I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients.Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared.Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasmaβ-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI.Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

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Comparison of non-invasive haemodynamic monitors of stress response to endo-tracheal intubation with perfusion index in patients undergoing elective surgery

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v23i2.35797 ◽

2020 ◽

Vol 23 (2) ◽

pp. 9-13

Author(s):

Sushila Lama Moktan ◽

Manan Karki

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

Tracheal Intubation ◽

Endotracheal Tube ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Elective Surgery ◽

Perfusion Index ◽

Non Invasive

Introduction: Laryngoscopy and intubation is always associated with a short term reflex sympathetic pressor response. The perfusion index is an indirect, non-invasive, and continuous measure of peripheral perfusion by pulse oximeter which can detect the stress response to intubation similar to heart rate, systolic blood pressure and diastolic blood pressure. Methods: This prospective observational study enrolled sixty-five normotensive patients of American society of anesthesiologists physical status grade I and II scheduled for elective surgery under general anaesthesia. Tracheal intubation was performed after induction with intravenous fentanyl, propofol and vecuronium. Heart rate, Systolic and Diastolic Blood Pressure and Perfusion Index were measured before induction of anesthesia, before intubation and one minute, three minutes, five minutes after the insertion of the endotracheal tube. Increase in heart rate by ?10 beats per minute, systolic and diastolic blood pressure by ?15 millimeters of mercury and decrease in Perfusion index ?10% after endotracheal intubation as compared to preintubationvalue were considered positive haemodynamic changes. Results: Endotracheal intubation produced a significant increase in heart rate and blood pressure whereas perfusion index decreased significantly. Our study showed that perfusion index response criterion achieved 97.7% (Confidence interval 97.58-97.86) sensitivity in detecting the stress response to insertion of endotracheal tube whereas systolic and diastolic blood pressure achieved sensitivity of 90% and 92% respectively. Conclusion: Perfusion Index is easier, reliable and non-invasive alternative to conventional haemodynamic criteria for detection of stress response to endotracheal intubation.

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Kinking of endotracheal tube during posterior fossa surgery

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.63629 ◽

2010 ◽

Vol 54 (2) ◽

pp. 172 ◽

Cited By ~ 3

Author(s):

Neerja Bharti ◽

Indu Bala

Keyword(s):

Endotracheal Tube ◽

Posterior Fossa ◽

Posterior Fossa Surgery

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A Comparison of Cerebellar Retraction Pressures in Posterior Fossa Surgery: Extended Retrosigmoid versus Traditional Retrosigmoid Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0036-1580065 ◽

2016 ◽

Vol 77 (S 01) ◽

Author(s):

Brandon Liebelt ◽

Meng Huang ◽

Gavin Britz

Keyword(s):

Posterior Fossa ◽

Retrosigmoid Approach ◽

Posterior Fossa Surgery ◽

Cerebellar Retraction

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A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial

BMC Anesthesiology ◽

10.1186/s12871-020-01222-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Erol Karaaslan ◽

Sedat Akbas ◽

Ahmet Selim Ozkan ◽

Cemil Colak ◽

Zekine Begec

Keyword(s):

Laryngeal Mask Airway ◽

Adverse Events ◽

Endotracheal Tube ◽

Sore Throat ◽

Fiberoptic Bronchoscopy ◽

Laryngeal Mask ◽

Controlled Clinical Trial ◽

Airway Protection ◽

Link Type ◽

Single Blind

Abstract Background There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events. Methods The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia. Results In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups. Conclusion The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases. Trial registration This trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03903679 on April 5, 2019.

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EXTENSIVE SPINAL CORD INFARCTION AFTER POSTERIOR FOSSA SURGERY IN THE SITTING POSITION: CASE REPORT

Neurosurgery ◽

10.1227/01.neu.0000125008.93625.5e ◽

2004 ◽

Vol 54 (6) ◽

pp. 1512-1516 ◽

Cited By ~ 26

Author(s):

Xavier Morandi ◽

Laurent Riffaud ◽

Seyed F.A. Amlashi ◽

Gilles Brassier

Keyword(s):

Spinal Cord ◽

Case Report ◽

Posterior Fossa ◽

Spinal Cord Infarction ◽

Posterior Fossa Surgery ◽

Sitting Position

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Reversible cerebral perfusion alterations in children with transient mutism after posterior fossa surgery

Child s Nervous System ◽

10.1007/s003810050191 ◽

1998 ◽

Vol 14 (3) ◽

pp. 114-119 ◽

Cited By ~ 48

Author(s):

A. Germanò ◽

Sergio Baldari ◽

Gerardo Caruso ◽

Mariella Caffo ◽

Gaspare Montemagno ◽

...

Keyword(s):

Posterior Fossa ◽

Cerebral Perfusion ◽

Posterior Fossa Surgery

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Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Neonatology ◽

10.1159/000516372 ◽

2021 ◽

pp. 1-9

Author(s):

Lindsay Johnston ◽

Taylor Sawyer ◽

Anne Ades ◽

Ahmed Moussa ◽

Jeanne Zenge ◽

...

Keyword(s):

Tracheal Intubation ◽

Adverse Events ◽

Multivariable Analysis ◽

Estimating Equation ◽

Oxygen Desaturation ◽

Physician Training ◽

Training Level ◽

Success Rates ◽

Emergency Airway ◽

Significant Difference

Introduction: Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. Methods: Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). Results: Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; p < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; p = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; p < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. Conclusion: Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

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Anaesthesia for posterior fossa surgery

Best Practice & Research Clinical Anaesthesiology ◽

10.1053/bean.1999.0048 ◽

1999 ◽

Vol 13 (4) ◽

pp. 557-573

Author(s):

G.Stuart Ingram ◽

Craig Goldsack

Keyword(s):

Posterior Fossa ◽

Posterior Fossa Surgery

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Comparison of the Intubating Laryngeal Mask Airway with the Fiberoptic Intubation in Anticipated Difficult Airway Management

Anesthesiology ◽

10.1097/00000542-200106000-00009 ◽

2001 ◽

Vol 94 (6) ◽

pp. 968-972 ◽

Cited By ~ 98

Author(s):

Olivier Langeron ◽

François Semjen ◽

Jean-Louis Bourgain ◽

Alain Marsac ◽

Anne-Marie Cros

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Adverse Events ◽

Oxygen Saturation ◽

Difficult Airway ◽

Difficult Intubation ◽

Laryngeal Mask ◽

Fiberoptic Intubation ◽

Alternative Technique ◽

Intubating Laryngeal Mask Airway

Background The intubating laryngeal mask airway (ILMA; Fastrach; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation. Methods One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation < 90%, bleeding) were recorded. Results The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05). Conclusion The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.

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