scholarly journals Comparative Study of Propofol Versus Thiopental Sodium with Succinylcholine for Laryngeal Mask Airway (LMA) Insertion

2018 ◽  
Vol 10 (1) ◽  
pp. 11-15
Author(s):  
Chandra Shekhar Karmakar ◽  
Md Afzalur Rahman ◽  
Mohammad Rezaul Karim ◽  
Monirul Islam ◽  
Md Shahidul Islam ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Low Dose ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Airway Reflex ◽  
Haemodynamic Changes ◽  
Thiopental Sodium ◽  
Group 2 ◽  
Insertion Condition ◽  
Group 1

Background: The increasing emphasis on day case anaesthesia has lead to the greater use of the laryngeal mask airway (LMA) as an alternative to intubation. Laryngoscopy and tracheal intubation are noxious stimuli, which cause a reflex increase in both sympathetic and sympathoadrenal activity that may result in tachycardia, hypertension and dysarrhythmias. Insertion of Laryngeal mask airway (LMA) is associated with less haemodynamic changes, minimal increase in intraocular and intracranial pressure and lower incidence of sore throat. Still its insertion requires sufficient depth of anesthesia to prevent airway reflex (gagging, coughing nd spasms). To insert LMA successfully propofol is the most frequently administered medication. But most of all recommend not using propofol singly for LMA insertion. Thiopental can’t suppress the upper airway reflexes as propofol but with low dose succinylcholine upper airway reflexes are attenuated so combination of thiopental sodium with succinylcholine may be another choice of drug.Objectives: This Prospective study was conducted to evaluate the effectiveness of Thiopental sodium and Succinylcholine for insertion of the LMA in comparison with Propofol.Methods: This interventional study was carried out in Sixty patients, aged 3-45 years who were scheduled for elective surgical procedure under general anaesthesia in ShSMCH. Patients were randomly assigned to two groups by odd and even number basis. In Group-1 (N1=30), LMA was inserted after induction with Thiopental sodium (5 mg/kg body weight i.v.) and Succinylcholine (0.5mg/kg i.v); in Group-2 (N2 = 30), the LMA was inserted with Propofol (2.5mg/kg i.v). Jaw relaxation, incidence of coughing- gagging , overall insertion condition and haemodynamic changes were observed.Results: Grade of jaw relaxation in Group-1 was Good in 93.3%, incomplete in 6.7% and 0% poor but in Group-2, 86.7% was good 10% incomplete and 3.3% was poor. Coughing occurred in 33.3% of patients in the Group-2 and there was only 10% in succinyl group (P=0.028) which is significantly higher in Group-2. Overall insertion condition in Group -1 was excellent in 86.7%, Good in 10% cases and poor in only 3.3% cases on the other hand in Group-2 excellent in 53.3%, Good in 33.3% cases and poor in only 13.3% cases (P=0.019).Conclusion: There was statistically significant difference in jaw relaxation in two groups and incidence of Gagging or Coughing is higher in Group-2. Overall insertion condition was significantly better in Group-1. We concluded that Thiopental sodium with low dose Suxamethonium is an effective alternative of Propofol.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 11-15

scholarly journals A Comparative Study of Laryngeal Mask Airway and Air-Q Intubating Laryngeal Airway Using Parker Flex Tip Tube

2020 ◽  
Vol 5 (1) ◽  
pp. 149-152
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta
Keyword(s):  
Laryngeal Mask Airway ◽  
Endotracheal Intubation ◽  
Airway Device ◽  
Laryngeal Mask ◽  
Supraglottic Airway ◽  
Intubating Laryngeal Mask Airway ◽  
Study Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: To facilitate tracheal intubation, intubating laryngeal mask airway(ILMA) was designed specifically. A relatively new supraglottic airway device, air-Q ILA is an alternative to ILMA to facilitate endotracheal intubation. Considering advantages of air-Q over ILMA are that the breathing tube of the device is shorter, wider and due to removable connector, a standard e Parker Flex Tip tracheal tube (product of Parker Medical Company) has a curved, centered, flexible and tapered distal tip that is designed to facilitate easy, rapid and non-traumatic intubation. It has double murphy eyes with an anterior curvature and a posterior opening bevel. It is designed so that the posterior bevel will decrease the incidence of the tube catching at the anterior or the lateral laryngeal structures during tracheal intubation.Subjects and Methods: This is a randomized, single-blind study. Total of 100 patients of either sex aged 18–60 years belonging to American Society of Anaesthesiologists (ASA) physical status I or II scheduled for elective surgery under general anesthesia with endotracheal intubation were included in the study and the patients with respiratory or pharyngeal pathology, mouth opening < 2.5 cm, body mass index ≥35 kg/m2, pregnancy and anticipated difficult airway were excluded from the study. The duration of the study was one year. The ethical clearance was taken from the institutional ethical committee. Written informed consent from all participants was obtained for participation in the study. Results: A total of 100 patients were allocated for the study. The insertion of the airway device was successful in all the patients of group 1. So, 50  patients were analysed for intubation in group 1. Air-Q ILA could not be inserted and resulted in failure in two cases. Hence, 48 patients were analysed statistically for intubation in group 2. The two groups were comparable with respect to age, weight and sex distribution. The mean age of patients in group 1 was 40.00 ± 10.76 years and in group 2 it was 40.56 ± 11.0 years (P = 0.651). There were 30 females and 20 males both in group 1 and group 2 (P = 1.000). The mean weight of patients in group 1 was 60.34 ± 8.06 kg and in group 2 was 60.10 ± 10.05 kg (P = 0.924). Conclusion:The  overall success rate using Parker Flex Tip tube was more with ILMA (99%) as compared to air-Q ILA (78%). It can be further suggested that Parker Flex Tip tube can be used as an alternative to silicone tube with ILMA, but more multicentre studies are required over larger populations to evaluate the utility of Parker Flex Tip tube with air-Q ILA.

scholarly journals Comparative evaluation of topical and intravenous lignocaine for insertion of laryngeal mask airway with propofol

2018 ◽  
Vol 5 (3) ◽  
pp. 573
Author(s):  
Saba Ahmed ◽  
Namrata Jain ◽  
Sanjay Saksena
Keyword(s):  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Comparative Evaluation ◽  
Laryngeal Mask ◽  
Age Group ◽  
Group 16 ◽  
Group 2 ◽  
Group 1

Background: Objective of present study to determine that administration of Intravenous Lignocaine prior to propofol is as effective as topically on the posterior oropharynx for LMA insertion.Methods: 60 patients of age group 16-45years of both sexes, ASA Grade I and II undergoing elective surgeries. Group 1: (n=30) Patients receiving Lignocaine 1.5 mg/kg IV over 30 seconds. Group 2: (n=30) Patients receiving lignocaine aerosol 40 mg topically. Conditions of LMA insertion, gagging laryngospasm ,coughing noted at time of insertion, ECG, NIBP, SPO2 and ETCO2 were recorded according to scheduled times.Results: In Conditions of insertion, difference between groups reached significance, p<0.05. In groups at first min, rise in heart rate, fall in DSP, SBP and MAP was significant. At two and three minutes post LMA insertion these parameters change slightly but statistically not significant.Conclusions: Topical Lignocaine 10% aerosol prior to propofol induction provides excellent conditions for LMA insertion without the use of neuromuscular blockages.

Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

2020 ◽  
pp. 105566562098023
Author(s):  
Ashwina S. Banari ◽  
Sanjeev Datana ◽  
Shiv Shankar Agarwal ◽  
Sujit Kumar Bhandari
Keyword(s):  
Upper Airway ◽  
P Value ◽  
Airway Patency ◽  
The Mean ◽  
Group 2 ◽  
Acoustic Pharyngometry ◽  
Nasoalveolar Molding ◽  
Area And Volume ◽  
Group 1

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

scholarly journals A randomized, controlled study to compare the effects of intravenous labetalol and esmolol on haemodynamic changes during laryngoscopy and intubation

2017 ◽  
Vol 5 (9) ◽  
pp. 4003
Author(s):  
Atit Kumar ◽  
Prashant Kumar Mishra ◽  
Saurabh Shukla
Keyword(s):  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Cardiovascular Stress ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Β Blocker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Direct laryngoscopy and endotracheal intubation frequently induce cardiovascular stress response characterised by hypertension and tachycardia due to reflex sympathetic stimulation. Considering the clinical significance of these changes stress attenuation is needed to blunt these responses. β- blockers are used to reduce the unwanted hemodynamic responses. Esmolol is ultra-short acting cardio selective β blocker. Labetalol is useful in not only attenuating the response to laryngoscopy and intubation but also in preventing perioperative cardiovascular events. Present study compared the efficacy of esmolol and labetalol for attenuation of sympathomimetic response to laryngoscopy and intubation.Methods: It was a prospective, randomized, controlled study carried out in 75 adult patients with ASA 1 and ASA 2 posted for elective surgeries. Patients were allocated randomly into Group-1 (esmolol) and Group-2 (labetalol) and Group-3 (placebo) of 25 patients each. Inj. esmolol (1mg/kg) or Inj. labetalol (0.4 mg/kg) or placebo (0.9NS) dissolved up to 5 ml in distilled water was injected intravenously 5 minutes prior to intubation. All patients premeditated with Inj. glycopyrrolate (4µg/kg). Patient were then induced with Inj. propofol (2mg/kg), Inj. scoline (2mg/kg) given followed by laryngoscopy and intubation. Haemodynamic readings were noted at T0 (baseline before injecting the drug), T1 (1 minute after injecting the drug), T2 (after intubation), T3 (2 minutes after intubation), T4 (4 minutes after intubation), T5 (6 minutes after intubation), T6 (8 minutes after injection), T7 (10 minutes after injection).Results: Gr-1, Gr-2 and Gr-3, when compared with each other for systolic BP, diastolic BP, mean BP, and HR, showed a statistically significant difference at different intervals.Conclusions: Both the drugs are found to be effective in attenuation of hemodynamic reflex without any side effects. Further studies are recommended to substantiate the findings in present study.

scholarly journals Low Dose X-Ray Sources and High Quantum Efficiency Sensors: The Next Challenge in Dental Digital Imaging?

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Arnav R. Mistry ◽  
Daniel Uzbelger Feldman ◽  
Jie Yang ◽  
Eric Ryterski
Keyword(s):  
Low Dose ◽  
Image Resolution ◽  
X Ray ◽  
Imaging Technologies ◽  
Group 4 ◽  
X Ray Imaging ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Objective(s). The major challenge encountered to decrease the milliamperes (mA) level in X-ray imaging systems is the quantum noise phenomena. This investigation evaluated dose exposure and image resolution of a low dose X-ray imaging (LDXI) prototype comprising a low mA X-ray source and a novel microlens-based sensor relative to current imaging technologies.Study Design. A LDXI in static (group 1) and dynamic (group 2) modes was compared to medical fluoroscopy (group 3), digital intraoral radiography (group 4), and CBCT scan (group 5) using a dental phantom.Results. The Mann-Whitney test showed no statistical significance(α=0.01)in dose exposure between groups 1 and 3 and 1 and 4 and timing exposure (seconds) between groups 1 and 5 and 2 and 3. Image resolution test showed group 1 > group 4 > group 2 > group 3 > group 5.Conclusions. The LDXI proved the concept for obtaining a high definition image resolution for static and dynamic radiography at lower or similar dose exposure and smaller pixel size, respectively, when compared to current imaging technologies. Lower mA at the X-ray source and high QE at the detector level principles with microlens could be applied to current imaging technologies to considerably reduce dose exposure without compromising image resolution in the near future.

Haemodynamic changes with the laryngeal mask airway - off the cuff

1997 ◽  
Vol 14 (5) ◽  
pp. 514-517
Author(s):  
S. Colbert ◽  
D. M. O'Hanlon ◽  
R. Page ◽  
F. Flanagan ◽  
D. Moriarty
Keyword(s):  
Laryngeal Mask Airway ◽  
Laryngeal Mask ◽  
Haemodynamic Changes

scholarly journals Effect of inhaled carbon dioxide on laryngeal abduction

2015 ◽  
Vol 118 (4) ◽  
pp. 489-494 ◽  
Author(s):  
Jonathan Cheetham ◽  
Amanda Jones ◽  
Manuel Martin-Flores
Keyword(s):  
Laryngeal Mask Airway ◽  
High Speed ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Maximal Response ◽  
High Temporal Resolution ◽  
Respiratory Drive ◽  
Laryngeal Function ◽  
Airway Patency ◽  
End Tidal

Hypercapnia produces a profound effect on respiratory drive and upper airway function to maintain airway patency. Previous work has evaluated the effects of hypercapnia on the sole arytenoid abductor, the posterior cricoarytenoid (PCA), using indirect measures of function, such as electromyography and direct nerve recording. Here we describe a novel method to evaluate PCA function in anesthetized animals and use this method to determine the effects of hypercapnia on PCA function. Eight dogs were anesthetized, and a laryngeal mask airway was used, in combination with high-speed videoendoscopy, to evaluate laryngeal function. A stepwise increase in inspired partial pressure of CO2 produced marked arytenoid abduction above 70-mmHg end-tidal CO2 (ETCO2) ( P < 0.001). Glottic length increased above 80-mmHg ETCO2 ( P < 0.02), and this lead to underrepresentation of changes in glottic area, if standard measures of glottic area (normalized glottic gap area) were used. Use of a known scale to determine absolute glottic area demonstrated no plateau with increasing ETCO2 up to 120 mmHg. Ventilatory parameters also continued to increase with no evidence of a maximal response. In a second anesthetic episode, repeated bursts of transient hypercapnia for 60 s with an ETCO2 of 90 mmHg produced a 43–55% increase in glottic area ( P < 0.001) at or shortly after the end of the hypercapnic burst. A laryngeal mask airway can be used in combination with videoendoscopy to precisely determine changes in laryngeal dimensions with high temporal resolution. Absolute glottic area more precisely represents PCA function than normalized glottic gap area at moderate levels of hypercapnia.

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