hossain ◽  
Jan I. Markendahl
Keyword(s):  
Communication Technology ◽  
Service Providers ◽  
Communication Technologies ◽  
Cost Structure ◽  
Small Scale ◽  
Area Network ◽  
Wide Area Network ◽  
Generic Framework ◽  
Cost Efficient ◽  
The Cost

AbstractSmall-scale commercial rollouts of Cellular-IoT (C-IoT) networks have started globally since last year. However, among the plethora of low power wide area network (LPWAN) technologies, the cost-effectiveness of C-IoT is not certain for IoT service providers, small and greenfield operators. Today, there is no known public framework for the feasibility analysis of IoT communication technologies. Hence, this paper first presents a generic framework to assess the cost structure of cellular and non-cellular LPWAN technologies. Then, we applied the framework in eight deployment scenarios to analyze the prospect of LPWAN technologies like Sigfox, LoRaWAN, NB-IoT, LTE-M, and EC-GSM. We consider the inter-technology interference impact on LoRaWAN and Sigfox scalability. Our results validate that a large rollout with a single technology is not cost-efficient. Also, our analysis suggests the rollout possibility of an IoT communication Technology may not be linear to cost-efficiency.

scholarly journals Use of nitrous oxide‐oxygen inhalation sedation in the COVID‐19 era

2021 ◽  
Vol 31 (3) ◽  
pp. 433-435
Author(s):  
Kunal Gupta ◽  
Dimitrios Emmanouil ◽  
Amit Sethi
Keyword(s):  
Nitrous Oxide ◽  
Inhalation Sedation ◽  
Oxygen Inhalation ◽  
Nitrous Oxide Oxygen
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