Pulmonary Complications after Airway Management with Laryngeal Masks or Endotracheal Intubation in Geriatric Patients Having Elective Surgery: The POLMA-EP Multi-Centre Randomized Trial

Objectives Airway management during anaesthesia in cats is always a demanding task and is associated with several complications. The aim of this study was to evaluate the practicability and complications during feline-specific laryngeal mask placement in anaesthetised cats as an alternative to endotracheal intubation. Methods In this prospective clinical study, laryngeal masks were placed in 148 anaesthetised cats. Success of placement was evaluated by capnography. Results Placement was possible at the first attempt in 136 cats, at the second attempt in eight cats and at the third attempt in one cat. In one cat, placement was not possible. Two cats were excluded. Failure to position the laryngeal mask at the first attempt was not different between laryngeal mask sizes ( P = 0.313) or positioning during placement ( P = 0.406). In nine cats, the laryngeal mask dislocated during the procedure. Dislocation occurred more often in the dorsal position than in the sternal ( P = 0.018) and right lateral positions ( P = 0.046). Mucous obstruction of the laryngeal mask occurred in one of these cats and regurgitation in another. Material-related issues, such as disconnection of the parts of the laryngeal mask and leakage of the balloon, were observed in 2/8 laryngeal masks. Conclusions and relevance The placement of a feline-specific laryngeal mask was easy to perform. In about 7% of the cases, replacement of the device was required due to mispositioning or dislocation. Full monitoring, including capnography, should be provided to uncover dislocation and airway obstruction immediately.

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Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

10.21203/rs.2.15885/v2 ◽

2019 ◽

Author(s):

Hao Li ◽

Ming-da Duan ◽

Yun-liang Zhang ◽

Shao-hua You ◽

Yu-xiang Song ◽

...

Keyword(s):

Airway Management ◽

Endotracheal Intubation ◽

Meta Analysis ◽

Blood Gas ◽

Success Rates ◽

Hospital Emergency ◽

Laryngeal Masks ◽

Emergency Airway Management ◽

Emergency Airway ◽

Ventilation Efficiency

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, ventilation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the ventilation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

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Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized control studies

10.21203/rs.2.15885/v3 ◽

2019 ◽

Author(s):

Hao Li ◽

Ming-da Duan ◽

Yun-liang Zhang ◽

Shao-hua You ◽

Yu-xiang Song ◽

...

Keyword(s):

Adverse Events ◽

Airway Management ◽

Endotracheal Intubation ◽

Meta Analysis ◽

Blood Gas ◽

Success Rates ◽

Hospital Emergency ◽

Laryngeal Masks ◽

Emergency Airway Management ◽

Emergency Airway

Abstract Background : Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed. Methods: Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators included overall intubation success rates, the success rates of the first intubation, insertion time, resuscitation efficiency rates, SpO2 rise time, the blood gas index and adverse events. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software. Results: We included 31 human studies. Compared to endotracheal intubation, the application of laryngeal mask for pre-hospital emergencies enhanced the resuscitation efficiency rates [RR=1.20, 95% CI (1.06, 1.35), P<0.001], improved the success of first intubation [RR=1.29, 95% CI (1.18, 1.40), P<0.001] and the patients’ blood gas index, shortened the insertion and SpO2 rise times [SMD=-3.48, 95% CI (-4.17, -2.80), P < 0.001; -2.19, 95% CI (-3.06, -1.32), P < 0.001] and reduced the incidence of adverse events [RR=0.41, 95% CI (0.30, 0.57, P<0.001]. All results were stable and statistically significant. Conclusions: Laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application.

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Laryngeal mask versus endotracheal intubation for pre-hospital emergency airway management: a meta-analysis of randomized manikin and human studies

10.21203/rs.2.15885/v1 ◽

2019 ◽

Author(s):

Hao Li ◽

Ming-da Duan ◽

Yun-liang Zhang ◽

Shao-hua You ◽

Yu-xiang Song ◽

...

Keyword(s):

Airway Management ◽

Endotracheal Intubation ◽

Meta Analysis ◽

Human Studies ◽

Laryngeal Mask ◽

Insertion Time ◽

Success Rates ◽

Hospital Emergency ◽

Laryngeal Masks ◽

Emergency Airway

Abstract Background Pre-hospital emergency airway management plays an important role in pre-hospital care. Laryngeal masks are increasingly employed for the airway management of pre-hospital critical patients and have achieved promising results. Although several randomized controlled trials have reported benefits, the efficacy of laryngeal masks in pre-hospital emergency airway management compared to endotracheal intubation have not been systematically reviewed.Methods Electronic databases (PubMed, Cochrane Library, Embase, Scopus and CNKI) were searched up to April 2019 for related randomized studies. Outcome indicators were overall intubation success rates, success rates of the initial intubation, insertion time, ventilation efficiency rates, SpO2 rise time and blood gas index. Two investigators selected the trials, extracted the data according to inclusion and exclusion criteria, and assessed the quality of the literature according to the Jada score. The meta-analysis was performed using stata14.0 software.Results We included 9 randomized manikin studies and 31 human studies. Meta-analysis of the manikin studies showed that the overall intubation success rates of the laryngeal mask group [RR=1.10, 95% CI (1.02, 1.18), P<0.05] and the success rates of first intubation [RR=1.25, 95% CI (1.01, 1.55), P <0.05] were significantly higher than the endotracheal intubation group. The insertion time of the laryngeal mask group was also significantly shorter [SMD = -1.53, 95% CI (-1.88, -1.17), P <0.05]. In human studies, excluding the success rates of first intubation and insertion time, the laryngeal mask was superior to endotracheal intubation and improved the patients’ blood gas index and shortened the SpO2 rise time. All the results were statistically significant.Conclusions Compared to endotracheal intubation, laryngeal masks could quickly and effectively improve patient ventilation in pre-hospital emergencies, highlighting its utility for clinical application .

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Magnet assisted endotracheal intubation as an alternative approach to difficult airway management

10.26226/morressier.57108e32d462b80290b4ae99 ◽

2016 ◽

Author(s):

Marta Grynovska

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Airway Management ◽

Alternative Approach

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Faculty Opinions recommendation of Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725823035.793528496 ◽

2017 ◽

Author(s):

Michael Aziz

Keyword(s):

Randomized Trial ◽

Critically Ill ◽

Endotracheal Intubation ◽

Apneic Oxygenation

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Protocol for a feasibility study of smoking cessation in the surgical pathway before major lung surgery: Project MURRAY

BMJ Open ◽

10.1136/bmjopen-2019-036568 ◽

2020 ◽

Vol 10 (11) ◽

pp. e036568

Author(s):

Sebastian T Lugg ◽

Amy Kerr ◽

Salma Kadiri ◽

Alina-Maria Budacan ◽

Amanda Farley ◽

...

Keyword(s):

Smoking Cessation ◽

Pilot Study ◽

Thoracic Surgery ◽

Elective Surgery ◽

Primary Objective ◽

Pulmonary Complications ◽

University Hospitals ◽

Patient Reported ◽

Ethical Approval ◽

Surgical Pathway

IntroductionSmoking prior to major thoracic surgery is the biggest risk factor for development of postoperative pulmonary complications, with one in five patients continuing to smoke before surgery. Current guidance is that all patients should stop smoking before elective surgery yet very few are offered specialist smoking cessation support. Patients would prefer support within the thoracic surgical pathway. No study has addressed the effectiveness of such an intervention in this setting on cessation. The overall aim is to determine in patients who undergo major elective thoracic surgery whether an intervention integrated (INT) into the surgical pathway improves smoking cessation rates compared with usual care (UC) of standard community/hospital based NHS smoking support. This pilot study will evaluate feasibility of a substantive trial.Methods and analysisProject MURRAY is a trial comparing the effectiveness of INT and UC on smoking cessation. INT is pharmacotherapy and a hybrid of behavioural support delivered by the trained healthcare practitioners (HCPs) in the thoracic surgical pathway and a complimentary web-based application. This pilot study will evaluate the feasibility of a substantive trial and study processes in five adult thoracic centres including the University Hospitals Birmingham NHS Foundation Trust. The primary objective is to establish the proportion of those eligible who agree to participate. Secondary objectives include evaluation of study processes. Analyses of feasibility and patient-reported outcomes will take the form of simple descriptive statistics and where appropriate, point estimates of effects sizes and associated 95% CIs.Ethics and disseminationThe study has obtained ethical approval from NHS Research Ethics Committee (REC number 19/WM/0097). Dissemination plan includes informing patients and HCPs; engaging multidisciplinary professionals to support a proposal of a definitive trial and submission for a full application dependent on the success of the study.Trial registration numberNCT04190966.

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Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

SAGE Open Medical Case Reports ◽

10.1177/2050313x211010015 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110100

Author(s):

Min Ho Lee ◽

Hyun Joo Kim

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Endotracheal Intubation ◽

Difficult Intubation ◽

Rescue Therapy ◽

High Flow ◽

Mask Ventilation ◽

Induction Process ◽

Management Method ◽

Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

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