scholarly journals Randomized clinical trial of trapezius squeezing test and jaw thrust as optimal indicators for Laryngeal mask airway insertion in adults under propofol anesthesia

2016 ◽  
Vol 3 (2) ◽  
pp. 64-68 ◽  
Author(s):  
Sushil Khanal ◽  
Bibhush Shrestha ◽  
Roshana Amatya ◽  
Moda Nath Marhatta
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Randomized Study ◽  
Laryngeal Mask ◽  
P Value ◽  
Laryngeal Mask Airway Insertion ◽  
Unsuccessful Attempt ◽  
Arterial Blood ◽  
Adequate Condition

Background: Laryngeal mask airway insertion requires a certain depth of anesthesia that blunts the airway reflexes. We compared the effectiveness of the trapezius squeezing test with that of the jaw thrust test as clinical indicators of adequate condition for laryngeal mask airway insertion in adults under propofol anesthesia.Methods: In this randomized study, seventy adult patients undergoing surgery with general anesthesia maintained with laryngeal mask airway were randomly allocated to the group T (trapezius squeezing, n = 35) or the group J (jaw thrust, n = 35). The laryngeal mask airway was inserted immediately after the loss of response to trapezius squeezing or jaw thrust.  We recorded successful and unsuccessful attempts. An unsuccessful attempt was defined as development of coughing, SPO2 < 90%, body movements during or within one minute of laryngeal mask airway insertion and failed insertion of laryngeal mask airway. Preparation time for laryngeal mask airway insertion, blood pressure, and heart rate were recorded.Results: The incidence of successful attempts was significantly higher in the group T than in the group J (p-value = 0.002). The time taken for preparation and insertion of laryngeal mask airway, arterial blood pressure and heart rate were comparable in both the groups.Conclusion: This study has demonstrated that the trapezius squeezing test is a superior indicator of an adequate condition for laryngeal mask airway insertion compared to the jaw thrust test in adults.

AN OBSERVATIONAL STUDY TO EVALUATE THE HAEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND LARYNGEAL MASK AIRWAY INSERTION

2021 ◽  
pp. 56-58
Author(s):  
Rahul Kumar ◽  
Anant Prakash ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Observational Study ◽  
Arterial Pressure ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion

Introduction: Airway management is a crucial skill for the clinical anaesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. The laryngeal mask airways (LMA) have become popular in airway management as a missing link between facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Haemodynamic stability is an important aspect to the anaesthesiologist for the benet of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. The aim of this study was to evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material And Methods: This was a prospective observational study on 46 patients of ASA I-II status divided into 2 groups of 23 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no signicant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classication. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure(DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically signicant. P<0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: This study demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is signicantly greater than that caused by LMA insertion.

scholarly journals Haemodynamic Changes at Induction during Laryngeal Mask Airway Insertion: Comparison of Propofol Versus Lignocaine-Thiopentone Admixture

2020 ◽  
Vol 3 (4) ◽  
pp. 422-429
Author(s):  
SI Nuhu ◽  
GA Ajogwu ◽  
HY Embu ◽  
FD Atteh ◽  
DU Orshio ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Drug Administration ◽  
Laryngeal Mask ◽  
Baseline Heart Rate ◽  
Laryngeal Mask Airway Insertion ◽  
Randomised Study ◽  
Post Induction ◽  
Haemodynamic Changes

To determine the haemodynamic changes at induction during laryngeal mask airway (LMA) insertion comparing propofol versus lignocaine-thiopentone admixture. In this comparative randomised study, patients of American Society of Anesthesiologists’ (ASA) class I and II with age range of 18-60 years scheduled for short elective surgeries were randomly assigned into two equal groups. Patients were premedicated with fentanyl 1ug.kg-1. Anaesthesia was induced with either 2.5mg.kg-1 propofol or a sequence of 2mg.kg-1 lignocaine and 5mg.kg-1 thiopental given by a trained assistance. Anaesthesia was maintained with 2% isoflurane and 100% oxygen. Haemodynamic variables [Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR)] were measured non-invasively in three periods; before drug administration, immediately after drug administration prior to insertion of LMA and finally after LMA insertion.In group A, the baseline heart rate (92.3±11) was compared to the post-induction heart rate (100.7±09) with p=0.765 and post-insertion heart rate (98.0±13) with p=0.767. Although, there was a rise in the heart rate from the baseline after induction and insertion of LMA, this was not statistically significant. Also, baseline SBP (120.7±09) was compared to the post-induction SBP (102.5±07) with p=0.001 and post-insertion SBP (102.59±07) with p=0.001. This was statistically significant. The baseline DBP (77.9±08) was compared to the post-induction DBP (67.0±12) with p=0.004 and post-insertion DBP (62.5±09) with p=0.001.This was statistically significant. The baseline MAP (92.6±01) was compared to the post-induction MAP (79.7±01) with p=0.008 and post-insertion MAP (76.2±07) with p=0.001. This was also statistically significant. In group B, the baseline heart rate (93.2±12) was compared to post-induction heart rate (99.2±11) with p=0.520 and post-insertion heart rate (94.8±12) with p=0.989. This was not statistically significant. The baseline SBP (120.7±13) was compared to the post-induction SBP (115.9±12) with p=0.139 and post-insertion SBP (117.5±13) with p=0.318. This was not statistically significant. The baseline DBP (80.6±14) was compared to the post-induction DBP (75.2±11) with p=0.636 and post-insertion DBP (76.6±13) with p=0.712. This was also not statistically significant. The baseline MAP (94.3±01) was compared to the post-induction MAP (87.5±01) with p=0.779 and post-insertion MAP (88.3±01) with p=0.882. This was not statistically significant. We concluded that propofol and lignocaine-thiopentone admixture exhibited similar haemodynamic profile in our study and therefore recommend that both drugs can be used for patients.

scholarly journals Comparative Evaluation of Topical Lignocaine Versus Intravenous Lignocaine for Laryngeal Mask Airway Insertion in Wardha, Maharashtra

2021 ◽  
Vol 10 (28) ◽  
pp. 2078-2082
Author(s):  
Swathi Reddy G. ◽  
Karuna Taksande
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Arterial Pressure ◽  
Comparative Evaluation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Hemodynamic Parameters ◽  
Group I

BACKGROUND The purpose of present study was to compare and evaluate both topical lignocaine and intravenous lignocaine for laryngeal mask airway (LMA) insertion prior to propofol. Main objective was to study the conditions for LMA insertion with respect to gagging, coughing, Laryngospasm and No. of attempts for LMA insertion and also study the hemodynamic parameters in both the groups (Heart rate, SBP,DBP, MAP, SpO2) METHODS This study included 60 patients of 30 in each group, ASA I & II day care surgeries were performed in our hospital between 2019 and 2021. Patients were randomized into two groups. Group I received intravenous lignocaine 1.5 mg / kg over 30 seconds and group II received topical lignocaine 40 mg. Conditions of LMA insertion, gagging, laryngospasm, coughing were noted at the time of insertion, ECG, NIBP, SPO2 and ETCO2 were recorded according to scheduled times. RESULTS In conditions of LMA insertion, difference between both the groups was found to be significant, P < 0.05 in groups with first minute rise in heart rate, fall in Systolic blood pressure, diastolic blood pressure, mean arterial pressure was significant. At two minutes and three minutes after the LMA insertion, HR, SBP, DBP, MAP all these parameters changed slightly but these changes were statistically not significant. CONCLUSIONS Prior to Propofol induction, compared to intravenous lignocaine, topical lignocaine 10 % aerosol provided excellent conditions for the insertion of LMA without the use of neuromuscular blockers. KEY WORDS IV Lignocaine, Topical Lignocaine, LMA

scholarly journals Randomized Double-blind Comparison of Ketamine-Propofol, Fentanyl-Propofol and Propofol-Saline on Haemodynamics and Laryngeal Mask Airway Insertion Conditions

2005 ◽  
Vol 33 (2) ◽  
pp. 223-228 ◽  
Author(s):  
P. K. Goh ◽  
C. L. Chiu ◽  
C. Y. Wang ◽  
Y. K. Chan ◽  
P. L. Loo
Keyword(s):  
Blood Pressure ◽  
Laryngeal Mask Airway ◽  
Mouth Opening ◽  
Interquartile Range ◽  
Laryngeal Mask ◽  
Controlled Clinical Trial ◽  
Laryngeal Mask Airway Insertion ◽  
Double Blind ◽  
Arterial Blood ◽  
Prolonged Apnoea

The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg.kg-1 (n=30), fentanyl 1 μg.kg-1 (n=30) or normal saline (n=30), before induction of anaesthesia with propofol 2.5 mg.kg-1. Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P=0.010) or saline (P=0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0–8.0)] and fentanyl groups [median 7.0, interquartile range (6.0–8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75–9.25); P=0.024]. The incidence of prolonged apnoea (>120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg.kg–1 improves haemo-dynamics when compared to fentanyl 1 μg.kg–1, with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).

scholarly journals The Median Effective Dose (ED50) of cis-Atracurium for Laryngeal Mask Airway Insertion during General Anaesthesia for Patients Undergoing Urinary Surgery

2019 ◽  
Author(s):  
Xiaohua Wang ◽  
Ke Huang ◽  
Dongxu Yao ◽  
Jixiu Xue ◽  
Tianlong Wang
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Effective Dose ◽  
General Anaesthesia ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Sequential Method ◽  
Laryngeal Mask Insertion ◽  
Train Of Four

Abstract Background In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis- atracurium dosage for laryngeal mask insertion is not standardised. We aimed to determine the optimal dose and hypnotic median effective dose of cis- atracurium using a sequential method for successful laryngeal mask insertion when inducting general anaesthesia. Method s : The cohort study protocol is registered at clinicaltrial.gov (NCT-03358680). Twenty-three patients undergoing elective urinary surgery were sequentially administered doses (mg·kg -1 ) of cis- atracurium as follows: 0.15, 0.1, 0.07, 0.05, 0.03, and 0.02. Systolic and diastolic blood pressure, heart rate, bispectral index, and train-of-four were continuously monitored. Successful laryngeal mask insertion occurred without resistance to mouth opening, resistance to insertion, coughing, swallowing, laryngospasm/airway obstruction, and head and body movement. The main outcome was the response to laryngeal mask airway insertion: ≥16 points and <16 points indicated “satisfactory” and “unsatisfactory” responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from “satisfactory” and “unsatisfactory” responses. Result s : The median effective dose of cis- atracurium was 0.0265 mg·kg -1 (95% CI 0.0236-0.0298) using the sequential method. The heart rate was decreased in the 0.05 group compared to the 0.03 group at timepoints T7, T8, and T10. The systolic blood pressure was decreased in the 0.02 group compared to the 0.05 group at timepoints T2, T3, T4. The train-of-four value was significantly lower in the 0.05 group than in the 0.03 group at timepoint T3. Conclusion s : cis- a tracurium was a good option for muscle relaxation in urinary surgery.

scholarly journals Frequency of excellent Laryngeal mask airway insertion conditions in children undergoing elective surgery: A comparison of propofol with ketofol.

2020 ◽  
Vol 27 (03) ◽  
pp. 607-612
Author(s):  
Humaira Ahmad ◽  
Amna Tariq ◽  
Asif Sagheer ◽  
Aisha Ahmad ◽  
Samina Aslam
Keyword(s):  
Laryngeal Mask Airway ◽  
Elective Surgery ◽  
Muscle Relaxation ◽  
Laryngeal Mask ◽  
Ethical Review ◽  
P Value ◽  
Induction Agent ◽  
Laryngeal Mask Airway Insertion ◽  
Study Evaluation ◽  
Trial Setting

Objectives: The laryngeal mask airway is used for provision of anesthesia for various surgical procedures as well as in emergency management of airway. It is a useful rescue tool in cases of failed intubation. Its insertion is associated with lesser complications. With advancement in medical equipment new versions of LMA with additional benefits are available. In this study evaluation of frequency of excellent LMA insertion conditions with use of ketofol or propofol as induction agent has to be evaluated. Purpose of the study is to identify which agent will provide favourable conditions for insertion, with least complications. Study Design: Randomized control trial. Setting: Departments of Anesthesia and Intensive Care Allied Hospital and Aziz Fatimah Hospital, Faisalabad. Period: From 01-01-2017 to 30-06-2018. Material & Methods: Approval from ethical review committee was obtained. 230 children presenting for elective surgery were enrolled into study using non-probability consecutive sampling. Two groups consisting of 115 each were generated by randomization. Group P received propofol and Group PK received 2:1 propofol ketamine mixture. Ease of LMA insertion was assessed on the basis of degree of muscle relaxation and adverse reactions to LMA insertion. Data was collected and analysed using SPSS version 18. Results: Results were presented in terms of frequency of excellent LMA insertion conditions. It showed that ketofol provides better LMA insertion as compared to propofol alone with p value of 0.007, which is significant. Conclusion: The study concluded that use of ketofol provides excellent insertion conditions for LMA insertion in children presenting for elective surgery.

scholarly journals The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

2019 ◽  
Author(s):  
Mehdi Sanatkar ◽  
Mehrdad Goudarzi ◽  
Alireza Ebrahim Soltani
Keyword(s):  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Ophthalmic Surgery ◽  
Hypertensive Patients ◽  
St Segment

 We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P<0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P<0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P<0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):289-294.

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