scholarly journals LMA® protector™ in patients undergoing laparoscopic surgeries: a multicenter prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanhong Liu ◽  
Yuxiang Song ◽  
Miaomiao Wang ◽  
Meihua Yang ◽  
Hao Shen ◽  
...  
Keyword(s):  
Sore Throat ◽  
Ventilation Rate ◽  
Drainage Tube ◽  
Leak Pressure ◽  
Clinical Trial Registry ◽  
Laryngeal Masks ◽  
Oropharyngeal Leak Pressure ◽  
Effective Ventilation ◽  
Gastric Reflux ◽  
Multicenter Prospective Observational Study

Abstract Background Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery. Methods Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™. Results Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients. Conclusions The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists. Trial registration The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018300, date of registration: September 2018).

scholarly journals LMA ® Protector™ In Patients Undergoing Laparoscopic Surgeries: A Multicenter Prospective Observational Study

2021 ◽  
Author(s):  
Yanhong Liu ◽  
Yuxiang Song ◽  
Miaomiao Wang ◽  
Meihua Yang ◽  
Hao Shen ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Ventilation Rate ◽  
Leak Pressure ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Laryngeal Masks ◽  
Airway Complications ◽  
Oropharyngeal Leak Pressure ◽  
Effective Ventilation ◽  
Multicenter Prospective Observational Study

Abstract Backgroundː Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery. Methodsː Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™. Resultsː A total of 300 patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18±5.88 cmH2O. 75 patients (25.86%) reported mild sore throat on the first day after surgery. No signs of aspiration were noticed in any of those patients. Conclusionsː The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that requiring no further treatment, no clinically diagnosed aspiration was noticed in our study. Trial registration: The trail was registered at the Chinese Clinical Trial Registry (ChiCTR1800018300, data of registration, September 2018).

scholarly journals Gum-elastic Bougie-guided Insertion of the ProSeal™ Laryngeal Mask Airway: A New Technique

2002 ◽  
Vol 30 (5) ◽  
pp. 624-627 ◽  
Author(s):  
A. Howath ◽  
J. Brimacombe ◽  
C. Keller
Keyword(s):  
Laryngeal Mask Airway ◽  
Gastric Tube ◽  
Cardiovascular Responses ◽  
Laryngeal Mask ◽  
Drainage Tube ◽  
Leak Pressure ◽  
Success Rates ◽  
Tube Insertion ◽  
Oropharyngeal Leak Pressure ◽  
Low Incidence

We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal™ laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1–2, aged 18 to 80 years) were studied. The ProSeal LMA drainage tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the drainage tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17–40) cmH 2 O and ventilation was possible without leak in all patients at 9.5 ml.kg –1 tidal volume. There were no drainage tube or gastric air leaks. Gastric tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.

scholarly journals Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sandeep Kumar Mishra ◽  
Mohammad Nawaz ◽  
M. V. S. Satyapraksh ◽  
Satyen Parida ◽  
Prasanna Udupi Bidkar ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neutral Position ◽  
Leak Pressure ◽  
Neck Position ◽  
Oropharyngeal Leak Pressure ◽  
Flexion Extension ◽  
Margin Of Safety ◽  
Effective Ventilation ◽  
End Tidal ◽  
Head And Neck Position

Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis) and ventilation scores between ProSeal LMA and the I-gel.Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left). The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2were noted in all positions.Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation), lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups.Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

scholarly journals A Randomized Controlled Trial Comparing Ambu AuraGain and i-gel in Young Pediatric Patients

2019 ◽  
Vol 8 (8) ◽  
pp. 1235 ◽  
Author(s):  
Ha-Jung Kim ◽  
Hee-Sun Park ◽  
Soo-Young Kim ◽  
Young-Jin Ro ◽  
Hong-Seuk Yang ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Pediatric Patients ◽  
Clinical Performance ◽  
Controlled Trial ◽  
Supraglottic Airway ◽  
Leak Pressure ◽  
Oropharyngeal Leak Pressure ◽  
Supraglottic Airway Devices ◽  
Effective Ventilation ◽  
Airway Devices

Supraglottic airway devices have been increasingly used because of their several advantages. Previous studies showed that the small-sized i-gel provides effective ventilation for young pediatric patients; however, few studies have reported the use of AuraGain in these patients. Herein, we compared the clinical performance of AuraGain and i-gel in young pediatric patients aged between 6 months and 6 years old and weighing 5–20 kg, who were scheduled to undergo extremity surgery under general anesthesia. In total, 68 patients were enrolled and randomly allocated into two groups: AuraGain group and i-gel group. The primary outcome was the requirement of additional airway maneuvers. We also analyzed insertion parameters, fiberoptic bronchoscopic view, oropharyngeal leak pressure, and peri-operative adverse effects. Compared with the AuraGain group, the i-gel group required more additional airway maneuvers during the placement of the device and maintenance of ventilation. The fiberoptic view was better in the AuraGain group than in the i-gel group. However, the oropharyngeal leak pressure was higher in the i-gel group. AuraGain might be a better choice over i-gel considering the requirement of additional airway maneuvers. However, when a higher oropharyngeal leak pressure is required, the i-gel is more beneficial than AuraGain.

scholarly journals Comparison of intra-gastric pressure between endotracheal tube and supraglottic airway devices in laparoscopic hepatectomy:A randomised, controlled, non-inferiority study

2020 ◽  
Author(s):  
Jin Hee Ahn ◽  
Jiseon Jeong ◽  
Se Hee Kang ◽  
Ji Eun Yeon ◽  
Eun A Cho ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Sore Throat ◽  
Second Generation ◽  
Laparoscopic Hepatectomy ◽  
Operation Time ◽  
Drainage Tube ◽  
Supraglottic Airway ◽  
Clinical Trial Registration ◽  
Gastric Pressure ◽  
Supraglottic Airway Devices

Abstract Background Supraglottic airway (SGA) devices do not definitively protect the airway from regurgitation of gastric contents. Increased gastric pressure and long operation time are associated with development of complications such as aspiration pneumonia. The aim of this study was to compare intra-gastric pressure between second-generation SGA and endotracheal tube (ETT) devices during long-duration laparoscopic hepatectomy.Methods A total of 66 patients was randomly assigned to two groups; 33 patients each in the ETT and SGA groups. Intra-gastric pressure was continuously measured via a gastric drainage tube with a three-way stopcock connected to the pressure monitoring device. Normal saline was added to the end of the gastric drainage tube at each operation time point.Results Intra-gastric pressure during pneumoperitoneum was no different between the two groups (p = 0.146) or over time (p = 0.094). The mean (SD) pH of the SGA tip measured after operation was 6.7 (0.4), and a pH less than 4 was not observed. Relative risk of postoperative complications was significantly higher in the ETT group relative to the SGA group (sore throat, 5.5; cough,13.0).Conclusions Use of SGA devices does not further increase intra-gastric pressure, even during prolonged upper abdominal laparoscopic surgery. Also, the frequency of postoperative sore throat and cough was significantly lower when the second-generation SGA device was used.Clinical trial registration of Korea (https://cris.nih.go.kr/cris/index.jsp): KCT0003512 Principle investigator: G S K; date of registration February 15, 2019, https://cris.nih.go.kr/cris).

A Randomized Crossover Comparison of Airway Sealing with the Laryngeal Mask Airway Ambu AuraFlex at Three Intracuff Pressures in Pediatric Laparoscopic Surgery

2019 ◽  
Author(s):  
Xiang Liu ◽  
Xiaona Tan ◽  
Qi Zhang ◽  
Li Qiao ◽  
Lei Shi
Keyword(s):  
Laparoscopic Surgery ◽  
Laryngeal Mask Airway ◽  
Airway Pressure ◽  
Laryngeal Mask ◽  
Peak Airway Pressure ◽  
Supraglottic Airway ◽  
Intracuff Pressure ◽  
Leak Pressure ◽  
Oropharyngeal Leak Pressure ◽  
Mucosal Change

Abstract Objective An adequate intracuff pressure is important to ensure sufficient sealing function when using supraglottic airway devices to protect the airway from secretions and achieve adequate positive pressure ventilation. The aim of this study is to analyze a feasible and effective alternative Ambu AuraFlex intracuff pressure in child's laparoscopic surgery. Study Design Seventy-two children were included in this study. After insertion of the laryngeal mask airway AuraFlex, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 10, 30, and 60-cmH2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, AuraFlex was maintained using the last intracuff pressure of the allocated sequence. Oropharyngeal leak pressure, peak airway pressure, the fiberoptic view, mucosal change, and complications were assessed at three intracuff pressures. Results The OLP at the intracuff pressure of 10 cmH2O was significantly lower than that of 30 cmH2O (2# 18.1 ± 1.5 vs. 19.5 ± 1.4 cmH2O, p = 0.001; 2.5# 17.7 ± 1.2 vs. 20.2 ± 1.4, p = 0.001) and 60 cmH2O (2# 18.1 ± 1.5 vs. 20.0 ± 1.3 cmH2O, p = 0.002; 2.5# 17.7 ± 1.2 vs. 20.8 ± 1.1, p = 0.003). Compared with the peak airway pressure in pre-and postpneumoperitoneum, the OLP was significantly higher. Subgroup analysis showed no differences in mucosal change and complications. Conclusion Intracuff pressures of 30 may be sufficient for the Ambu AuraFlex in child's laparoscopic surgery, and there may be no added benefit of an intracuff pressure of 60 cmH2O, as oropharyngeal leak pressures were similar.

Experimental Investigation of Ventilation Effectiveness in an Airliner Cabin Mockup

2016 ◽  
Author(s):  
Jignesh A. Patel ◽  
Byron W. Jones ◽  
Mohammad H. Hosni ◽  
Ali Keshavarz
Keyword(s):  
Distribution System ◽  
Ventilation Rate ◽  
Mean Value ◽  
Tracer Gas ◽  
Flight Duration ◽  
Factors Affecting ◽  
Aircraft Cabin ◽  
Local Ventilation ◽  
Effective Ventilation ◽  
Ventilation Effectiveness

Frequent air travel and long flight duration makes the study of airliner cabin environmental quality a topic of utmost importance. Ventilation effectiveness is one of the more crucial factors affecting air quality in any environment. Ventilation effectiveness, along with the overall ventilation rate, is a measure of the ability of the air distribution system to remove internally generated pollutants or contaminants from a given space. Because of the high occupant density in an aircraft cabin, local variations in ventilation are important as a passenger will occupy the same space for the duration of the flight. Poor ventilation in even a small portion of the cabin could impact multiple people for extended time periods. In this study, the local effective ventilation rates and local ventilation effectiveness in an eleven-row, full-scale, Boeing 767 cabin mockup were measured. These measurements were completed at each of the 77 seats in the mockup. Each seat was occupied by a heated mannequin. In order to simulate the thermal load inside the cabin, the mannequins were wrapped with a heating wire to generate approximately 100 W (341 BTU/hour) of heat. Carbon dioxide was used as a tracer gas for the experiments and the tracer gas decay method was employed to calculate the local effective ventilation rate and local ventilation effectiveness. The overall ventilation rate, based on total supply air flow, was approximately 27 air changes per hour. Local ventilation effectiveness ranged from 0.86 to 1.02 with a mean value of 0.94. These ventilation effectiveness values are higher than typically found in other indoor applications and are likely due to the relatively high airspeeds present in the aircraft cabin and the high degree of mixing they provide. The uniformity is also good with no areas of particularly low ventilation effectiveness being identified. No clear patterns with respect to seat location, window versus center versus aisle, were found.

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