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Laryngeal Mask Airway (laryngeal + mask_airway)
Kinds of Laryngeal Mask Airway Selected AbstractsResistive load of laryngeal mask airway and proseal laryngeal mask airway in mechanically ventilated patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2003G. Natalini Background:, The ProSeal Laryngeal Mask Airway (PLMA) ventilation tube is narrower and shorter than the standard Laryngeal Mask Airway (LMA) and is without the vertical bars at the end of the tube. In this randomized, crossover study, PLMA and LMA resistances were compared. Methods:, Respiratory mechanics was calculated in 26 anesthetized, mechanically ventilated patients with both LMA and PLMA. The laryngeal mask positioning was fiberoptically evaluated. Differences in the respiratory mechanics of the LMA and the PLMA were attributed to the differences between the laryngeal masks. Results:, In the total study population the airway resistance was 1.5 ± 2.6 hPa.l,1.s,1 (P = 0.005) higher with the PLMA than with the LMA. During the PLMA use, the peak expiratory flow reduced by 0.02 ± 0.05 l min,1 (P = 0.046), the expiratory resistance increased by 0.6 ± 1.3 hPa.l,1.s,1 (P = 0.022), and the time constant of respiratory system lengthened by 0.09 ± 0.18 s (P = 0.023). These differences doubled when the LMA was better positioned than the PLMA, whereas they disappeared when the PLMA was positioned better than the LMA. Conclusions:, The standard LMA offers a lower resistive load than the PLMA. Moreover, the fitting between the laryngeal masks and the larynx, as fiberoptically evaluated, plays a major role in determining the resistive properties of these devices. [source] Prevention of tracheal tube dislodgement and provision for reintubation during removal of Laryngeal Mask AirwayPEDIATRIC ANESTHESIA, Issue 5 2010Rajeev SharmaArticle first published online: 6 JAN 2010 No abstract is available for this article. [source] ClassicTM Laryngeal Mask Airway in cardiac pediatric surgeryPEDIATRIC ANESTHESIA, Issue 4 2005Elena Miranda No abstract is available for this article. [source] The reliability of endtidal CO2 in spontaneously breathing children during anaesthesia with Laryngeal Mask AirwayTM, low flow, sevoflurane and caudal epiduralPEDIATRIC ANESTHESIA, Issue 5 2002Per AASHEIM MD Background: Noninvasive devices for monitoring endtidal CO2 (PECO2) are in common use in paediatric anaesthesia. Questions have been raised concerning the reliability of these devices in spontaneous breathing children during surgery. Our anaesthetic technique for elective infraumbilical surgery consists of spontaneous breathing through a Laryngeal Mask Airway (LMATM), low fresh gas flow, sevoflurane and a caudal epidural. We wanted to compare PECO2 and arterial CO2 (PaCO2) during surgery. Methods: Twenty children, aged 1,6 years, scheduled for infraumbilical surgery, were studied and one arterial sample was taken 45 min after induction of anaesthesia. PECO2, inspiratory PCO2, oxygen saturation, heart rate, respiratory rate, mean arterial blood pressure and expiratory sevoflurane concentration were measured every 5 min. The respiratory and circulatory parameters were stable during surgery. Results: The mean PaCO2 , PECO2 difference was 0.15 (0.16) kPa [1.1 (1.2 mmHg)]. Conclusions: PECO2 is a good indicator of PaCO2 in our anaesthetic setting. [source] Use of the Laryngeal Mask AirwayTM in mucopolysaccharidosesPEDIATRIC ANESTHESIA, Issue 5 2002FAUZIA ANIS KHAN No abstract is available for this article. [source] Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study,ANAESTHESIA, Issue 5 2009B. M. Wahlen Summary The classic Laryngeal Mask Airway (cLMAÔ), ProSeal Laryngeal Mask Airway (PLMAÔ), Intubating Laryngeal Mask AirwayÔ (ILMAÔ), Combitube (CTÔ), Laryngeal Tube (LTÔ) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non-anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible. [source] Difficult intubation of a child through laryngeal mask airway with two tracheal tubesACTA PAEDIATRICA, Issue 12 2006TANIL KENDIIRLI Abstract Difficult tracheal intubation occurs infrequently. It is estimated that difficult laryngoscopy occurs in 1,2% of patients. Tracheal intubation of especially small infants can be challenging. When faced with a difficult airway, intubation through a laryngeal mask airway is one method of obtaining a secure airway. Here, we report a 23-mo-old girl with chronic lung disease and severe pneumonia, who was admitted to our paediatric intensive care unit. Since the patient could not be intubated by the standard method, because her larynx was up and forward, she was intubated successfully with a laryngeal mask airway through which two consecutive tracheal tubes were inserted. Conclusion: Laryngeal mask airway has an important role as a back-up device in case direct visualization of the larynx is not possible. [source] Laryngeal morbidity after use of the laryngeal mask airwayACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010T. MENCKE No abstract is available for this article. [source] Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA SupremeÔ and the ETTACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010W. ABDI Background: We designed a prospective randomized single-blind study to compare efficiency and post-operative upper airway morbidity when the laryngeal mask airway (LMA) SupremeÔ is used as an alternative to the endotracheal tube (ETT). Methods: One hundred and thirty-eight elective pelvic laparoscopic ASA I,II female patients were assigned to receive either the LMA Supreme® or the ETT for airway management. Balanced anesthesia and ventilation techniques were standardized to control end-tidal CO2 and BIS value in the range 4.5,5 kPa and 40,50, respectively, and to maintain adequate hemodynamic stability. A single surgeon blinded to the airway management technique performed all surgical procedures. The ventilation efficiency of each airway was evaluated. Anesthesia- and surgery-related times were calculated and anesthesia details were recorded. Post-operative pain and pharyngolaryngeal morbidity were measured in a blind fashion using a numerical rating scale (NRS) (0,100). Results: Surgery duration was similar in both groups. Airway management duration was shorter with the LMA Supreme®. Post-operative pharyngolaryngeal morbidity incidence and all symptoms' intensity were significantly increased after ETT as compared with LMA Supreme® anesthesia. At the end of the PACU stage, the incidence and mean NRS of post-operative hoarseness were reduced when LMA Supreme® was used as an alternative to the ETT (16% vs. 47%; P<0.01 and 9 vs. 19, P<0.01, respectively). Conclusion: We demonstrated that choosing an LMA Supreme® was an efficient pharyngolaryngeal morbidity-sparing strategy. Moreover, we showed that the LMA Supreme® and the ETT were equally effective airways for a routine gynecological laparoscopy procedure. [source] Safe use of a laryngeal mask airway in children undergoing a tonsillectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009F. S. Xue No abstract is available for this article. [source] Comparison between intubation and the laryngeal mask airway in moderately obese adultsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009M. ZOREMBA Background: Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. Methods: We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t -test analysis. Statistical significance was considered to be P<0.05. Results: Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). Conclusions: In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function. [source] The I-gel®, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: an observational study in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009L. BEYLACQ Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Like the LMA-ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I,II, undergoing a short-duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH2O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I-gel® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management. [source] Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009R. GRAVNINGSBRÅTEN Background: It is still disputed whether laryngeal mask airway (LMA) is safe and convenient for adenotonsillectomy, and whether these procedures can be safely undertaken in an office-based short-stay ambulatory setting. We report the result of this practice in 1126 consecutive children <16 years of age. Methods: The patients received general anaesthesia with propofol and remifentanil. For analgesic prophylaxis, they received paracetamol, fentanyl and local anaesthetic administration. NSAIDs were given to patients weighing above 15 kgs. A surgical technique with elevation, scissors and electrocoagulation was used. Post-operatively, the tonsillectomies were observed in the unit for at least 1.5 h and the adenoidectomies for at least 15,20 min. Results: Conversion from LMA to an endotracheal tube was carried out in six patients (0.5%), mostly due to airway leakage during ventilation. One patient had a pulmonary atelectasis and was re-intubated. No re-operation was needed in the clinic after surgery, and all patients, except for the one with atelectasis (0.1%), were discharged home as planned. In 122 patients answering a questionnaire, after discharge, two patients (1.6%) were admitted to hospital and re-operated due to bleeding; a further six patients (4.9%) were admitted for observation. In 25% of the patients, nausea and vomiting occurred after discharge, including 21% vomiting of swallowed blood during home travel. Only 5.6% reported significant post-discharge pain. Conclusion: With a well-trained team, adenotonsillectomy on children can be carried out safely in an office-based setting with LMA and a short post-operative stay. [source] Cerebral state index response to incision: a clinical study in day-surgical patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2006R. E. Anderson Background:, Inadequate anaesthesia, with somatic/autonomic response or awareness, is often revealed at intubation and surgical incision. Anaesthetic depth monitors should be able to prevent this risk. This explorative study examined the ability of the cerebral state monitor to predict autonomic/somatic responses to incision. Methods:, Forty-two ASA I,II day-surgical patients [19 men and 23 females; mean age 52 (29,79) years, mean weight 77 (50,118) kg] were induced clinically with fentanyl/propofol with sevoflurane after placement of the laryngeal mask airway. The cerebral state index (CSIÔ) was blindly recorded 4 min prior to and 4 min after incision. Results:, During the 4 min prior to incision, the mean CSIÔ was 45 (16,62) and increased by 9 (,13,40) when the mean value for the first 4 min after incision was subtracted from the value prior to incision, corresponding to a relative change of 21% (,21,118). The change in CSIÔ did not show any consistent relation to the value before incision. Five patients showed minor movements after incision and six patients had > 25% increase in blood pressure. Neither CSIÔ nor the change in index differed between patients who did or did not respond somatically or autonomically to incision. The last CSIÔ value just prior to incision was 44 for non-responders and 40 and 42 for somatic and autonomic responders, respectively. Conclusion:, The CSIÔ in the majority of patients was within acceptable ranges during clinically adjusted anaesthesia prior to incision but seems not to be able to reliably predict an autonomic or somatic response to incision. [source] Bilateral hypoglossal nerve injury following the use of the laryngeal mask without the use of nitrous oxideACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2004M. Sommer Hypoglossal nerve injury is a rare complication of anaesthesia airway management in adults. Until now the use of nitrous oxide for anaesthesia supposedly contributed to this complication. We present a case of bilateral hypoglossal nerve injury following the use of a laryngeal mask airway without the use of nitrous oxide. At the conclusion of 3 h of surgery in extreme side rotation, a 15-year-old boy of 88 kg could not extend his tongue beyond his teeth. An MRI confirmed the absence of pharyngeal haematoma and the absence of thrombosis of the basilar artery. We conclude that even when patients have no medical history and nitrous oxide is not being used, prolongation of the operation in an extreme position might increase the risk of major complications with a laryngeal mask. [source] Resistive load of laryngeal mask airway and proseal laryngeal mask airway in mechanically ventilated patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2003G. Natalini Background:, The ProSeal Laryngeal Mask Airway (PLMA) ventilation tube is narrower and shorter than the standard Laryngeal Mask Airway (LMA) and is without the vertical bars at the end of the tube. In this randomized, crossover study, PLMA and LMA resistances were compared. Methods:, Respiratory mechanics was calculated in 26 anesthetized, mechanically ventilated patients with both LMA and PLMA. The laryngeal mask positioning was fiberoptically evaluated. Differences in the respiratory mechanics of the LMA and the PLMA were attributed to the differences between the laryngeal masks. Results:, In the total study population the airway resistance was 1.5 ± 2.6 hPa.l,1.s,1 (P = 0.005) higher with the PLMA than with the LMA. During the PLMA use, the peak expiratory flow reduced by 0.02 ± 0.05 l min,1 (P = 0.046), the expiratory resistance increased by 0.6 ± 1.3 hPa.l,1.s,1 (P = 0.022), and the time constant of respiratory system lengthened by 0.09 ± 0.18 s (P = 0.023). These differences doubled when the LMA was better positioned than the PLMA, whereas they disappeared when the PLMA was positioned better than the LMA. Conclusions:, The standard LMA offers a lower resistive load than the PLMA. Moreover, the fitting between the laryngeal masks and the larynx, as fiberoptically evaluated, plays a major role in determining the resistive properties of these devices. [source] Airway management behaviour, experience and knowledge among Danish anaesthesiologists , room for improvementACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2001M. S. Kristensen Background: Problems with managing the airways in relation to anaesthesia causes severe morbidity and mortality. A large proportion of these adverse respiratory events is preventable. Still patients continue to die from airway disasters related to anaesthesia, also in Scandinavia. The goal of this study is to identify which efforts are likely to improve this situation. Methods: A questionnaire asking about experience, behaviour and availability of various items of equipment was mailed to all members of the Danish Society of Anaesthesiologists and were returned anonymously. Results: More than 65% of respondents have sufficient access to a flexible fibrescope, but still 17% of specialists have no access and the vast majority (>67%) has little (1,10 times) or no experience in its use for awake intubation. A total of 52,70% knew the basic principles of the ASA difficult airway algorithm, but despite this only 25,50% would perform awake intubation if a difficult intubation was expected. More than 20% of respondents had experienced preventable airway management mishaps. In all, 18,46% did not know how to oxygenate via the cricothyroid membrane. Conclusion: There is room for improvement regarding airway management skills among Danish anaesthesiologists. It is likely that airway management can be improved by: A) Better knowledge of an appropriate plan, algorithm, for airway management. B) Awake intubation used more often. C) More experience in fibreoptic intubation. D) All anaesthesiologists accepting that previous difficult intubation is an indicator of future difficulties. E) All anaesthesiologists knowing, and practising on manikins, how to oxygenate via the cricothyroid membrane. F) Always having a laryngeal mask airway immediately available when inducing anaesthesia. [source] Anesthetic experience of 100 pediatric tracheostomiesPEDIATRIC ANESTHESIA, Issue 7 2009FIONA WRIGHTSON MB ChB FRCA Summary Background:, Tracheostomy is more hazardous in the pediatric population than in adults (Paediatr Nurs, 17, 2005, 38; Int J Pediatr Otorhinolaryngol, 67, 2003, 7; J R Soc Med, 89, 1996, 188). Airway management in these children and infants is potentially challenging. Previous case series of pediatric tracheostomy published in the surgical journals make little mention of anesthetic techniques used and do not describe airway management. The aim of this study was to review the anesthetic, and in particular the airway management of children undergoing tracheostomy at Great Ormond Street Hospital (GOSH). Methods:, Between September 2004 and December 2007, the ENT surgical database showed that 109 children had a surgical tracheostomy performed at GOSH. We were only able to locate the notes of 100 of these cases. The anesthetic records of these 100 patients undergoing tracheostomy were analyzed retrospectively. Results:, Ninety-four percent (94/100) of tracheostomies were elective, and 6% (6/100) were emergency. In this study, 26% (26/100) of children were recorded as difficult to intubate. These difficult airways were managed as follows: 10/26 used a laryngeal mask airway (LMA), 5/26 were managed with facemask alone, 3/26 had fiber-optic intubation, 5/26 had surgical intubation and 2/26 were intubated with the aid of a bougie and cricoid pressure. Conclusions:, This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child. [source] A cohort evaluation of the pediatric ProsealÔ laryngeal mask airway in 100 unpremedicated childrenPEDIATRIC ANESTHESIA, Issue 4 2009Michelle White No abstract is available for this article. [source] Effects of head posture on the oral, pharyngeal and laryngeal axis alignment in infants and young children by magnetic resonance imagingPEDIATRIC ANESTHESIA, Issue 6 2008RENAUD VIALET MD Summary Background:, Objective anatomical studies supporting the different recommendations for laryngoscopy in infants and young children are scarce. The objective of this study was to measure by magnetic resonance imaging (MRI) the consequences of head extension on the oral, pharyngeal and laryngeal axes in infants and young children. Methods:, Thirty patients (age: 33 ± 28 months; weight 14 ± 9 kg), under general inhalated anesthesia delivered via a laryngeal mask airway, were studied in two anatomic positions: head in the resting position and in simple extension. The following measurements were made on each scan: the face and the neck axes, the pharyngeal axis, the laryngeal axis, and the line of vision of glottis. The various angles between these axes were defined: , angle between line of vision and laryngeal axis, and , angle between pharyngeal axis and laryngeal axis. From an anatomical point of view, laryngoscopy and passage of a naso-tracheal tube would be facilitated if these angles are narrow. Results:, Placing the patient from the resting position into extension led to a narrowing of the angle , but a widening of the angle ,. Conclusions:, In infants and young children, under general anesthesia and with a laryngeal mask airway in place, just a slight head extension improves alignment of the line of vision of the glottis and the laryngeal axis (narrowing of angle ,) but worsened the alignment of the pharyngeal and laryngeal axes (widening of angle ,). [source] The rotational technique with ProSeal laryngeal mask airway does not improve the ease of insertion in childrenPEDIATRIC ANESTHESIA, Issue 5 2006Kazuhiro Watanabe MD No abstract is available for this article. [source] ProSealTM laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performancePEDIATRIC ANESTHESIA, Issue 3 2006MELISSA WHEELER MD Summary Background:, The ProSealTM LMA (PLMATM) has recently been introduced in pediatric sizes (1.5, 2, 2.5, 3). Limited pediatric data have been published. Methods:, After Institutional Review Board (IRB) approval, the PLMATM was placed in 120 children aged 4 months to 13 years (5,50 kg). The following data were collected prospectively: induction agent, number of placement attempts (limited to three), placement success or failure, PLMATM size, leak pressure, ventilatory pattern [spontaneous (SV) or controlled positive pressure ventilation (PPV)], success or failure of gastric suction tube placement, hypoxemia, dislodgement, laryngospasm, bronchospasm, aspiration, and traumatic placement. Results:, The PLMATM was easily placed in children with a higher first attempt success rate (94%) than reported for adults. Overall PLMATM and gastric tube placement were both 100% successful. Leak pressures were similar to those reported for the PLMATM in adults and higher than reported for the ClassicTM LMATM in children. No bronchospasm, laryngospasm, hypoxemia, dislodgement, or aspiration occurred. Conclusions:, Although the PLMATM can be used with SV or PPV, the higher leak pressure achieved with the PLMATM, and the ability to evacuate fluid and air from the stomach suggest that it may be a useful alternative to tracheal intubation for procedures in which PPV is desired in children aged 4 months to 13 years. [source] Right lung atelectasis during general anesthesia with laryngeal mask airwayPEDIATRIC ANESTHESIA, Issue 1 2006S. Kucukguclu No abstract is available for this article. [source] Prevention of aspiration under general anesthesia by use of the size 2½ ProSealTM laryngeal mask airway in a 6-year-old boy: a case reportPEDIATRIC ANESTHESIA, Issue 10 2005KAI GOLDMANN MD DEAA Summary We report a case where use of the size 2 ProSealTM laryngeal mask airway helped to prevent pulmonary aspiration of regurgitated gastric fluid. We describe the management of this case and discuss the potential advantages of this modified laryngeal mask airway for supraglottic airway management in pediatric patients. [source] Airway protection with the ProSealTM laryngeal mask airway in a childPEDIATRIC ANESTHESIA, Issue 12 2004CHRISTIAN KELLER md Summary We describe a case where a size 2 ProSealTM laryngeal mask airway successfully channelled regurgitated fluid away from the respiratory tract in a 5-year-old child following an inguinal hernia repair. [source] Manikin training for neonatal resuscitation with the laryngeal mask airwayPEDIATRIC ANESTHESIA, Issue 6 2004Donna Gandini MB BS Summary Background :,We describe our experience of brief (,15 min) manikin-only training with the laryngeal mask airway (LMATM) for neonatal resuscitation in 80 health care workers. Methods :,Prior to training, 31% had not heard of the LMA, 57% did not know the LMA could be used for neonatal resuscitation and 88% thought it was a disposable device. Results :,The mean (sd) range time to insert the LMA after training was 5 (2, 5,16) s and there were no failed insertions. The preferred technique for neonatal resuscitation, before vs after training, changed from 72 to 14% for the face mask (P < 0.00001), from 6 to 80% for the LMA (P < 0.00001), from 5 to 0% for laryngoscope-guided tracheal intubation (P = 0.04) and from 16 to 5% for unknown (P = 0.02). All considered that training was adequate and the LMA should be available on neonatal resuscitation carts. Confidence in using the LMA increased from 8 to 97% (P < 0.0001). Conclusions :,We conclude that LMA insertion success rates are high and confidence increases after brief manikin-only training. [source] The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndromePEDIATRIC ANESTHESIA, Issue 6 2003Martin J.L. Bucx MD Summary Upper airway obstruction and difficult tracheal intubation are often encountered in patients with Treacher Collins syndrome (mandibulofacial dysostosis). In this case report, the use of a laryngeal mask airway (LMATM) in a 10-day-old newborn with severe Treacher Collins syndrome and acute airway obstruction is described. It successfully relieved the airway obstruction and was left in situ for an exceptionally long period of 4 days. The difficult decisions with respect to the management of the airway and specifically the role of the laryngeal mask are described. In our opinion, in some newborns with severe mandibulofacial disorders and upper airway obstruction, where conservative airway management procedures have failed, the laryngeal mask can be considered not only to relieve the obstruction but also to buy time until there is full insight into the medical condition and its consequences. [source] Incidence of postoperative nausea and vomitingin paediatric ambulatory surgeryPEDIATRIC ANESTHESIA, Issue 8 2002I. Villeret SummaryBackground: We performed a prospective descriptive study over a 5-month period to determine the incidence of postoperative nausea and vomiting (PONV) during the first 24 h following elective ambulatory paediatric surgery, excluding head and neck procedures. Methods: Four hundred and seven patients, aged 15 days to 16 years, were analysed prospectively. Results: The incidence of PONV was 9.4%, occurring most frequently during the first 3 h after anaesthesia and in hospital but rarely during the journey home. It was associated with age, previous history of PONV, tracheal intubation or use of the laryngeal mask airway (LMAÔ), controlled or manual ventilation, opioids and absence of oral intake of liquids or solids. Conversely, type of surgery, premedication, induction mode, association of regional anaesthesia, inhaled nitrous oxide, duration of anaesthesia, stay in the postanaesthesia care unit and duration of journey after discharge were not significantly associated with PONV. Conclusions: PONV never induced complications or delayed patient discharge and curative treatment was rapidly effective. [source] Anaesthetic management of a patient with myotonic dystrophyPEDIATRIC ANESTHESIA, Issue 4 2001DRCOG, R.J. White MBBS A 13-year-old boy with myotonic dystrophy underwent insertion of a percutaneous gastrostomy feeding tube under general anaesthesia. We used a laryngeal mask airway and a spontaneously breathing technique with propofol total intravenous anaesthesia. Postoperative vomiting and aspiration, 12 h after the procedure, subsequently required intubation and ventilation. We discuss the anaesthetic management of this case and review the features of the disease to be considered when contemplating anaesthesia in such patients. [source] Comparison of the Intersurgical SolusTM laryngeal mask airway and the i-gel supralaryngeal deviceANAESTHESIA, Issue 8 2010S. Amini Summary We compared the performance of the Intersurgical SolusTM laryngeal mask airway (LMA) with that of the i-gel in 120 patients of ASA physical status during general anaesthesia with respect to oropharyngeal leak pressure, peak airway pressure, airway manipulation, insertion time, fibreoptic view, ventilatory parameters, and peri-operative complications. After receiving a standardised induction of anaesthesia, either a Solus LMA (60 patients) or an i-gel (60 patients) was inserted. One hundred and fifteen patients completed the study. The leak pressure was significantly higher in the LMA group than the i-gel group (mean (SD) 22.7 (7.7) cmH2O vs 19.3 (7.1) cmH2O; p = 0.02). A better fibreoptic view of the larynx was obtained in patients in the LMA group (p = 0.02) compared to those in the i-gel group and less airway manipulation was required in the LMA group (p < 0.01). Both devices have good performance with very low peri-operative complications. However, the Solus LMA provides a better oropharyngeal seal, provides a better fibreoptic view, and requires less manipulation to secure the airway than the i-gel. [source] | ||||||||||