scholarly journals Results of the randomized comparative study of second-generation supraglottic airways in orbital osteosynthesis

2020 ◽  
Vol 16 (6) ◽  
pp. 46-53
Author(s):  
I. V. Kostetskiy ◽  
A. A. Shamrikov ◽  
V. A. Bagin ◽  
A. A. Kaliskin
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Ventilation ◽  
Peak Inspiratory Pressure ◽  
Leak Pressure ◽  
Oropharyngeal Leak Pressure ◽  
Significant Difference ◽  
Artificial Pulmonary Ventilation ◽  
Lma Supreme ◽  
Jaw Thrust Maneuver ◽  
Equal Efficacy

The objective: to assess and compare supraglottic airways of LMA-Supreme and i-gel during orbital osteosynthesis.Subjects and methods. 91 patients were included into the study. All of them underwent osteosynthesis of the orbit. The patients were randomly divided into two groups. LMA-Supreme group included 42 patients, while i-gel group included 49 patients.Results. The parameters of hemodynamics, gas exchange, and artificial pulmonary ventilation (APV) did not basically differ between the groups at different stages of the study. The oropharyngeal leak pressure differed between the groups at the end of surgery and made (Me – median, Q1 and Q3 – upper and lower quartiles): 28.0 (22.0; 30.0) and 21.0 (19.0; 27.0) mm WG the LMA-Supreme and i-gel groups, respectively; p = 0.021. A significant difference was observed in the insertion time of supraglottic airways (Me is the median, Q1 and Q3 are the upper and lower quartiles): 27.5 (19.3; 36.5) sec. for LMA-Supreme and 15.0 (13.8; 25.0) sec. – for i-gel; p = 0.001. When inserting the LMA-Supreme duct in 33 (78.6%) patients, jaw thrust maneuver, extension of the neck, etc. were required; while in the i-gel group, similar maneuvers were necessary in 18 (36.7%) patients; p < 0.001. The number of postoperative complications was minimal in both groups.Conclusion. Both supraglottic airways can be used with equal efficacy in osteosynthesis of the orbit. At the same time, the i-gel duct has an advantage over the LMA-Supreme in speed and simplicity of insertion. The LMA-Supreme had greater leak pressure at the end of surgery, which might be an advantage in patients requiring greater peak inspiratory pressure to provide effective APV.

scholarly journals A Randomised Control Trial Comparing the Efficacy of LMA-Supreme and I-Gel as Rescue Ventilatory Device in Patients with Simulated Difficult Airway Undergoing Anaesthesia with Controlled Ventilation

2021 ◽  
Author(s):  
Sadia Rahman ◽  
Nidhi Agarwal ◽  
Sushil Guria ◽  
Swati Jain ◽  
Mona Swain
Keyword(s):  
Difficult Airway ◽  
Randomised Control Trial ◽  
P Value ◽  
Leak Pressure ◽  
Glottic Opening ◽  
Controlled Ventilation ◽  
Oropharyngeal Leak Pressure ◽  
Group I ◽  
Lma Supreme ◽  
Ventilatory Device

Introduction: In an unanticipated difficult airway or in an emergency situation of cannot-intubate-cannot-ventilate scenario, Supraglottic Airway Devices (SGD) are recommended as rescue devices for establishing airway quickly to prevent hypoxia. Aim: To compare efficacy of i-gel airway and Laryngeal Mask Airway supreme (LMA supreme) as ventilatory devices and the time taken for their insertion in anaesthetised and paralysed patients with simulated difficult airway. Materials and Methods: One hundred and eighty adult patients with simulated difficult airway were randomly allocated to two groups of 90 patients each. In group I: i-gel and in group S: LMA supreme was inserted. Primary outcome studied was time taken for insertion of SGD. Secondary outcomes were the number of attempts taken for insertion of device, oropharyngeal leak pressure, ease of gastric catheter insertion, fibreoptic bronchoscopic view of anatomical alignment of device with glottic opening. Quantitative variables were compared using unpaired t-test/Mann-Whitney Test, between the two groups. Qualitative variable were compared using Chi-Square test/Fisher’s-exact test. Results: Total time taken for successful insertion was significantly shorter with group i-gel as compared to group LMA supreme {median (IQR) {19 (18.25-21)} versus {24 (23-24)} with p-value ≤0.0001. Overall success rate of insertion (96.67% vs 97.78%, p=1.000) and oropharyngeal leak pressure (p-value=0.555) of i-gel and LMA-S were comparable. i-gel has better anatomic alignment with glottic opening as compared to LMA-S (p-value ≤0.0001). Gastric tube insertion was easy in all patients in both the groups. Conclusion: Shorter time for the insertion of i-gel was observed due to absence of inflatable cuff, although both LMA-S and i-gel are equally efficacious as ventilatory devices in patients with simulated difficult airway under general anaesthesia with controlled ventilation.

scholarly journals Prospective Clinical and Fiberoptic Evaluation of the Supreme Laryngeal Mask Airway ™

2009 ◽  
Vol 110 (2) ◽  
pp. 262-265 ◽  
Author(s):  
Arnd Timmermann ◽  
Stefan Cremer ◽  
Christoph Eich ◽  
Stephan Kazmaier ◽  
Anselm Bräuer ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Cuff Pressure ◽  
Laryngeal Mask ◽  
Leak Pressure ◽  
Cuff Volume ◽  
Oropharyngeal Leak Pressure ◽  
Company Limited ◽  
Patient Reported ◽  
The Mean ◽  
Lma Supreme

Background In March 2007, a new disposable laryngeal mask airway (LMA) became available. The LMA Supreme (The Laryngeal Mask Company Limited, St. Helier, Jersey, Channel Islands) aims to combine the LMA Fastrach feature of easy insertion with the gastric access and high oropharyngeal leak pressures of the LMA ProSeal. Methods The authors performed an evaluative study with the LMA Supreme, size 4, on 100 women to measure the ease of insertion, determinate the laryngeal fit by fiberoptic classification, evaluate the oropharyngeal leak pressure, and report adverse events. Results Insertion of the LMA Supreme was possible in 94 patients (94%) during the first attempt, and in 5 patients (5%) during the second attempt. In one small patient, the LMA Supreme could not be inserted because of limited pharyngeal space. This patient was excluded from further analysis. Insertion of a gastric tube was possible in all patients at the first attempt. The median time for LMA Supreme insertion was 10.0 s (+/-4.7 s; range, 8-30 s). Laryngeal fit, evaluated by fiberscopic view, was rated as optimal in all patients, both immediately after insertion of the LMA Supreme and at the end of surgery. After equalization to room pressure, the mean cuff volume needed to achieve 60 cm H2O cuff pressure was 18.4 ml (+/-3.8 ml; range, 8-31 ml). The mean oropharyngeal leak pressure at the level of 60 cm H2O cuff pressure was 28.1 cm H2O (+/-3.8 cm H2O, range, 21-35 cm H2O). Eight patients (8.1%) complained of a mild sore throat. No patient reported dysphagia or dysphonia. Conclusions Clinical evaluation of the LMA Supreme showed easy insertion, optimal laryngeal fit, and low airway morbidity. Oropharyngeal leak pressure results were comparable to earlier data from the LMA ProSeal.

Systematic Review and Meta-analysis of Endoscopic vs Microscopic Stapes Surgery for Stapes Fixation

2021 ◽  
pp. 019459982199066
Author(s):  
Sandra Ho ◽  
Prayag Patel ◽  
Daniel Ballard ◽  
Richard Rosenfeld ◽  
Sujana Chandrasekhar
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Stapes Surgery ◽  
Chorda Tympani Nerve ◽  
Stapes Fixation ◽  
Operative Outcomes ◽  
Significant Difference ◽  
The Mean ◽  
Postoperative Vertigo ◽  
Hearing Outcomes

Objective To systematically review the current literature regarding the operative outcomes of stapes surgery for stapes fixation via the endoscopic and microscopic approaches. Data Sources PubMed, Embase, and Web of Science. Review Methods An electronic search was conducted with the keywords “endoscop* or microscop*” and “stapes surgery or stapedectomy or stapedotomy or otosclerosis or stapes fixation.” Studies were included if they compared endoscopy with microscopy for stapes surgery performed for stapes fixation and evaluated hearing outcomes and postoperative complications. Articles focusing on stapes surgery other than for stapes fixation were excluded. Results The database search yielded 1317 studies; 12 remained after dual-investigator screening for quantitative analysis. The mean MINORS score was 18 of 24, indicating a low risk of bias. A meta-analysis demonstrated no statistically significant difference between the groups with regard to operative time, chorda tympani nerve manipulation or sacrifice, or postoperative vertigo. There was a 2.6-dB mean improvement in the change in air-bone gap in favor of endoscopic stapes surgery and a 15.2% increased incidence in postoperative dysgeusia in the microscopic group, but the studies are heterogeneous. Conclusions Endoscopic stapes surgery appears to be a reasonable alternative to microscopic stapes surgery, with similar operative times, complications, and hearing outcomes. Superior visibility with the endoscope was consistently reported in all the studies. Future studies should have standardized methods of reporting visibility, hearing outcomes, and postoperative complications to truly establish if endoscopic stapes surgery is equivalent or superior to microscopic stapes surgery.

scholarly journals Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 926
Author(s):  
Karl Schwaiger ◽  
Laurenz Weitgasser ◽  
Maximilian Mahrhofer ◽  
Kathrin Bachleitner ◽  
Selim Abed ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Data Extraction ◽  
Free Flaps ◽  
Risk Groups ◽  
The Elderly ◽  
Demographic Development ◽  
Autologous Breast Reconstruction ◽  
Significant Difference

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

Systematic Review and Meta-analysis of Complications Following Mastectomy and Prosthetic Reconstruction in Patients With and Without Prior Breast Augmentation

2021 ◽  
Author(s):  
Maria Chicco ◽  
Ali R Ahmadi ◽  
Hsu-Tang Cheng
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Skin Flap ◽  
Prosthetic Reconstruction ◽  
Hematoma Formation ◽  
Significant Difference ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Early Late

Abstract Background There is limited evidence available in literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. Objectives The purpose of this systematic review and meta-analysis is to compare postoperative complications between women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. Methods A systematic search was conducted in February 2020 for studies comparing women with versus without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late and overall complications. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through meta-analysis. Results Our meta-analysis, which included six studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the two groups in rates of early (36.7% vs. 24.8%; OR=1.57, 95% CI 0.94 to 2.64; P=0.09), late (10.1% vs. 19.9%; OR=0.53, 95% CI 0.06 to 4.89; P=0.57) and overall complications (36.5% vs. 31.2%; OR=1.23, 95% CI 0.76 to 2.00; P=0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% versus 2.15%; OR=2.68, 95% CI 1.00 to 7.16; P=0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis and prosthesis loss. Conclusions Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.

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