General anesthesia using supraglottic airway device in a myasthenic patient undergoing reverse shoulder arthroplasty

Purpose. The aim of this study was to compare the effects of desflurane, sevoflurane, and propofol on the glottic opening area during general anesthesia using remifentanil. Methods. Ninety patients undergoing hand and upper limb surgery combined with brachial plexus block under general anesthesia were enrolled in the study. The patients were randomized into three groups to receive desflurane (group D), sevoflurane (group S), or propofol (group P) for maintenance of anesthesia. Following induction of general anesthesia with remifentanil, continuous fiberoptic video recording around the glottis via an i-gel™ supraglottic device was started after establishing mechanical ventilation. Desflurane, sevoflurane, or propofol was administrated after video recording was started. The changes in normalized glottic opening area (n-GOA) and peak inspiratory pressure (PIP) during surgery were compared between the three groups. Results. Intraoperative changes of n-GOA in group D showed significant differences compared with group S and group P (−0.0656 ± 0.0772 vs. −0.0076 ± 0.0499 and +0.0269 ± 0.0809, P=0.005 and P<0.0001). The changes of PIP in group D showed significant differences compared with group S and group P (+3.7 ± 3.4 cmH2O vs. +1.0 ± 1.3 cmH2O and −0.3 ± 3.6 cmH2O, P=0.002 and P<0.0001). Four cases of relapsed glottic stenosis in group D were improved by changing desflurane to propofol. Conclusions. Desflurane narrowed the n-GOA and increased the PIP compared to sevoflurane and propofol during general anesthesia with remifentanil. Clinicians should be aware of the possibility of glottic stenosis during desflurane-remifentanil anesthesia when the airway is secured by a supraglottic airway device without the use of neuromuscular blockade.

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Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks

Anesthesiology ◽

10.1097/aln.0000000000001710 ◽

2017 ◽

Vol 127 (2) ◽

pp. 307-316 ◽

Cited By ~ 7

Author(s):

Kurt Ruetzler ◽

Sandra Esther Guzzella ◽

David Werner Tscholl ◽

Tanja Restin ◽

Marco Cribari ◽

...

Keyword(s):

General Anesthesia ◽

Muscle Relaxation ◽

Intensive Therapy ◽

Airway Device ◽

University Hospital ◽

Supraglottic Airway ◽

Leak Pressure ◽

Supraglottic Airway Device ◽

Air Leak ◽

Supraglottic Airway Devices

Abstract Background Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. Methods The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. Results The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. Conclusions The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

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