AIRWAY DEVICE

Introduction: Intersurgical-gel (I-gel) is a new supraglottic airway device that is widely being used to secure airway during general anaesthesia. Objectives: The objective of the study is to compare the ease of insertion of Intersurgical-gel and Laryngeal mask airway (LMA). Material & Method: This study was conducted in Department of anaesthesia Hameed Latif Hospital, Lahore. 100 American Society of Anesthesiologists (ASA) I-II, patients were enrolled in this study for elective surgery divided in 2 groups of 50 each. LMA and I-gel were used in groups A and B respectively for intra operative maintenance of airway. Randomization through random number table in Statistical Package for Social Sciences (SPSS) version 17 was used. Results: There were 50 patients in both groups. There were no statistical significant difference between the patients age of two groups. There was absolutely no difference between 2 groups regarding ease of insertion because both groups had 84% easy and 16% satisfactory insertions. Insertion time of LMA and I-gel in First and Second attempt were also comparable and statistically nonsignificant. Airway manipulations was required in both groups for insertion of device, in LMA group 30% required and 70% did not require and in i-gel group 48% required and 52% did not require. There is no statistical significant difference between both groups. Bleeding was noticed on 2% of i-gel and with LMA no bleeding occurred and 2% laryngospasm incidence noticed in both groups. Conclusion: we found that regarding ease of insertion there is statistically no significant difference between I-gel and LMA.

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The Combitube in Elective Surgery

Anesthesiology ◽

10.1097/00000542-200101000-00016 ◽

2001 ◽

Vol 94 (1) ◽

pp. 79-82 ◽

Cited By ~ 49

Author(s):

Luis A. Gaitini ◽

Sonia J. Vaida ◽

Somri Mostafa ◽

Boris Yanovski ◽

Milian Croitoru ◽

...

Keyword(s):

Elective Surgery ◽

Airway Device ◽

Spontaneous Ventilation ◽

Mechanically Ventilated ◽

Entire Duration ◽

Duration Of Surgery ◽

American Society ◽

End Tidal ◽

American Society Of Anesthesiologists ◽

Spontaneously Breathing

Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.

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Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA in paediatric cases.

International Journal of Medical Research and Review ◽

10.17511/ijmrr.2021.i02.07 ◽

2021 ◽

Vol 9 (2) ◽

pp. 95-101

Author(s):

Dr. Nimish Jain ◽

◽

Dr. Susheela Taxak ◽

Dr. Karampal Singh ◽

◽

...

Keyword(s):

General Anaesthesia ◽

Elective Surgery ◽

Airway Device ◽

Blind Study ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Physical Status ◽

Aim Analysis ◽

American Society ◽

Single Blind

Aim: Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA inpaediatric cases. Methods: We did a prospective, randomised single-blind study on Eighty patientsof either sex belonging to American Society of Anaesthesiologists (ASA) physical status class I or II,between 6 months to 8 years of age, scheduled to undergo elective surgery for less than one andhalf hour duration under general anaesthesia. In this study we analysed the ease of insertion,attempts and time were taken to insert the supraglottic airway device. Results: The ease ofinsertion observed was easy in 39(97.5%) in the i-gel group and 35(87.5%) in cLMA group in ourstudy. The i-gel was placed successfully in 39 out of 40 (97.5%) patients in the first attempt, andachieved 100% insertion on the second attempt. Correct positioning of cLMA in the first attempt wasseen in 35 out of 40 (87.5%) patients. The remaining 5 patients (12.5%) required a secondattempt. The average insertion time of cLMA (12.88 ± 1.771 seconds) was longer than the averagetime of insertion of i-gel (9.48 ± 1.037 seconds), and these differences were highly significantstatistically (p= 0.000). Conclusion: To conclude, i-gel and cLMA is effective and safe devices foruse in children. Both are easy to insert and have insignificant morbidity, however, time taken andattempts of insertions for i-gel was lesser than cLMA. Also, the ease of insertion was relatively easyfor i-gel than cLMA in pediatric cases.

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The Addition of Phenylephrine Contributes to the Development of Transient Neurologic Symptoms after Spinal Anesthesia with 0.5% Tetracaine

Anesthesiology ◽

10.1097/00000542-199710000-00009 ◽

1997 ◽

Vol 87 (4) ◽

pp. 771-778 ◽

Cited By ~ 52

Author(s):

Shinicki Sakura ◽

Mariko Sumi ◽

Yasuko Sakaguchi ◽

Yoji Saito ◽

Yoshihiro Kosaka ◽

...

Keyword(s):

Spinal Anesthesia ◽

Elective Surgery ◽

Single Case ◽

Neurologic Symptoms ◽

Single Case Report ◽

Significant Difference ◽

Anesthetic Solution ◽

American Society ◽

American Society Of Anesthesiologists ◽

To Receive

Background Recent reports indicate that transient neurologic symptoms commonly occur after single-injection spinal anesthesia with lidocaine. Information regarding tetracaine has been limited to a single case report. In addition, little is known about the cause of these symptoms or the cofactors that affect their occurrence. The present study sought to determine whether the presence of phenylephrine or the concentration of glucose in the anesthetic solution affects the incidence of transient neurologic symptoms after spinal anesthesia with 0.5% tetracaine. Methods One-hundred sixty patients classified as American Society of Anesthesiologists physical status I or II who were scheduled for elective surgery on a lower limb or perineum were sequentially assigned to one of four equal groups to receive intrathecal 0.5% tetracaine in 7.5% or 0.75% glucose, with or without 0.125% phenylephrine. Patients were evaluated on postoperative day one for the presence of pain, dysesthesia, or both in the legs or buttocks by an investigator unaware of the drug given. Results Symptoms were present in 10 patients (12.5%) receiving a spinal anesthetic containing phenylephrine, but in only one patient (1.3%) receiving spinal anesthesia without phenylephrine. There was no significant difference in the incidence of symptoms between groups receiving 7.5% glucose and those receiving 0.75% glucose (8.8% and 5% of patients, respectively). Conclusions These results suggest that adding phenylephrine to tetracaine for spinal anesthesia increases the potential for transient neurologic symptoms, but that the concentration of glucose does not affect their occurrence.

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A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

The American Surgeon ◽

10.1177/0003134820973384 ◽

2020 ◽

pp. 000313482097338

Author(s):

Elizabeth McCarthy ◽

Benjamin L. Gough ◽

Michael S. Johns ◽

Alexandra Hanlon ◽

Sachin Vaid ◽

...

Keyword(s):

Postoperative Recovery ◽

Logistic Regression Models ◽

Community Institution ◽

Physical Status Classification ◽

Estimated Blood Loss ◽

Comparative Review ◽

Significant Difference ◽

American Society ◽

The Individual ◽

American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

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Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

Medical Sciences ◽

10.3390/medsci9020021 ◽

2021 ◽

Vol 9 (2) ◽

pp. 21

Author(s):

Cyrus Motamed ◽

Migena Demiri ◽

Nora Colegrave

Keyword(s):

Neuromuscular Blockade ◽

Lower Limit ◽

Elective Surgery ◽

Orotracheal Intubation ◽

Neuromuscular Blocking ◽

Physical Status Classification ◽

Train Of Four ◽

Surgery First ◽

American Society ◽

American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

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Obtenção de Consentimento Informado para Anestesia em Cirurgia Eletiva num Hospital Terciário: Práticas e Contexto Ético-Legal

Acta Médica Portuguesa ◽

10.20344/amp.10592 ◽

2019 ◽

Vol 32 (1) ◽

pp. 53

Author(s):

Luís Guilherme Casimiro ◽

Sara Marisa Pereira ◽

Sofia Cardoso Pires ◽

Joana Mourão

Keyword(s):

Informed Consent ◽

Elective Surgery ◽

University Hospital ◽

Anesthetic Technique ◽

Patient Relationship ◽

Active Process ◽

Legal Principles ◽

American Society ◽

American Society Of Anesthesiologists ◽

Written Informed Consent

Introduction: Informed consent is an active process of the doctor-patient relationship, based on ethical and legal principles. The anesthetic act has inherent risks, which should be subject of specific consent. The aim of this study was to evaluate the degree of implementation of written specific informed consent for anesthesia in the context of elective surgery.Material and Methods: An observational prospective study, at a tertiary university hospital, in 230 patients aged 60 years or older, undergoing elective surgery between May and July 2017. Eligible patients who consented to participate were interviewed clinically on the day before surgery. In the postoperative period, the anesthetic technique and the existence of the written informed consent for the anesthetic and surgical procedures were assessed. Patients who were unable to give informed consent or those admitted in the Intensive Care Unit after surgery were excluded. Results: Written informed consent for the surgical procedure was obtained for 225 (97.8%), while it was obtained in just 96 (41.7%) patients for the anesthetic act. There was a higher prevalence of stroke, anemia, and higher Charlson and physical American Society of Anesthesiologists scores in patients without written informed consent for the anesthetic act.Discussion: We identified a low implementation of written informed consent for anesthesia. This situation may have important implications in the context of disciplinary, civil or criminal liability.Conclusion: Despite its importance, the practice of written informed consent for anesthesia in this institution is not yet implemented on a regular basis.

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Electroacupuncture at St36 Accelerates the Recovery of Gastrointestinal Motility after Colorectal Surgery: A Randomised Controlled Trial

Acupuncture in Medicine ◽

10.1136/acupmed-2013-010490 ◽

2014 ◽

Vol 32 (3) ◽

pp. 223-226 ◽

Cited By ~ 25

Author(s):

Zhaodi Zhang ◽

Changsong Wang ◽

Quanyi Li ◽

Mingyue Zhang ◽

Haifang Zhao ◽

...

Keyword(s):

Colorectal Surgery ◽

Gastrointestinal Motility ◽

Controlled Trial ◽

Bowel Function ◽

Group 13 ◽

Group Data ◽

Significant Difference ◽

American Society ◽

Randomised Controlled ◽

American Society Of Anesthesiologists

Objectives To evaluate whether electroacupuncture (EA) at ST36 can accelerate the recovery of gastrointestinal motility after colorectal surgery. Methods Forty patients of American Society of Anesthesiologists physical status II and III undergoing elective open resection of malignant colorectal tumours were included in this study. Using a sealed envelope method, the patients were randomly divided into two groups either receiving EA (EA group) or sham EA (SEA group). Data regarding the recovery of bowel function (times to the first bowel sounds, passage of flatus and defaecation) were collected and analysed. Results In the EA group, the time intervals from surgery to the first bowel movement and passage of flatus were shorter than in the SEA group (13±10 h vs 19±13 h, p<0.05 and 23±14 h vs 32±18 h, p<0.05, respectively). There was no significant difference between the groups regarding the time to first defaecation (68±45 h vs 72±53 h, p>0.05). Conclusions EA at ST36 accelerates the recovery of gastrointestinal motility after colorectal surgery. Trial Registration JJ22011-15.

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A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20205450 ◽

2020 ◽

Author(s):

Pushpal Gandhi ◽

Mahendra Agrawal ◽

Bhavika Agrawal ◽

Simarn Behl

Keyword(s):

Epidural Analgesia ◽

Comparative Evaluation ◽

Hemodynamic Parameters ◽

Regional Technique ◽

Significant Difference ◽

Group 2 ◽

Reversible Loss ◽

American Society ◽

The One ◽

American Society Of Anesthesiologists

Background: Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.Methods: Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).Results: There is no significant difference in age, weight, sex, and ASA grade in all three groups.Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group. Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.Conclusions: Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.

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A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

10.21203/rs.3.rs-944545/v1 ◽

2021 ◽

Author(s):

Wirat Wasinwong ◽

Sarocha Termthong ◽

Prae Plansangkate ◽

Jutarat Tanasansuttiporn ◽

Riam Kosem ◽

...

Keyword(s):

Primary Outcome ◽

Elective Surgery ◽

Controlled Study ◽

Injection Pain ◽

Syringe Pump ◽

Intravenous Catheter ◽

Randomized Controlled ◽

American Society ◽

American Society Of Anesthesiologists ◽

Median Pain

Abstract Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

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Impact of a semi-structured briefing on the management of adverse events in anesthesiology: A randomized pilot study.

10.21203/rs.2.13966/v2 ◽

2019 ◽

Author(s):

Christopher Neuhaus ◽

Johannes Schäfer ◽

Markus A. Weigand ◽

Christoph Lichtenstern

Keyword(s):

Rapid Sequence Induction ◽

Airway Device ◽

Supraglottic Airway ◽

Anesthesia Induction ◽

Team Members ◽

Rapid Sequence ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Alternative Means ◽

Airway Devices

Abstract Background : Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. Methods : 37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine. Results : We observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p=0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p=0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm. Conclusions : Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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