8/12/2019 Comparison of the Laryngeal Mask Airway SupremeTM.774
http://slidepdf.com/reader/full/comparison-of-the-laryngeal-mask-airway-supremetm774 1/2
232 Airway Management
Use Flexible Reinforced Laringeal Mask (SUFRLM) and Wired Endotracheal
Tube (WETT) in oral surgery of adult patients with regard to: surgical condi-
tions, time of induction and emergence of anesthesia and time of discharge
from the recovery room. In adition we also compared the postoperative inci-
dence of dysphagia, dysphonia and sore throat between both devices.
Materials and Methods: Prospective randomized study conducted on 28
adult patients, 14 in each group, of ASA I - III, who were submitted to oral
surgery under general anesthesia between January and December of 2011.
Anesthesia was induced with fentanyl and propofol and no muscular relaxant
was used. SUFRLM or WETT was inserted and cuff inflated. Anesthesia was
maintained with O2 and Sevoflurane. The data were collected by the anesthe-
siologist and the recovery nurse that was blind for the type of airway device
used. The output data were processed by the SPSS statistical soft ware, com-
paring dichotomous variables with Chi2 test, at a significance level of 0.05.
Results and Discussion: No statistical diffrences were found in what con-
cerns to induction (SUFRLM 6.71 min Vs WETT 5.14 min, p= 0.27, CI 95%
(0.48 - 3.6)) and emergence (SUFRLM 4.57 min Vs WETT 5.79 min, p= 0.277,
CI 95% (0.46- 1.03)) times.The recovery time in the WETT group was shorter
than the SUFRLM group (SUFRLM 163.15 min Vs WETT 103.21 min, p= 0.01,
CI 95% (28.3 - 91.57)). There were no statistical differences in the surgical
conditions, the incidence of dysphonia or dysphagia and suplemental O2
needs in the recovery room. The incidence of sore throat was higher in the
SUFRLM group (SURFLM n=5 (35%) vs WETT n=0 (0%), p= 0.014).
Conclusion(s): The use of SUFRLM appears to be responsible for higher re-
covery times, and superior incidence of sore trhoat when compared with the
WETT, in oral surgery in adults. Nevertheless we will continue studying this
subject in order to achieve a more representative sample.References:1. J Anesth 21:99, 2007;
2. European Journal of Anaesthesiology 27:11 pp941-946, 2010.
19AP3-1
The effect of cricoid pressure on glottic view improvement at
laryngoscopy
Maleki A., Zahedi H.
Tehran University/Tebi Center Hospital, Department of Anaesthesiology,
Tehran, Iran, Islamic Republic of
Background and Goal of Study: The effect of cricoid pressure on the view at
laryngoscopy is unknown. However, cricoid pressure may make the best view
at lar yngoscopy.1 Cricoid pressure is a superficially simple in practice but it is
a complex manoeuvre which is difficult to perform optimally.2,3 The aim of the
present study was to evaluate the efficacy of cricoid pressure on laryngeal
view improvement at laryngoscopy.Materials and Methods: The investigation was carried out as a prospective
randomized double blind study. A total of 84 patients undergoing standard-
ized general anesthesia presenting for elective ophthalmic surgery in Fara-
bi Hospital in 2010-2011 years. Then patients were randomly assigned to :
Group I (with cricoid pressure) (n = 42), group II (without cricoid pressure)
(n = 42) at laryngoscopy. Cricoid pressure was applied in an upward and
backward direction with t wo fingers by the thumb and forefinger on each side
of cricoid cartilage. All patients were assessed by one blind anesthesiologist
for laryngoscopic views and their changes in each groups. Results were ana-
lyzed by X2 test. A P value of < 0.05 was taken as significant.
Results and Discussion: Demographic data were similar in two groups
(p>0.05). The grades of the in first view at Laryngoscopy was not significantly
dif ference in groups (p=0.803). The changes in glottic view show significant
dif ference between two groups (p=0.000). The improved view was 69% in
pressure group and 23.8% in without pressure group (p=0.000). The changes
in glottic views was better with cricoid pressure in an upward and backward
direction.
Conclusion(s):Use of cricoid pressure in an upward and backward directionwith the thumb and forefinger on each side of cricoid cartilage, can provide
the best view at laryngoscopy. It is safe and effective by trained anesthesi-
ologist. These data suggest cricoid pressure particularly in an upward and
backward direction, should be considered when the initial glottic view is not
adequate for intubation.
References:1. Randell T, Määttänen M, Kyttä J. The best view at laryngoscopy using the McCoy
laryngoscope with and without cricoid pressure. Anaesthesia. 1998 Jun;53(6):536-9.
2. Jabalameli M, Hashemi J, Mazoochi M. The ef fect of differ ent Sellick’s maneuver on
laryngoscopic view and intubation time. Journal of Research in Medical Sciences 2005;
10 (5):285-287.
3. Brimacombe J, Berry A. Review article: Cricoid pressure. CAN I ANAESTH 1997; 44:
4: 414-425.
19AP3-2
Consideration of the devices which can decrease the air
leakage while in using LMA
Tennichi T., Toyama K., Taki Y., Nagase N.
Takaoka City Hospital, Department of Anaesthesiology and Intensive Care,
Takaoka, Japan
Background and Goal Study: Laryngeal mask airway (LMA) is the advanced
airway management tools. But, when we use LMA under mechanical ven-tilation, we often encounter the air leakage. Therefore, we saw if we can’t
decrease the air leakage.
Then, we discovered that the air leakage while in using LMA could be de-
creased by pressing the body surface of the neck.
As the result of trial and error, we made new devices for decreasing the air
leakage and evaluated the effect of them.
Material and method: We found that the air leakage could be decreased
by compressing external side between infrahyoid region on both sides and
upper border of thyroid cartilage percutaneously with two cylindrical gauze
(2cm thick around, 5~8cm long).
Then, we made devises which can be fixed by wrapping them around their
neck with Velcro.
We made varied sizes of them and put it which can decrease the air leakage
most effectively on.
Eighty-one patients were undergone general anesthesia while in using LMA.
When the air leakage occurred, we put it on. Then, we divided them into four
groups based on amount of leaking air.
Result: Air leakage was occurred in thirt y-nine patients. Among them, we
used the devices in thirt y-six patients belonging to three groups (group2,3,4).
(amount of leaking air; group1: none, group2: 79±43ml, group3: 223±87ml,
group 4: avaluative)
After using the devices, the air leakage decreased significantly for every
group.
(amount of leaking air; group2: 31±30ml, group3: 26±18ml, group4:
60±50ml) (P< 0.0005)
Furthermore, there were no problems of the breathing, blood circulatory and
nerve system.
Discussion: According to a report, some people increased the amount of cuff
when the air leakage occurred. But it was pointed out the possibility of tissue
perfusion abnormality.
No one has reported whether the air leakage could be decreased by com-
pressing the regions percutaneously.
The regions fall under near the outside superior border of the thyroid car tilage
anatomically.
There were no complications. Therefore, it can be concluded that the devicesare safe to use.
Conclusion: While in using LMA under mechanical ventilation, the devices
can decrease the air leakage safely.
19AP3-3
Comparison of the Laryngeal Mask Airway SupremeTM
insertion techniques: reverse insertion technique vs.
standard insertion technique
Tampo A., Suzuki A., Sako S., Iwasaki H.
Asahikawa Medical University, Depar tment of Anaesthesiology and Intensive
Care, Asahikawa, Japan
Background and Goal of Study: Laryngeal Mask Airway (LMA) is widely
used for routine and dif ficult airway management, and also in emergency situ-
ations. “Thumb insertion” is a well known technique used when the anaesthe-
siologist is restricted to access patient’s head end. The latest LMA, Supreme™
(SLMA), has an anatomical shaped design with holding tab so that the anes-thesiologist does not need to insert an index finger along with the LMA shaft.
In addition, the insertion of the SLMA from patient side is not studied yet.
Thus, we conducted the manikin study to evaluate that SLMA is also use-
ful when the performer is restricted to standard insertion approach. In this
study, we compared the utility of SLMA with standard and reverse insertion
techniques.
Materials and Methods: After institutional approval and written informed
consent from participants, twenty seven anesthesiologists in our department
attempted insertion of SLMA with standard and reverse (approach from the
side) insertion techniques on an air way management trainer manikin (Laerdal
Medical, Stavanger, Norway). After brief introduction of the device and prac-
tice for inserting the SLMA into the manikin, participant performed two inser-
tion with different techniques. For each technique, insertion time (the time that
the participant hold the device to complete the first successful ventilation),
8/12/2019 Comparison of the Laryngeal Mask Airway SupremeTM.774
http://slidepdf.com/reader/full/comparison-of-the-laryngeal-mask-airway-supremetm774 2/2
233 Airway Management
ease of insertion (scored with verbal rating scale; VRS), were evaluated. Af ter
insertion, ventilation status was evaluated. SLMA position was evaluated with
the percentage of glottic opening (POGO) score by using a fiberoptic bron-
choscope to observe the vocal cord via the outlet of the SLMA air conduit.
For statistical analysis, paired t-test was used and P < 0.05 is considered as
significant. Data are reported as mean ± sd.
Results and Discussion: The time for insertion showed no difference be-
tween both techniques (13.4 ± 2.1 sec with the standard technique, and 13.9
± 2.4 sec with the reverse technique).
However, the ease of insertion score was grater with the standard technique
(94.4 ± 5.4) compared to the reverse technique (87.5 ± 11.2). The ventilation
status and POGO scores were not significant between the two techniques.
Conclusions: Reverse insertion technique of LMA SupremeTM is equally ef-
fective compared with standard insertion technique. This technique can be
used under emergency situations that the access to the patient head end is
restricted.
19AP3-4
Evaluation of the LMA position using ultrasound in pediatric
patients
Kim J.M., Kil H.-K.
Yonsei University College of Medicine, Department of Anaesthesiology and
Pain Medicine, Seoul, Korea, Republic of
Background and Goal of Study: Although the LMA insertion is not dif ficult
and the majority of cases with LMA fare well in ventilation, the fiberscopicassessment demonstrates a high incidence of LMA malpositioning. The fiber-
scopic grading of Rowbottom et al. is commonly used for positioning LMA,
but the rotated degree of LMA is not considered in that grading. We hypoth-
esized that the LMA can af fect the position of the arytenoids/thyroid cartilages
and it may be detected on ultrasound.
This study was designed to assess the predictability of detecting the rotated
LMA according to the position change of arytenoids/thyroid cartilages using
the ultrasound.
Materials and Methods: Children, aged 1 ms - 6 years, undergoing infraum-
bilical surgery were enrolled. Ultrasound was performed on the supraglottic
and vocal cords area before and after the LMA insertion. Transverse images
were obtained on the end-expiratory phases. LMA-position was evaluated
with Bonfils fiberscope. Position grading was made as usual. If grade >3 was
showed, LMA was repositioned while observing with fiberscopy. If the face of
LMA was rotated to one-side, the LMA was rotated to the opposite side a little.
The ultrasound findings of pre- and post-LMA were compared. On fiberscopic
images, conventional LMA grade and the degree of rotation were measured.
Results and Discussion: A total of 26 cases were completed in the study. In9/26 cases, LMA was rotated to left or right side in a range of 10-40◦. In 8/9
cases, ultrasound showed asymmetrical elevation of the arytenoids/thyroid
cartilage after the LMA insertion.
LMA- grade Number Rotated LMA US-detectable
I 13 6 5
II 6 2 2
III 3 0 0
IV 0 0 0
V 4 1 1
[Table1. Patients characteristics]
[Sonographic findings and fiberscopic finding]
Conclusion(s): Real-time ultrasound can be useful in positioning of the ro-
tated LMA
19AP3-5
Real-time changes of pressure-volume curve provide objective
information on efficiency of face mask ventilation during
induction of anaesthesia: an observational study
Hascilowicz T., Kiyama S., Hobo S., Ohashi Y., Yoshioka S., Uezono S.
Jikei University School of Medicine, Department of Anaesthesiology and
Intensive Care, Tokyo, Japan
Background and Goal of Study: Face mask ventilation (FMV) is one of es-sential skills of anaesthetists. Opioids, sedatives and neuromuscular blocking
agents (NMBA), as well as patient- and anaesthetist-related factors, influence
ef ficiency of FMV. However, no objective methods to assess efficiency of FMV
have been established. The purpose of the present study was to examine
whether real-time visualization of pressure-volume curve (P-V curve) changes
enables objective assessment of FMV during induction of anaesthesia.
Materials and Methods: Ten anaesthetists (trainees and staf f-grade) ven-
tilated lungs of 26 patients following induction of general anaesthesia. P-V
curves continuously drawn on the spirometry display of Aisys Carestation (GE
Healthcare, Helsinki, Finland) were video-recorded. Shape and tilt of diagonal
line of P-V curves were graphically processed and analysed.
Results: 1) Changes of P-V curve were easily recognised in a real-time fash-
ion. 2) P-V curve changed significantly during FMV in 11 patients (42%). 3)
P-V curve changes corresponded well with the subjective “feel” of easier FMV
after administration of NMBA. 4) In patients with subjectively more difficult but
possible FMV, shape of P-V curves showed characteristic sequential increase
of tilt angle, which reflected effects of drugs used for induction as well as
gradually improving fitting of a face mask.
Conclusion(s):Real-time observation of the P-V cur ve during induction of an-
aesthesia provides objective information on the ef ficiency of FMV. Compared
to other parameters used to assess FMV efficiency (e.g. VTi /V
Te ratio, P
max), P-V
curve can be a visual objective proof of ease or difficulty of FMV.
[PV curve changes during mask ventilation]
19AP3-6
Jet speed: subjective and objective review of speed at which
anaesthetists can perform needle cricothyroidotomy and jet
ventilation
Shonfeld A., Boynton C., Vaughan D.
Northwick Park Hospital, Department of Anaesthesiology, London, United
KingdomBackground and Goal of Study: Needle cricothyroidotomy (NCTO) is an im-
portant rescue technique in can’t intubate, can’t ventilate scenarios [1]. NAP4
highlighted the difficulty in performing NCTO and lack of successful oxygen-
ation [2]. This projects aim was to look at performance of anaesthetists of all
grades in performing the procedure.
Materials and Methods: We constructed a model larynx from a sheep’s lar-
ynx and trachea and medical adhesive tape and gained consent from par-
ticipants. We instructed the participants to perform a NCTO and attempt to
oxygenate. We then gave an example demonstration of how to perform a
NCTO and use the Sanders jet ventilator. The par ticipants were then asked to
perform a NCTO and oxygenate again and the first and second times were
compared. The candidates completed a questionnaire before and after the
practical assessment.
Results and Discussion: The candidates ranged from 1st year trainees to
senior consultants. 20% of anaesthetists had previously performed a NCTO