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Desurkar, Vinayak N. "Combined TEE and LMA technique." Journal of Cardiothoracic and Vascular Anesthesia 18, no. 3 (June 2004): 395. http://dx.doi.org/10.1053/j.jvca.2004.03.026.
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Krishna, Handattu Mahabaleswara, and Laxmi Shenoy. "A rescue technique for LMA Classic insertion in unanticipated limitation of mouth opening." Indian Journal of Respiratory Care 03, no. 02 (November 30, 2022): 497–99. http://dx.doi.org/10.5005/ijrc-3-1-497.
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Sudden unanticipated limitation in mouth opening can cause serious problems in airway management. We report a case in which mouth opening became restricted after induction of anaesthesia resulting in inability to insert LMA Classic by standard insertion technique. An alternative technique consisting of LMA insertion without intraoral manipulation was used in this case as a rescue technique and LMA could be inserted successfully.
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Macario, Alex, Pearl C. Chang, Dan B. Stempel, and John G. Brock-Utne. "A Cost Analysis of the Laryngeal Mask Airway for Elective Surgery in Adult Outpatients." Anesthesiology 83, no. 2 (August 1, 1995): 250–57. http://dx.doi.org/10.1097/00000542-199508000-00003.
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Background Since the introduction of the laryngeal mask airway (LMA) into the United States in 1991, the device has become widely used in anesthesia practice. The purpose of this economic analysis was to use existing data to evaluate the costs of the LMA relative to three other common airway management techniques and to identify the variables that had the greatest effect on cost efficiency. Methods We evaluated four airway management techniques for healthy adults receiving an isoflurane-nitrous oxide-oxygen anesthetic for elective outpatient surgery: (1) LMA with spontaneous ventilation; (2) face mask with spontaneous ventilation; (3) tracheal intubation after succinylcholine with subsequent spontaneous ventilation; and (4) tracheal intubation after nondepolarizing neuromuscular blockade and controlled ventilation. We analyzed published clinical studies of the LMA and obtained cost data from Stanford University Medical Center. The best available estimates of the independent variables were incorporated into a baseline case. For each airway technique we derived cost equations that excluded costs common to all four techniques. Results Relative to airway management with an LMA, calculated values for the baseline analysis included additional isoflurane costs for use of a face mask ($ 0.12/min) and for tracheal intubation with ($ 0.043/min) and without neuromuscular blockade ($ 0.06/min). With a neuromuscular blocking drug cost of $ 0.21/min and an LMA cost per use of $ 20, the face mask with spontaneous ventilation was the cost-efficient airway choice for anesthetics lasting as long as 100 min. Increasing the LMA reuse rate from 10 to 25 made the LMA the least costly airway technique for cases lasting more than 70 min. Conclusions If the LMA is reused 40 times, the LMA is the cost-efficient airway choice for outpatients receiving an isoflurane-nitrous oxide-oxygen anesthetic lasting longer than 40 min. This finding does not change if the cost of neuromuscular blockade or the incidence of airway-related complications is varied over a clinically relevant range.
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Mariani, Gonzalo, María Virasoro, Sebastián Burgos, María Labanca, Pablo Otero, and Cristian Bernardo. "Surfactant Administration through Laryngeal Mask Airway: A Randomized Controlled Study in Rabbits." American Journal of Perinatology 35, no. 07 (December 8, 2017): 669–75. http://dx.doi.org/10.1055/s-0037-1608931.
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Background Minimally invasive techniques for surfactant administration for infants with respiratory distress syndrome (RDS) of moderate severity have been proposed. The laryngeal mask airway (LMA) helps in securing the airway without the need of laryngoscopy, but still requires the use of positive pressure ventilation (PPV) to flush surfactant into the lungs. Objective This article compares the effectiveness of two techniques for LMA surfactant administration, instillation into the LMA lumen followed by PPV versus direct laryngeal instillation through a preinserted feeding tube inside the LMA during spontaneous respirations. Study Design This is a randomized controlled trial (RCT) of 18 rabbits with acquired respiratory distress after lung lavage. After surfactant was given, the rabbits remained on continuous positive airway pressure (CPAP). Gas exchange parameters were assessed at baseline and at 30 minutes and lung parenchyma pathology features were analyzed. Results Time required for surfactant administration, oxygenation improvement, and histopathologic findings did not differ between groups. The new technique decreased the need of PPV (p < 0.05). Conclusion In this animal model, surfactant administration through a preinserted feeding tube within the LMA lumen is safe and effective while providing the benefits of a minimally invasive approach. This technique reduces the need of PPV and may prevent its potential risks.
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Goyal, Monica, Akanksha Dutt, and Anjum S. Khan Joad. "Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison." F1000Research 2 (May 9, 2013): 123. http://dx.doi.org/10.12688/f1000research.2-123.v1.
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We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity were assessed in both study groups. On statistical analysis, both groups were comparable in all respects. From our study it can be concluded that thumb insertion is an effective insertion technique for the LMA Classic™.
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Raghavan, P., Mithun Raju P., and Arnold Plazid T. "Comparison of two insertion techniques of classic laryngeal mask airway: standard versus 90-degree rotation." International Journal of Research in Medical Sciences 5, no. 2 (January 23, 2017): 420. http://dx.doi.org/10.18203/2320-6012.ijrms20170015.
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Background: Laryngeal mask airway (LMA) devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been suggested to improve the insertion success rate of laryngeal masks. The objective of the present study was to compare the ease of insertion of laryngeal mask in terms of, success rate at the first attempt, number of LMA insertion attempts, time duration of LMA insertion and complications like blood stain on LMA and sore throat.Methods: This prospective cohort study was conducted to compare the success rate of insertion at the first attempts between standard technique and 90 degree rotational technique at Department of Anaesthesiology, Amala institute of medical sciences, Thrissur, India during the period from March 2014-september 2015. A total of 160 patients each group consisting of 80 was included in the study after meeting inclusion criteria. Success rate of insertion at first attempts, number of insertion attempts, and insertion time of successful attempt, overall success rate, blood staining of laryngeal mask airway (LMA) and postoperative sore throat were recorded.Results: Significant difference was existed between the two groups with regard to gender. Statistically insignificant differences were observed for demographics like age, weight, ASA grades between the two study groups. Significant differences were observed among the study groups on all findings of LMA insertion. Statistically insignificant difference was detected for the time of duration of LMA insertion and change in heart rate, but mean arterial pressure was found statistically significant between the two groups.Conclusions: This study found that 90 degree rotational technique has high success rate of insertion at first attempt & is less traumatic than standard technique.
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Stocks, Rose Mary S., Robert Egerman, Jerome W. Thompson, and Michael Peery. "Airway Management of the Severely Retrognathic Child: Use of the Laryngeal Mask Airway." Ear, Nose & Throat Journal 81, no. 4 (April 2002): 223–26. http://dx.doi.org/10.1177/014556130208100410.
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Successful airway management of an infant or child with moderate to severe retrognathia first requires recognition of a potential problem. If the child cannot be intubated in a standard fashion, the use of a laryngeal mask airway (LMA) should be considered. We describe two cases wherein a toddler and an infant with severe retrognathia failed multiple attempts at traditional intubation. Both had an anterior larynx and hypoplasia of the mandible. In both cases, a subsequent LMA was successfully placed. The severely retrognathic newborn or child presents to the physician a unique challenge in airway management. Techniques to manage this difficult pediatric airway are different from those used in the adult. Otolaryngologists should be aware of this intubation technique and include it in their armamentarium of airway-management strategies. The LMA is not recommended as the technique of choice for securing a difficult airway, but it is an effective alternative when indicated, and it might be life-saving.
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Messiha, A., D. Sumal, F. van Damme, and M. Bater. "Modified technique in securing the LMA in multiple extractions." Oral Surgery 6, no. 1 (January 22, 2013): 9–15. http://dx.doi.org/10.1111/j.1752-248x.2012.01167.x.
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Kazemi, Asef Parviz, Mohammad Ali Daneshforooz, and Shahriar Omidvari. "A Comparison between a Two Person Insertion Technique of Laryngeal Mask Airway and the Classic One Person Technique." Galen Medical Journal 2, no. 4 (December 2, 2013): 179–82. http://dx.doi.org/10.31661/gmj.v2i4.148.
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Background: Various studies are seeking to find new methods to improve techniques of laryngeal mask airway (LMA) insertion and reduce possible complications. In this study, we embarked on a clinical study to investigate the advantages of a new insertion method of laryngeal mask and to compare it with the classic method.Materials and Methods: Two hundred patients aged 20-60 years old in 2012 were randomly divided into two groups allocated to receive either the new technique of insertion of LMA (two-person method) or the classic method (one-person method). In the two person method, jaw thrust and mouth opening is done by a technician and then anesthesiologist inserts the LMA. Oxygen saturation, time to insert laryngeal mask, end-tidal carbon dioxide pressure, and the ease of insertion in both groups were measured. The collected data were analyzed by using ANOVA test. P-value< 0.05 was considered as statistically significant.Results: The measured end-tidal pressure of carbon dioxide (ETCO2) and saturation of O2 were 31.68 mmHg and 98.87 % in the classic method and 30.47 mmHg and 99.42 % in the two-person method, respectively. These differences were statistically significant for both values. However, the discrepancy of insertion time and ease of insertion between the two groups were not statistically considerable.Conclusion: The new technique introduced in this study is associated with higher rate of success, as evidenced by enhancement of saturation of O2 and reduction of ETCO2. Therefore, this method could be considered as a safe and effective method in order to establish a secure airway in anesthetized patients in future studies.
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Soedarso, Doddy. "Accuration Insertion Lma with Video Laryngoscope Compare with Classic Technique." SOJ Anesthesiology & Pain Management 4, no. 1 (June 21, 2017): 1–4. http://dx.doi.org/10.15226/2374-684x/4/1/00142.
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Howath, A., J. Brimacombe, and C. Keller. "Gum-elastic Bougie-guided Insertion of the ProSeal™ Laryngeal Mask Airway: A New Technique." Anaesthesia and Intensive Care 30, no. 5 (October 2002): 624–27. http://dx.doi.org/10.1177/0310057x0203000514.
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We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal™ laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1–2, aged 18 to 80 years) were studied. The ProSeal LMA drainage tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the drainage tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17–40) cmH 2 O and ventilation was possible without leak in all patients at 9.5 ml.kg –1 tidal volume. There were no drainage tube or gastric air leaks. Gastric tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.
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Pathak, Ruchi, Komal Modi, and Kanchanaa S. P. "A study of BlockBuster laryngeal mask airway versus Fastrach/Intubating laryngeal mask airway as a conduit for blind oro-tracheal intubation: A prospective randomized controlled study." Indian Journal of Clinical Anaesthesia 9, no. 4 (November 15, 2022): 422–27. http://dx.doi.org/10.18231/j.ijca.2022.086.
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A Laryngeal Mask Airway (LMA) has two parts, a simple breathing tube and a mask. The mask at the laryngeal end of the tube aligns against the glottis and provides better channel of ventilation than the face mask. There have been modifications in the basic design of the LMA to incorporate gastric drainage channel and some devices are also equipped with a channel for intubation to secure airway by guiding endotracheal tube (ETT) through it. In this study we evaluated the performance of two LMA devices that can aid in rescue ventilation and are also equipped with a channel for intubation namely the BlockBuster LMA(2012) and the Fastrach/ Intubating LMA(1997) for blind oro-tracheal intubation in terms of First attempt success rate and Over-all success rate of intubation. A hundred consenting patients of age group 18-60 years and ASA status I or II, were randomly allocated into two groups Group BB (BlockBuster LMA) and Group FT (Fastrach LMA) with 50 patients each. Standard anesthesia technique was used for both groups. After insertion of airway device, cuff was inflated and ventilation was attempted (maximum 2 attempts). Once ventilation was achieved, ETT of appropriate size was inserted through LMA (maximum 2 attempts). The correct placement of ETT was confirmed by capnography. Data was collected for number of attempts of tracheal intubation, time taken for intubation and complications. First attempt success rate of intubation was more in Blockbuster LMA than Fastrach LMA. Over-all success rate of Intubation was 100% for both devices. Time taken for intubation and incidence of post-operative sore throat was less in BlockBuster LMA than Fastrach LMA(p-value<0.05). Blockbuster LMA is better conduit for oro-tracheal intubation than Fastrach LMA in terms of higher first attempt success rate, lesser time taken for intubation and lesser post-operative complications.
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Nord, Anders, Doris Cunha-Goncalves, Rikard Linnér, Federico Bianco, Fabrizio Salomone, Francesca Ricci, Marta Lombardini, Massimo Micaglio, Daniele Trevisanuto, and Valeria Perez-de-Sa. "Lung Deposition of Surfactant Delivered via a Dedicated Laryngeal Mask Airway in Piglets." Pharmaceutics 13, no. 11 (November 4, 2021): 1858. http://dx.doi.org/10.3390/pharmaceutics13111858.
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It is unknown if the lung deposition of surfactant administered via a catheter placed through a laryngeal mask airway (LMA) is equivalent to that obtained by bolus instillation through an endotracheal tube. We compare the lung deposition of surfactant delivered via two types of LMA with the standard technique of endotracheal instillation. 25 newborn piglets on continuous positive airway pressure support (CPAP) were randomized into three groups: 1—LMA-camera (integrated camera and catheter channel; catheter tip below vocal cords), 2—LMA-standard (no camera, no channel; catheter tip above the glottis), 3—InSurE (Intubation, Surfactant administration, Extubation; catheter tip below end of endotracheal tube). All animals received 100 mg·kg−1 of poractant alfa mixed with 99mTechnetium-nanocolloid. Surfactant deposition was measured by gamma scintigraphy as a percentage of the administered dose. The median (range) total lung surfactant deposition was 68% (10–85), 41% (5–88), and 88% (67–92) in LMA-camera, LMA-standard, and InSurE, respectively, which was higher (p < 0.05) in the latter. The deposition in the stomach and nasopharynx was higher with the LMA-standard. The surfactant deposition via an LMA was lower than that obtained with InSurE. Although not statistically significant, introducing the catheter below the vocal cords under visual control with an integrated camera improved surfactant LMA delivery by 65%.
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Brimacombe, Joe, and D. Gandini. "Resuscitation of Neonates with the Laryngeal Mask Airway—A Caution." Pediatrics 95, no. 3 (March 1, 1995): 453–54. http://dx.doi.org/10.1542/peds.95.3.453b.
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We would like to report our experience with the laryngeal mask airway (LMA) for neonatal resuscitation. The LMA was used in neonates with apnea or heart rate <100 min-1 who had no evidence of meconium aspiration. The LMA was inserted using the standard technique with the cuff fully deflated and then inflated with 2 to 5 mL air.1 It was then held in place manually and connected to a pediatric Mapleson F circuit. Intermittent positive-pressure ventilation or continuous positive airway pressure was administered until respiration was established.
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Esen, Asım, Mefkur Bakan, Ufuk Topuz, Zeynep Ertaş Dursun, and Kazım Karaaslan. "A new maneuver for classical laryngeal mask airway insertion: Prospective randomized study." Journal of Surgery and Medicine 6, no. 8 (August 31, 2022): 713–17. http://dx.doi.org/10.28982/josam.1120640.
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Background/Aim: Laryngeal mask airway (LMA) has been frequently used for airway management. But the satisfaction of the insertion and trauma at insertion remain problems. We present a new insertion maneuver for classical LMA (cLMA) with a partially inflated cuff and examine its success and complication rate.
Methods: In 4 months, 158 patients who were classified as ASA I–III and older than 18 years old and were planned for LMA were included in this study consecutively (according to the study design, one patient was excluded during the study). Emergency cases, patients with any contraindications with LMA, patients who were expected to undergo surgery for more than 2 h, patients with preoperative respiratory tract infection or sore throat, patients undergoing oral or nasal surgery, and patients with aspirated oropharyngeal secretions after removal of LMA was excluded from the study. Age, gender, height, weight, ASA scores, comorbidities, and the duration of anesthesia and surgery of the patients were recorded. One-hundred-fifty-seven consecutive patients were randomized into two groups by a coin toss [control group (group C) and study group (group S)]. The groups were compared in terms of LMA insertion success, the number of insertion attempts, the presence of blood on the LMA or in secretions, and postoperative sore throat. Classical Laryngeal Mask Airway was inserted with Brain’s standard technique in group C and with the new technique in group S. In the new technique, the head and neck of the patient were supported in a straight position, the mouth was opened, cLMA was held with a dominant hand from the tube part and inserted until the tip touches to the oropharynx. The index finger of the non-dominant hand was inserted into the mouth to pass by the cLMA and reach the tip of the cLMA. The tip of cLMA was directed to the caudal by the index finger. Then, cLMA was inserted by the guidance of the index finger until it reached the triangular base of the oropharynx.
Results: There was no statistically significant difference in terms of demographic data and placement success; placement success was better in the study group (100% versus 98.6% and P = 0.45). Similarly, the count of attempts was better in the study group. The mean attempt number was 1.11 in group S and 1.28 in group C (P = 0.02). Also, blood on LMA was seen to be more common in group C (P = 0.04). There were no statistical differences in sore throat, but it was less seen in group S.
Conclusion: The new maneuver was better than the standard technique and easy to use in daily practice.
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Prince, Jordan, Cameron Goertzen, Maryam Zanjir, Michelle Wong, and Amir Azarpazhooh. "Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis." Anesthesia Progress 68, no. 4 (December 1, 2021): 193–205. http://dx.doi.org/10.2344/anpr-68-04-02.
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Objective: Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management. Methods: A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I2 statistic. Sensitivity and age-subgroup analyses were explored. Results: Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I2 = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I2 = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I2 = 0%; moderate quality). Conclusion: Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required.
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Ye, Mei Ying. "Hybrid Optimization Approach for Evaluating Photovoltaic Cell Parameters." Applied Mechanics and Materials 373-375 (August 2013): 1261–64. http://dx.doi.org/10.4028/www.scientific.net/amm.373-375.1261.
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A new hybrid intelligent technique is proposed to evaluate photovoltaic cell model parameters in this paper. The intelligent technique is based on a hybrid of genetic algorithm (GA) and LevenbergMarquardt algorithm (LMA). In the proposed hybrid intelligent technique, the GA firstly searches the entire problem space to get a set of roughly estimated solutions, i.e. near-optimal solutions. Then the LMA performs a local optima search in order to carry out further optimizations. An example has been used to demonstrate the evaluation procedure in order to test the performance of the proposed approach. The results show that the proposed technique has better performance than the GA approach in terms of the objective function value, the computation time and the reconstructedI-Vcurve shape.
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Ye, Mei Ying, Hui Jiang, You Sheng Xu, and Xiao Dong Wang. "Bouc-Wen Hysteresis Model Parameter Identification by Means of Hybrid Intelligent Technique." Advanced Materials Research 108-111 (May 2010): 1397–402. http://dx.doi.org/10.4028/www.scientific.net/amr.108-111.1397.
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A hybrid intelligent technique is proposed to identify Bouc-Wen hysteresis model parameters. This intelligent technique is based on a hybrid of genetic algorithm (GA) and Levenberg–Marquardt algorithm (LMA). In the hybrid intelligent technique, the GA, a popular evolutionary optimization method, firstly searches the entire problem space to get a set of roughly estimated solutions. The LMA, a well-known numerical method, then performs a local optima search in order to carry out further optimizations. The performance of the hybrid intelligent technique is compared with GA method in terms of parameter accuracy. The simulation experiments of Bouc-Wen hysteresis model with known parameters are illustrated to show that a high quality solution can be achieved by means of the hybrid intelligent technique. The concept of hybrid intelligent technique may benefit the parameter identification in diverse hysteresis model problems.
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Low, Song Lin, Azlina Masdar, Nadia Md. Nor, Azrin Mohd Azidin, Hsueh Jing Low, and Siti Nidzwani Mohamad Mahdi. "Evaluating the Optimal Operating Table Height for ProSeal-LMA™ Insertion." International Journal of Clinical Practice 2022 (November 17, 2022): 1–7. http://dx.doi.org/10.1155/2022/5118362.
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Introduction. ProSeal-Laryngeal Mask Airway™ (P-LMA™) is one of the commonly used laryngeal mask airways. Despite the proper insertion technique, suboptimal positioning and airway morbidity still occurs. This study explored the possibility of the operating table height position affecting successful P-LMA™ placement. Methods. A total of 138 patients aged between 18 and 65 years old with the American Society of Anesthesiologists (ASA) I or II status, who required general anaesthesia and had no contraindication towards the use of P-LMA™, were recruited. They were randomly positioned into three anatomical landmarks, which were umbilicus, lowest rib margin, and xiphoid. P-LMA™ was inserted following muscle paralysis, and the first successful placement was evaluated using positional and performance tests. Duration, ease of P-LMA™ insertion, and airway complications were compared. Results. Demographic and airway features were comparable among all groups. The P-LMA™ placement success rate improved when the table height was positioned at the lowest rib margin ( p = 0.002 ). All three positions were comparable in terms of duration, ease of insertion, and airway morbidities. Conclusion. The lowest rib margin anatomical landmark can be used as a guide in achieving the optimal operating table height for successful P-LMA™ placement.
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Bocxlaer, Bert Van, and Roland Schultheiß. "Comparison of morphometric techniques for shapes with few homologous landmarks based on machine-learning approaches to biological discrimination." Paleobiology 36, no. 3 (2010): 497–515. http://dx.doi.org/10.1666/08068.1.
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Biometric analyses are useful tools for the study of organisms, their phylogenetic affiliation, and the pattern and rate of their evolution. Various morphometric techniques have been developed to analyze morphological variation, but methodological choices are often made arbitrarily because quantitative comparisons are lacking or inconclusive. Here we address morphometric quantification of taxa with few unambiguously identifiable landmarks (<15), utilizing ornamented and unornamented gastropod shells. Support vector machines were applied to evaluate classification performances of landmark (LMA), elliptic Fourier (EFA), and semi-landmark analysis (SLM). This evaluation is based on the discrimination of between-group differences relative to within-group variation, and thus allows comparing how the techniques treat different types of biological information. The results suggest that EFA performs slightly better than SLM (and certainly LMA) in discerning a priori identified taxa with unornamented shells, but that SLM is significantly superior to other techniques for ornamented shells. Alignment and homology problems may cause the subtle variations in ornamentation to become blurred as noise in EFA, even though EFA is often cited to be able to deal with complex shapes. Performance of LMA depends entirely on how accurately the structure can be covered with landmarks. Guidelines in choosing a morphometric technique in diverse cases are provided.
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Vidricková, Petra, and Martin Boldižár. "Usage of Laryngeal Mask Airway Devices in Veterinary Medicine." Macedonian Veterinary Review 43, no. 2 (October 1, 2020): 131–39. http://dx.doi.org/10.2478/macvetrev-2020-0020.
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AbstractProviding a secure airway management during general anesthesia could be problematic in some medical cases, especially when there is a risk of regurgitation and aspiration of the gastric content due to increased intragastric pressure. The current study aimed to test the applicability of two types of LMA in several animal species and to compare its effectiveness to the endotracheal intubation method in securing sealed airway respiration as an alternative to using endotracheal tubes. The study was conducted in dogs (n=33), cats (n=9), swine (n=9), rabbits (n=5), sheep (n=7) and roe deer (n=1). One or both types of laryngeal masks were used for each animal species: LMA Classic™-cLMA and LMA ProSeal™-PLMA. The assessment of each laryngeal mask was performed by determining the insertion technique, the possibilities of first-attempt insertion and malposition, the compliance with various animal species, ventilation time, cuff pressure, and sealing capacity. The highest LMA size compatility in dogs (23,87±14,30 kg) was size-3 in six and size-4 in forteen subjects; In swine (43,22±12,32 kg), size-4; In rabbits (3,84±0,36 kg) size-1; and in sheep (48,29±4,65 kg) size-3 and size-4. Ventilation time was highest in swine and roe deer (121,11±42,85 min and 300,00 min, respectively) and lowest in cat (28,33±16,96 min). First-attempt LMA insertion success was lowest in rabbits (60%), and highest in sheep and roe deer (100%). Malposition was with highest rate in rabbits (40%) and lowest in cat, sheep and roe deer (0%). Gastric reflux was most frequently observed in sheep (71,4%) and roe deer (100%). The usage of LMA in the veterinary anesthetic practice significantly improves airway management in animals during general anesthesia. The inflated LMA cuff does not prevent its disposition. Therefore, both the drain and respiratory tubes must be fixed. The usage of LMA in rabbits was associated with higher incidence of malposition and other complications. Our findings suggest that LMA designed for humans can be used for airway management in veterinary medicine.
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von Ungern-Sternberg, Britta S., Krisztina Boda, Craig Schwab, Craig Sims, Chris Johnson, and Walid Habre. "Laryngeal Mask Airway Is Associated with an Increased Incidence of Adverse Respiratory Events in Children with Recent Upper Respiratory Tract Infections." Anesthesiology 107, no. 5 (November 1, 2007): 714–19. http://dx.doi.org/10.1097/01.anes.0000286925.25272.b5.
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Background The laryngeal mask airway (LMA) has been advocated as an alternative technique to tracheal intubation for airway management of children with recent upper respiratory tract infections (URIs). The authors determined the occurrence of adverse respiratory events and identified the associated risk factors to assess the safety of LMA in children. Methods During a period of 5 months, parents of children scheduled to undergo general anesthesia with an LMA were asked to fill out a questionnaire regarding their child's medical history and potential symptoms of URI. In addition, all episodes of adverse respiratory events in the perioperative period (laryngospasm, bronchospasm, coughing, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded. Results Among the 831 children included in the study, 27% presented with a history of a recent URI within the last 2 weeks before anesthesia. The presence of a recent URI doubled the incidence of laryngospasm (odds ratio, 2.6; 95% confidence interval, 1.3-5.0), coughing (odds ratio, 2.7; 95% confidence interval, 1.7-4.3), and oxygen desaturation (odds ratio, 1.9; 95% confidence interval, 1.2-2.8). This incidence was even higher in young children; in those undergoing ear, nose, and throat surgery; and when there were multiple attempts to insert the LMA. Conclusion An LMA used in children with recent URIs was associated with a higher incidence of laryngospasm, cough, and oxygen desaturation compared with healthy children. However, the overall incidence of adverse respiratory events was low, suggesting that if anesthesiologists allow at least a 2-week interval after a URI, they can safely proceed with anesthesia using an LMA.
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Cooper, John R. "Use of a LMA ™ and a Sequential Technique for Unanticipated Difficult Intubations." Anesthesiology 97, no. 5 (November 1, 2002): 1326. http://dx.doi.org/10.1097/00000542-200211000-00050.
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FEROZE, FAHEEM, NAVEED MASOOD, AMIN KHUWAJA, and Fakhar Ilyas Malik. "NEONATAL RESUSCITATION." Professional Medical Journal 15, no. 01 (March 10, 2008): 148–52. http://dx.doi.org/10.29309/tpmj/2008.15.01.2716.
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Background: The key to success in newborn resuscitation is theknowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process.The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube (ETT) or Face Mask (FM),both of these techniques require expertise and are associated with high rates of failure. Hence a third potential optionhas been suggested to overcome these problems. Objectives: To evaluate the efficacy of Laryngeal Mask Airway(LMA) in neonatal resuscitation and artificial ventilation and to compare it with that of ETT and FM. To evaluate LMA’sefficiency in situation where endotracheal intubation and facemask ventilation is difficult or not possible. Design: A Noninterventional, analytical / comparative study Setting: Combined Military Hospital Rawalpindi. Period: 20 weeks (1stJanuary 2002 to 31 May 2002). Subjects: A group of 75 neonates born with C-Section were selected on the basis ofnon-probability convenience sampling. They were subdivided into three sub gps with 25 neonates in each sub gp.Interventions; 75 neonates born after C-Section, were divided into sub gps i.e. A, B, and C containing a no of 25neonates in each gp. They were ventilated with ETT, FM and LMA respectively. These newborn babies had an Apgarscore < 4. They were resuscitated using a fix protocol. The efficacy of ventilation with either technique was evaluatedin terms of placement and ventilation. Results: The LMA emerged, as a valuable and better option in newbornresuscitation. Moreover, it was a successful tool in situations where endotracheal intubation and facemask ventilationwas difficult or impossible. Conclusion: The LMA is a potential valuable adjunct for the management of neonatalairway.
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Sahaya, Anupriya, R. K. Singh, Nikita Baser, and Shilpa Sharda. "Comparison of I-gel and laryngeal mask airway classic in terms of ease of insertion and hemodynamic response: a randomised observational study." International Journal of Research in Medical Sciences 11, no. 7 (June 30, 2023): 2567–72. http://dx.doi.org/10.18203/2320-6012.ijrms20232101.
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Background: The gold standard technique for preserving a patent airway throughout anaesthesia is tracheal intubation. I-gel is a relatively new addition to the SADs. I-gel has combined the concept of the non-cuffed SADs like the SLIPA and gastric tube of the proseal LMA yet retaining the shape of laryngeal mask. Hence, we have compared ease of insertion, number and duration of insertion attempts among the two devices. Methods: This study was conducted on patients undergoing elective surgery under GA in Pacific Medical College and Hospital, Udaipur. Patients were divided into two groups: group A= LMA classic, a variant of supraglottic airway device and group B= I-gel, a variant of supraglottic airway device. The two devices were than compared with respect to success rate of insertion, time taken for insertion and ease of gastric tube placement (number of attempts) and post-operative airway morbidity. Results: Mean insertion time was 8.66±3.21 seconds in C-LMA and 6.49±1.92 seconds in I-gel (p<0.001). 97.14% was the success rate of single time attempt insertion with I-gel as compared to 88.57% in C-LMA. There was a failure rate of 11.43% in single attempt insertion with CLMA as compared to 2.86% with I-gel (p>0.05). Conclusions: We hereby concluded with our study that successful and shorter duration of insertion, with less hemodynamic response, makes I-gel™ a suitable alternative to LMA classic™ during general anesthesia.
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Iqbal, Shahid, M. Baqirali Khan, M. Zahid Hanif, Tahir Nazeer, M. Muazam Butt, Rifah, Amna Tahir, M. Arif Rasheed, and Abdul Majid. "Comparison of Laryngeal Mask Airway (Classic) and I-Gel; Ease of insertion." Pakistan Journal of Medical and Health Sciences 16, no. 8 (August 31, 2022): 15–17. http://dx.doi.org/10.53350/pjmhs2216815.
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Background: At the time of induction during general anaesthesia the different complication can occur with endotracheal tube. Supraglottic devices are alternative of endotracheal tube and it prevents such complications. Aim: To compare the frequency of ease of insertion with lma and i-gel® during general anaesthesia. Method: 270 patients of asa class p1 & p2 undergoing general anaesthesia for elective surgeries were included after taking informed consent. Patients were divided into two groups a (lma classic) & b (i-gel) by using random number table. Each group comprised of 135 patients. In both groups dose of propofol was 2.5mg /kg body weight was given intravenously within 30 sec along with nalbuphine 0.1 mg /kg body weight and midazolam 0.05mg / kg body weight. The study design was quasi experimental and sampling technique was purposive non probability convenience sampling. Chi square test was used and collected data was analysed with spss version 20. Result: The ease of insertion in the lma classic group was 82% while the ease of insertion in i-gel® was 84 %. Statistically there was no significant difference of ease of insertion between two groups (p value = 0.41). Conclusion: Both devices have same level of ease of insertion. Keywords: Lma (laryngeal mask airway classic), i-gel®, general anaesthesia, ease of insertion
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Kailash Prabhudev and Naveen Kumar K. "A Prospective Study of Single Breath Vital Capacity Inhalation Induction with High Concentration of Sevoflurane (Sbvc-Hc) for LMA Insertion in Adults for Short Surgical Cases." Academia Anesthesiologica International 5, no. 1 (May 22, 2020): 30–33. http://dx.doi.org/10.21276/aan.2020.5.1.6.
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Background: Sevoflurane is a new volatile anesthetic agent with rapid induction and recovery. A randomized study was carried to access conditions for LMA insertion using Sevoflurane in 25 ASA I & II patients undergoing short duration surgeries.Subjects and Methods:This prospective study was conducted at Department of Anesthesiology and Critical Care, SVS Medical College and Hospital, Mahabubnagar, Telangana, India. After obtaining the institutional ethics committee and written informed consent from the patients, 25 subjects of either sex were included in this study. Age of the subjects was 18 to 60 years. Patients received injection Fentanyl 1 – 2mcg/kg prior to induction. All patients were pre-oxygenated for 3 min with 100% oxygen using a fresh gas flow of 81/min. All patients received inhalational induction with 8% Sevoflurane and O2 flow at 8 L/min with single vital capacity breathe technique. Loss of verbal contact was considered as the desired endpoint for induction, which was assessed by the response to calling out the patient’s name. Then the time of loss of eyelash reflex and jaw relaxation was assessed by anesthesiologist. After adequate jaw relaxation, LMA insertion was attempted.Results:The mean loss of verbal contact was 65.40±9.67second, while the mean for time for loss of eyelash reflex and jaw relaxation were found to be 81.20±9.39 seconds and 103.20 ±12.07 seconds respectively. The mean time for LMA insertion was 122.00±15.61 and the mean attempts for successful LMA insertion was 1.12±0.33. LMA insertion was easy in 23 cases as against difficult in 2 cases. In 2 cases transient cough and biting were recorded. LMA insertion was excellent and satisfactory in 88.0 and 12 percent. However, the mean heart rate at 5 minute after induction showed a significant fall at 5 minutes after induction. The mean values of SBP, DBP and MAP did not differ significantly at pre and induction. However, a significant decrease in SBP was noticed at 1, 2 and at 5 minutes.Conclusion:Sevoflurane is an smooth inhalation anesthesia with rapid onset with adequate jaw relaxation for insertion of LMA in Adults for short duration surgeries. Sevoflurane has got good hemodynamic profile with lesser complications owing to choice of inhalation agent for insertion of LMA.
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Kanagalingam, J., R. Hurley, H. R. Grant, and A. Patel. "A new technique for the management of inaccessible anterior glottic lesions." Journal of Laryngology & Otology 117, no. 4 (April 2003): 302–6. http://dx.doi.org/10.1258/00222150360600922.
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We describe a new technique for removing anterior vocal fold lesions, which cannot be visualized with conventional suspension laryngoscopy. These situations are rare and the only alternative surgeons have had previously is an open laryngeal procedure. The technique we describe involves the use of a laryngeal mask airway (LMA), a flexible bronchoscope with biopsy channel, a 400 μm laser fibre and KTP/532 nm laser. This method was used to treat two patients in whom conventional suspension laryngoscopy had previously been attempted and abandoned.
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Galtier, Thomas, Sayan Gupta, and Igor Rychlik. "Crossings of Second-Order Response Processes Subjected to LMA Loadings." Journal of Probability and Statistics 2010 (2010): 1–22. http://dx.doi.org/10.1155/2010/752452.
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The focus of this paper is on the estimation of the crossing intensities of responses for second-order dynamical systems, subjected to stationary, non-Gaussian external loadings. A new model for random loadings—the Laplace driven moving average (LMA)—is used. The model is non-Gaussian, strictly stationary, can model any spectrum, and has additional flexibility to model the skewness and kurtosis of the marginal distribution. The system response can be expressed as a second-order combination of the LMA processes. A numerical technique for estimating the level crossing intensities for such processes is developed. The proposed method is a hybrid method which combines the saddle-point approximation with limited Monte Carlo simulations. The performance and the accuracy of the proposed method are illustrated through a set of numerical examples.
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Amit B. Kadam and Jamale P B. "Clinical trial for comparison of clinical performance of I-Gel with LMA-proseal in elective surgeries." International Journal of Research in Pharmaceutical Sciences 11, no. 4 (September 25, 2020): 5350–56. http://dx.doi.org/10.26452/ijrps.v11i4.3156.
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The I-gel is genuinely interesting second era aviation route gadget with delicate gel like non inflatable sleeve. The objective of this study was to evaluate and compare the ease of insertion and number of insertion attempts, airway sealing pressure, and evaluation of device position and occurrence of complication. Total70 adult patients were allocated to either i-gel group or P-LMA group with 35patients in each group. Both i-gel and P- LMA were introduced with standard technique. The outcomes measured ease of insertion, number of insertion attempts, airway sealing pressure, changes, evaluation of device position and complications. the i-gel group the success rate at ease of insertion was greater (97% vs72% respectively;P=0.012). Airway sealing pressure was lesser (24.72±1.37 cmH2Ovs 30.09±2.64 cmH2O respectively; P=0.0003). The incidence of postoperative sore throat was lower (2.8% vs 25.7% respectively;P=0.01). Changes in parameters were not clinically significant. The i-gel is easier to insert than P-LMA however with a lower airway sealing pressure. It has a lower incidence of postoperative complications.
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Brimacombe, J., and A. Berry. "Insertion of the Laryngeal Mask Airway—A Prospective Study of Four Techniques." Anaesthesia and Intensive Care 21, no. 1 (February 1993): 89–92. http://dx.doi.org/10.1177/0310057x9302100121.
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The standard insertion technique (ST 0) for laryngeal mask airway insertion was compared to three alternative techniques in 120 patients. The alternative techniques included insertion using the standard approach, but with the cuff either semi-inflated (ST 0.5) or fully inflated (ST 1.0), and a non-standard approach using a back-to-front technique (like a Guedel airway) and with the cuff fully deflated (T 180). Successful insertion was judged by fibreoptic positioning and function. The results confirmed that the ST 0 and T 180 were superior to ST 0.5 and ST 1.0 in terms of fibreoptic positioning (P<0.02) and that insertion with the cuff deflated (ST 0 and T 180) resulted in fewer insertion failures than with the cuff inflated (ST 0.5 and ST 1.0) (P<0.05). Insertion with the LMA back-to-front with the cuff deflated produced similar fibreoptic and functional results to the standard technique. In 23%, however, there was some residual rotation of 25–90% to the coronal plane.
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R.S, Naveen Gowda, Suresh C, and Chandrashekar E. "Comparison of 2 Different Techniques of LMA Insertion Namely Traditional Standard Technique of Blind Insertion and Use of Laryngoscope for Guided Insertion of LMA for Successful Placement in an Anatomical Position." Journal of Evidence Based Medicine and Healthcare 7, no. 41 (October 12, 2020): 2371–74. http://dx.doi.org/10.18410/jebmh/2020/491.
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Obsa, Mohammed Suleiman, Azeb Lencha Sholla, Betelhem Girma Baraki, Getahun Dendir Welde, Temesgen Bati Gelgelu, and Melese Meleku Kuruche. "Effect of Laryngeal Mask Air Way Insertion versus Endotracheal Intubation over Hemodynamic Responses in Pediatrics Patient Who Underwent Ophthalmic Surgery at Menelik II Hospital, Addis Ababa: A Prospective Observational Study Design." Anesthesiology Research and Practice 2020 (June 1, 2020): 1–6. http://dx.doi.org/10.1155/2020/7021641.
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Background. The airway of an anesthetized child is usually maintained with an endotracheal tube or laryngeal mask airway. However, both are related with some level of pressor response which may be risky in several groups of patient. Methods. An institutional-based prospective observational study design was employed. A systematic random sampling technique was used to select study participants. Data were entered into Epi info version 7 and transported to SPSS version 20 for analysis. Normality of the data was checked using Shapiro–Wilk tests. An independent t test was used to determine the mean differences between the two groups while the paired sample t test was used to determine the mean differences within the groups. A p value of less than 0.05 was used as a cut-off point for the presence of association. Results. The changes in systolic and diastolic blood pressure were returned to baseline values at five and three minutes in both groups, respectively. However, the changes in the heart rate and mean arterial pressure returned to baseline values in five minutes in the ETT group and three minutes in the LMA group. At baseline, the difference in systolic blood pressure between the two groups was not statistically significant (p=0.328). Conclusions. A significant hemodynamic pressor response was observed after the insertion of both LMA and ETT groups. However, the LMA group has less hemodynamic change as compared to the ETT group. Therefore, the practice of LMA insertion was strongly recommended.
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Kurian, Vinay Babu, Anil Shetty, and Raveendra U. S. "Racing against Time: Huge Multiple Mass on the Neck." Journal of Health and Allied Sciences NU 06, no. 04 (December 2016): 89–91. http://dx.doi.org/10.1055/s-0040-1708683.
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AbstractDefining, describing and identifying 'difficult' airways are difficult tasks. The majority of difficult patients that anesthesiologists encounter look 'more-or-less' normal. Anesthesiologists must be prepared to adapt their technique if difficulty occurs. There can be no doubt that the advent of the laryngeal mask airway (LMA) has decreased the frequency of difficulty with the airway. Flexible fiberoptic in tubation is a tremendously useful technique, which every anesthesiologist should attempt to master. The advantage of vision, the pre-eminent sense, needs no explanation.
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Rajan, Govind R. "Fiberoptic Wire-Guided Transoral and Through the LMA Intubation Technique Using Modified Gum Elastic Bougie." Anesthesia & Analgesia 100, no. 2 (February 2005): 599–600. http://dx.doi.org/10.1213/01.ane.0000144080.77294.4e.
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Micaglio, Massimo, Matteo Parotto, Daniele Trevisanuto, Vincenzo Zanardo, and Carlo Ori. "Glidescope™ /gastric-tube guided technique: a back-up approach for ProSeal™ LMA insertion." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 53, no. 10 (October 2006): 1063–64. http://dx.doi.org/10.1007/bf03022539.
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Prakash, Sugatha, and Sreedevi J. "Comparison of intravenous induction with propofol to vital capacity breath induction with sevoflurane for insertion of laryngeal mask airway." International Journal of Clinical Trials 4, no. 1 (January 25, 2017): 65. http://dx.doi.org/10.18203/2349-3259.ijct20170311.
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<p class="abstract"><strong>Background:</strong> The increasing emphasis on day care anaesthesia has led to the greater use of laryngeal mask airway (LMA) as an alternative to tracheal intubation for short procedure surgeries. Satisfactory insertion of LMA after induction of anaesthesia requires sufficient depth for suppression of airway reflexes. This study was performed to compare intravenous induction with Propofol to vital capacity breath induction with sevoflurane for LMA insertion<span lang="EN-IN">. </span></p><p class="abstract"><strong>Methods:</strong> In this study 100 ASA 1 and ASA 2 patients aged between 20 and 40 years, undergoing short surgical procedures lasting 30 to 60 minutes, were included. The P group received Inj. Propofol 2.5 mg/kg IV whereas the S group received Sevoflurane 8% vital capacity breaths. After the loss of eyelash reflex, which was considered the end point of induction, the LMA insertion was attempted by an anaesthesiologist blinded to the induction technique. The data that was recorded was induction time with both the drugs, characteristics of LMA insertion, hemodynamic responses and complications if any. The number of attempts at insertion was also noted<span lang="EN-IN">.</span></p><p class="abstract"><strong>Results:</strong> Induction time was 60.1±8.98 secs for propofol induction and 72.8±15.86 for sevoflurane vital capacity breath induction which was found statistically significant. The insertion conditions were found excellent in 88% in the propofol group and 90% in the sevoflurane group which was comparable. There was no statistically significant difference found in the time or characteristics of insertion between both the groups. No incidence of complications was found in both groups<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Induction with sevoflurane vital capacity breath inhalation compared equally with induction with intravenous propofol for LMA insertion in patients undergoing short surgical procedures.</p>
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González Ariceaga, Citlalli Celeste, Muhammad Inam Afzal, Muhammad Umer, Syed Muhammad Usman Shah, Haroon Ahmad, Muriel Jacquot, and Catherine Cailliez-Grimal. "Effect of alginate beads on olfactory sensory perception of paraffin coated cheese." Czech Journal of Food Sciences 36, No. 3 (June 28, 2018): 255–60. http://dx.doi.org/10.17221/431/2016-cjfs.
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Flavour encapsulation is now an established technique, but different methods are associated with significant loss of flavour. In this work, we propose a novel alternative: the direct encapsulation of bacteria that produce useful aromatic compounds. The effect of alginate beads containing 3-methylbutanal or Carnobacterium maltaromaticum LMA 28 on olfactory sensory perception of paraffin-coated cheese was investigated. The abilities of bacteria to produce 3-methylbutanal and of alginate beads to diffuse this volatile compound in cheese was evaluated. Size, shape and encapsulation efficiency of alginate beads were determined. Moreover, the possible antimicrobial repercussions on the lactic acid flora of cheese were also examined. Alginate beads in both treatments were found to be uniform and spherical with a mean diameter of 1.69 ± 0.15 mm. Entrapped Carnobacterium maltaromaticum LMA 28 was able to produce 3-methylbutanal in sufficient amounts to facilitate diffusion through paraffin coating. The results identify bacterial encapsulation as superior to direct encapsulation of volatile compounds for imparting 3-methylbutanal olfactory notes to cheese.
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Ambrogi, Marcello C., Olivia Fanucchi, Stylianos Korasidis, Federico Davini, Raffaello Gemignani, Fabio Guarracino, Franca Melfi, and Alfredo Mussi. "Nonintubated Thoracoscopic Pulmonary Nodule Resection under Spontaneous Breathing Anesthesia with Laryngeal Mask." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 9, no. 4 (July 2014): 276–80. http://dx.doi.org/10.1097/imi.0000000000000075.
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Objective During the past 20 years, the use of video-assisted thoracoscopic surgery has increased as an important minimally invasive tool. To further reduce its invasiveness, after a preliminary experience, we decided to use a nonintubated spontaneous breathing general anesthesia, for video-assisted thoracoscopic surgery resection of lung nodule, using a laryngeal mask (LMA). This study aimed to verify the safety and the feasibility of this technique. Methods Twenty consecutive patients who underwent thoracoscopic wedge of lung nodule under spontaneous breathing general anesthesia with LMA are the subjects of this study. Clinical data, American Society of Anesthesiologists status, Adult Comorbidity Evaluation-27 score, and Revised Cardiac Risk Index score were recorded for each patient. General inhalatory anesthesia (sevoflurane) was given in all cases through an LMA, without muscle relaxants, thus allowing spontaneous breathing. All procedures were performed in the lateral decubitus position. The maximum and minimum values of end-tidal carbon dioxide tension and oxygen saturation were recorded during the procedure. The level of technical feasibility was stratified by the operating surgeon according to four levels: excellent, good, satisfactory, and unsatisfactory. Results There were 13 men and 7 women (mean age, 57 years). The mean induction anesthesia time was 6 minutes, whereas the mean operative time was 38 minutes. The values of oxygen saturation as well as minimum and maximum end-tidal carbon dioxide tension were 99.1%, 33.6 mm Hg, and 39.1 mm Hg, respectively. No mask displacement occurred. The mean operative time was 38 minutes (range, 25–90 minutes). The level of technical feasibility was defined as excellent in 19 cases and good in 1 case. No mortality occurred. Morbidity consisted of pleural effusion (one case), which was medically resolved. The mean postoperative stay was 3.5 days. Histopathologic results were one squamous cell lung cancer (lung primary), one adenocarcinoma (lung primary), five metastasis from colon cancer, four metastasis from breast cancer, three metastasis from renal cancer, three sarcoidosis, two amartocondroma, and one tuberculosis. Conclusions Our experience suggests that thoracoscopic wedge resection of lung nodule is safe and feasible under spontaneous breathing anesthesia with LMA. This technique permits a confident manipulation of lung parenchyma and a safe stapler positioning, without cough, pain, or panic attack described for awake epidural anesthesia, avoiding the risks related to tracheal intubation and mechanical ventilation.
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Bhattacharjee, Ishita, Susanta Sarkar, Chiranjib Bhattacharyya, Debojyoti Das, and Mohanchandra Mandal. "I-Gel and LMA classic in the hands of novice: A comparative study." Asian Journal of Medical Sciences 12, no. 9 (September 1, 2021): 103–10. http://dx.doi.org/10.3126/ajms.v12i9.37384.
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Background: Supraglottic airway devices (SADs) such as LMA classic (cLMA), I-Gel, etc. are indispensable tool for the anaesthesiologists experienced in airway management. But studies evaluating the performance of these devices in the hands of unskilled personnel are scarce. Aims and Objective: To determine the procedure time and the proportion of patients having successful placement of I-gel and LMA classic by first-year Post Graduate Trainees (PGTs) of Anaesthesiology who tried insertion of those devices after a short training in mannequins without any hands-on training regarding placement of the devices in human. Materials and Methods: After getting Institute’s Ethics Committee’s approval for this interventional study, forty adult patients, posted for short surgical or gynaecological surgery, were randomly allocated in to two groups to have placement of either I-Gel (group ‘I’, n=20) or cLMA (group ‘C’, n=20) by first-year PGTs. The procedure time (Primary outcome) i.e. the time taken for successful placement of either device was determined and compared. A standard technique of anaesthesia was followed in every patient. Any adverse event such as sore throat, odynophagia, blood stain on the device, etc. was also recorded. Results: All patients were comparable with respect to demographic data and Mallampati scores. The mean procedure time (seconds) was considerably lower in I-Gel group compared with cLMA (63.3 ± 57.2 versus 163.0 ± 158.3, respectively, P value <0.001). The incidence of successful placement at first attempt was significantly higher for I-Gel group. The incidence of adverse events was comparable. Conclusion: Procedure time for I-Gel insertion is significantly shorter than with LMA Classic along with a higher success rate with first attempt for the former. I-Gel may be a better alternative as airway device for the unskilled anaesthesiologist.
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Arzhakova, N. I., V. A. Efremov, S. V. Bessonov, Konstantin Yur'evich Ukolov, V. A. Novosel'tseva, N. I. Arzhakova, V. A. Efremov, S. V. Bessonov, K. Yu Ukolov, and V. A. Novosel'tseva. "Solution for the Problem of Difficult Respiratory Tract in Planned Orthopaedic Surgery." N.N. Priorov Journal of Traumatology and Orthopedics 18, no. 2 (June 15, 2011): 106–9. http://dx.doi.org/10.17816/vto2011182106-109.
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Methods to solve the situation of difficult intubation in planned orthopaedic surgery are presented. Total number of 101 patients with problematic conventional tracheal intubation due to various orthopaedic pathology (Bekhterev's disease, abnormality of development or posttraumatic instability of cervical spine, etc.) was studied. In 49 patients tracheal intubation was performed using laryngeal mask LMA C-Trach with videovisualization (main group), in 52 patients - using fiberoptic bronchoscope (control group). The results achieved showed high efficacy of LMA C-Trach technology for solving difficult intubation problem. Application of laryngeal mask was successfully performed even in patients with Hallo-apparatus fixed cervical spine. Unlike fiber bronchoscope insertion placing of laryngeal mask was atraumatic in relation to stomatopharynx and enabled to perform adequate pulmonary ventilation till tracheal intubation. Videovisualization ensured accurate localization of trachea and its intubation with atraumatic reinforced tube under visual control. Only in 2 patients use of that technology failed and it was related to the bleeding from tonsils after multiple unsuccessful attempts of trachea intubation using direct laryngoscopy. Above described technique is not only a highly effective method for solving the problem of difficult intubation but decreases psychologic strain of the anesthesiologic team.
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Irfanulla, Mohammed, Thrivikram Shenoy, and Ranjan Rk. "A COMPARATIVE STUDY OF CAUDAL BUTORPHANOL AND FENTANYL FOR ALLEVIATING POST-OPERATIVE PAIN IN INFRAUMBILICAL PROCEDURES IN CHILDREN BELOW 3 YEARS OF AGE." Asian Journal of Pharmaceutical and Clinical Research 12, no. 1 (January 7, 2019): 336. http://dx.doi.org/10.22159/ajpcr.2018.v12i1.28180.
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Objective: Caudal block is a common regional anesthetic technique used in children. However, it is limited by relatively shorter duration of analgesia. The objective of this study was to compare the analgesic efficacy of caudal blockade using butorphanol (1) and fentanyl in children below 3 years, undergoing infraumbilical surgeries.Methods: Patients were randomly allocated to two groups of 30 each. Without premedication, patients were induced with thiopentone, relaxed with atracurium for facilitation of LMA insertion, and maintained on O2, N2O, and halothane. Caudal block was then performed using an aseptic technique. One group received caudal butorphanol (25 μg/kg) with 0.25% bupivacaine (0.1 ml/kg) and the other received fentanyl (1 μg/kg). Incision was allowed after 15 min of block. After the completion of surgery, LMA was removed and patients were shifted to the PACU. Non-invasive blood pressure and heart rate were recorded; pain was assessed using modified objective pain score (MOPS) (2) at 2, 4, 6, 12, and 24 h, postoperatively. Oral paracetamol was given at a score >4.Results: The mean duration of analgesia in Group F was 12.47 (standard deviation [SD] 8.216) and 19.67 (SD 7.009) in Group B (p: 0.001, HS). Mean MOPS was 4.6 in the fentanyl group as compared to 2.6 in the butorphanol group at the end of 24 h (p=0.001, HS). Thus, butorphanol provided longer duration of analgesia compared to fentanyl.Conclusion: Caudal additives are safe in children and butorphanol provides significantly longer duration of analgesia as compared to fentanyl, thus avoiding caudal catheterization and intravenous analgesics.
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Irfanulla, Mohammed, Thrivikram Shenoy, and Ranjan Rk. "A COMPARATIVE STUDY OF CAUDAL BUTORPHANOL AND FENTANYL FOR ALLEVIATING POST-OPERATIVE PAIN IN INFRAUMBILICAL PROCEDURES IN CHILDREN BELOW 3 YEARS OF AGE." Asian Journal of Pharmaceutical and Clinical Research 12, no. 1 (January 7, 2019): 336. http://dx.doi.org/10.22159/ajpcr.2019.v12i1.28180.
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Objective: Caudal block is a common regional anesthetic technique used in children. However, it is limited by relatively shorter duration of analgesia. The objective of this study was to compare the analgesic efficacy of caudal blockade using butorphanol (1) and fentanyl in children below 3 years, undergoing infraumbilical surgeries.Methods: Patients were randomly allocated to two groups of 30 each. Without premedication, patients were induced with thiopentone, relaxed with atracurium for facilitation of LMA insertion, and maintained on O2, N2O, and halothane. Caudal block was then performed using an aseptic technique. One group received caudal butorphanol (25 μg/kg) with 0.25% bupivacaine (0.1 ml/kg) and the other received fentanyl (1 μg/kg). Incision was allowed after 15 min of block. After the completion of surgery, LMA was removed and patients were shifted to the PACU. Non-invasive blood pressure and heart rate were recorded; pain was assessed using modified objective pain score (MOPS) (2) at 2, 4, 6, 12, and 24 h, postoperatively. Oral paracetamol was given at a score >4.Results: The mean duration of analgesia in Group F was 12.47 (standard deviation [SD] 8.216) and 19.67 (SD 7.009) in Group B (p: 0.001, HS). Mean MOPS was 4.6 in the fentanyl group as compared to 2.6 in the butorphanol group at the end of 24 h (p=0.001, HS). Thus, butorphanol provided longer duration of analgesia compared to fentanyl.Conclusion: Caudal additives are safe in children and butorphanol provides significantly longer duration of analgesia as compared to fentanyl, thus avoiding caudal catheterization and intravenous analgesics.
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Vyas, Amit, Kamalraj Singh Baghel, Pawan Nandurkar, and Sonali Tripathi. "Comparison of conventional awake extubation with endotracheal tube – laryngeal mask airway exchange extubation for evaluation of respiratory and hemodynamic parameters during emergence in neurosurgical patients." Asian Journal of Medical Sciences 13, no. 12 (December 1, 2022): 37–42. http://dx.doi.org/10.3126/ajms.v13i12.47827.
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Background: Emergence from general anesthesia and tracheal extubation may be associated with tremendous physiological and metabolic stress in patients which could be major concern for the anesthesiologist in patients especially with neurosurgical patients. Aims and Objectives: The study was designed to find a novel method to achieving a smooth extubation in neurosurgery by compare the respiratory complications and hemodynamic stress response between conventional awake extubation of an endotracheal tube (ETT) and that following exchange extubation of ETT using a laryngeal mask airway (LMA) in craniotomy surgeries. Materials and Methods: A total of 60 patients of American Society of Anesthesiologists physical status I and II between ages 18 and 60 years undergoing neurosurgery were evaluated for respiratory events such as bucking, coughing, desaturation, and hemodynamic changes due to sympathetic stimulation such as tachycardia, hypertension, and any other complications that have occurred in any of the two extubation methods. Results: In Group A, 86.67% patients have shown significant events of bucking and coughing while desaturation events were comparable between two groups. Manipulation events, that is, chin lift and jaw thrust had to perform in 66.67% and 21.67%, respectively, in patients of Group A compared to only 03.33% patients in Group L. (P<0.05). In Group A, 97.33% patients shown tachycardia compared to 30% in Group L where only 30%. Similarly, mean arterial pressure after extubation found to be significantly high in 63.33% of the patients in Group A with 63.33% as compared to13.33% of patients in Group L (P<0.05). Conclusion: ETT/LMA exchange is the most effective technique for achieving the clinical endpoints of the study, that is, prevention of emergence hypertension and respiratory complications compared to awake extubation methods. The exchange of ETT with LMA in deeper plane of anesthesia significantly reduces emergence related the hemodynamic and respiratory unwonted events.
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Fong, Ming-Lun Alan, and Kai-Kwong Dennis Tsang. "GIS Retrofitting Technique for Hong Kong Sports Center with a Large Hall." Architecture 3, no. 3 (July 4, 2023): 410–27. http://dx.doi.org/10.3390/architecture3030022.
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The energy consumption of air conditioning systems in large spaces is a concern due to inefficiencies caused by the high ceiling. This paper presents the Green aIr-distribution System (GIS) retrofitting technique as a solution to reduce energy consumption and optimize thermal comfort in a large Hong Kong sports center to achieve carbon neutrality. A comparison is made between the existing air distribution system with ceiling supply and return as baseline model and the GIS with occupied wall supply and ceiling return as retrofit models regarding ventilation performance, thermal comfort, and energy aspects. Computational fluid dynamics (CFD) is employed to analyze the average operative temperature, airspeed, and other thermal comfort parameters. The findings demonstrate that implementing the GIS in the large sports center allows for a 1.5 °C increase in the supply temperature without significantly compromising thermal comfort. The algorithm for developing GIS for the large space application is also discussed. Additionally, the GIS model exhibits notable improvements in ventilation factors, such as Local Mean Age (LMA), Local air change index (LACI), and Air Distribution Performance Index (ADPI), resulting in improved air quality and reduced energy use within the occupied space.
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Singh, U. K., R. K. Tiwari, and S. B. Singh. "Inversion of 2-D DC resistivity data using rapid optimization and minimal complexity neural network." Nonlinear Processes in Geophysics 17, no. 1 (February 3, 2010): 65–76. http://dx.doi.org/10.5194/npg-17-65-2010.
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Abstract. The backpropagation (BP) artificial neural network (ANN) technique of optimization based on steepest descent algorithm is known to be inept for its poor performance and does not ensure global convergence. Nonlinear and complex DC resistivity data require efficient ANN model and more intensive optimization procedures for better results and interpretations. Improvements in the computational ANN modeling process are described with the goals of enhancing the optimization process and reducing ANN model complexity. Well-established optimization methods, such as Radial basis algorithm (RBA) and Levenberg-Marquardt algorithms (LMA) have frequently been used to deal with complexity and nonlinearity in such complex geophysical records. We examined here the efficiency of trained LMA and RB networks by using 2-D synthetic resistivity data and then finally applied to the actual field vertical electrical resistivity sounding (VES) data collected from the Puga Valley, Jammu and Kashmir, India. The resulting ANN reconstruction resistivity results are compared with the result of existing inversion approaches, which are in good agreement. The depths and resistivity structures obtained by the ANN methods also correlate well with the known drilling results and geologic boundaries. The application of the above ANN algorithms proves to be robust and could be used for fast estimation of resistive structures for other complex earth model also.
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Dolan, Anne M., and Michael F. Moore. "Anaesthesia for Tracheobronchial Stent Insertion Using an Laryngeal Mask Airway and High-Frequency Jet Ventilation." Case Reports in Medicine 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/950437.
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An approach which promotes a rapid return to spontaneous respiration after tracheobronchial stent (TBS) insertion is considered the optimal one and is a belief shared by anaesthetists, respiratory physicians, and surgeons alike (Calvey and William (2008)). The value of the laryngeal mask airway (LMA), followed by use of the Monsoon 111 Acutronic jet ventilator pressure limiting system of ventilation, for the deployment of stents in the three individual cases that of tracheoesophageal fistula, a bronchoesophageal fistula, and tracheal compression from an invading oesophageal malignant tumour are reported. The roles of target controlled anaesthesia, high-frequency jet ventilation (HFJV), and the laryngeal mask airway in optimising the surgical field and reducing the risk of bronchospasm at emergence are advantages of this technique.
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Kumar, Dileep. "AN INNOVATIVE USE OF LARYNGEAL MASK AIRWAY IN PATIENTS UNDERGOING FOR NASAL SURGERY." Journal of Ayub Medical College Abbottabad 34, no. 3 (June 21, 2022): 585. http://dx.doi.org/10.55519/jamc-03-10251.
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Emergence from general anaesthesia after nasal surgery offers several challenges, especially if there is presence of blood and secretion in pharynx. This may provoke bucking, coughing and laryngospasm. Some of these patients may require high concentration of oxygen through the anaesthesia mask, however, this may be difficult due to presence of nasal packs and/or splints (1). Various methods have been advocated to overcome emergence challenges in these patients for example patient involvement by recalling mouth breathing at the time of extubation, avoidance of nasal splints and packing and allowing deep endotracheal tube extubation (2). Nevertheless, post-operative minor respiratory insults leading to development of negative pressure pulmonary oedema are still reported in 8% surgical patients undergoing nasal surgery (3).
Author suggest an alternative approach in patients who undergo nasal surgery for therapeutic and cosmetic indications. This approach will overcome issues associated with nasal obstruction, nasal packing and use of nasal splints. It also attenuates the sympathetic surge associated with extubation and other respiratory complications. Moreover, it prevents the mechanical pressure on nose and may favour better nasal surgical cosmetic outcome.
Author suggest the use of Laryngeal Mask Airway (LMA) at the end of nasal surgeries (septoplasty, rhinoplasty, functional endoscopic sinus surgery and repair of nasal laceration) as a face mask. Once the surgery ends, the effect of muscle relaxant is reversed while maintaining anaesthesia MAC at a deeper level (Isoflurane MAC 1.2 or Sevoflurane MAC 1.8 in 100% oxygen) and applying a 15-degree head down tilt. This is followed by the removal of throat pack and suctioning of oral cavity. Next step is to remove endotracheal tube from patient’s trachea followed by insertion of an appropriately sized oropharyngeal (Guedel) airway (Fig-Ia). Last step is to place an LMA over the patient’s lips and hold with both hands (Fig-Ib-Ic) to maintain an air tight seal. The patient breathes through the LMA and is allowed to wake up on the operating table. Positive pressure ventilation can also be applied if patient holds his breath or goes into laryngospasm without forcing any pressure over the nose. This approach avoids the direct mechanical pressure on operated nose. We have used this technique in our patients, and it was found useful approach.
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PASSAUER, JENS, ECKHART BÜSSEMAKER, URSULA RANGE, MARIA PLUG, and PETER GROSS. "EvidenceIn VivoShowing Increase of Baseline Nitric Oxide Generation and Impairment of Endothelium-Dependent Vasodilation in Normotensive Patients on Chronic Hemodialysis." Journal of the American Society of Nephrology 11, no. 9 (September 2000): 1726–34. http://dx.doi.org/10.1681/asn.v1191726.
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Abstract.Cardiovascular mortality is excessive in hemodialyzed patients. Observations in atherosclerosis suggest that endothelial dysfunction and impaired nitric oxide (NO) may be involved. However, the relation of endothelial NO to its vascular effects has not been studied conclusively in uremia. Therefore, to study these questions an invasive technique was used in normotensive patients who were on hemodialysis (HD;n= 11) and in matched control subjects (n= 11). Pharmacologic agents were infused into the brachial artery to test the chain of events from NO generation to smooth muscle cell relaxation, measuring forearm blood flow by venous occlusion plethysmography. Glyceroltrinitrate (GTN 1:2.2 nmol/min; GTN 2:4.4; GTN 3:8.8), infused to establish the reaction of the vessel wall to defined doses of NO, caused a reduced response in HD patients (control subjects: 183 ± 20 [SEM], 246 ± 26, and 338 ± 29%; HD patients: 161 ± 7, 206 ± 12, and 262 ± 24%; baseline = 100% for each group,P= 0.032 by ANOVA). All subsequent data were corrected for this decreased response to defined doses of NO in HD patients. L-arginine (10 mg/min), given to exclude substrate deficiency of NO synthase (NOS), caused no significant changes (control subjects: 108 ± 4%; HD patients: 103 ± 4%;P= NS). Acetylcholine (ACH 1:55 nmol/min; ACH 2:110; ACH 3:220), infused to stimulate endothelial NOS, had a significantly reduced effect in HD patients (control subjects: 246 ± 32, 340 ± 40, and 465 ± 52%; HD patients: 251 ± 55, 244 ± 36, and 318 ± 50%;P= 0.002).N-monomethyl-L-arginine (LMA 1:1 μmol/min; LMA 2:2; LMA 3:4), given to block baseline NO generation, showed an enhanced response in HD patients (control subjects: 90 ± 2, 83 ± 2, and 74 ± 4%; HD patients: 84 ± 3, 73 ± 3, and 64 ± 4%;P= 0.037). Vascular response to three doses of norepinephrine (60, 120, and 240 pmol/min) was comparable in both groups, which indicated similar endothelium-independent vasoconstriction. In summary, in normotensive HD patients, (1) vasodilation to defined doses of exogenous NO was reduced, (2) there was no evidence of substrate deficiency of NOS, and (3) stimulation of NOS was impaired; however, (4) baseline NO generation was increased. It is concluded that in HD patients, the NO system has a reduced capacity to regulate vascular tone and this impairment is most significant under conditions of NOS stimulation.
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Rich, James M. "Recognition and Management of the Difficult Airway with Special Emphasis on the Intubating Lma-Fastrach/Whistle Technique: A Brief Review with Case Reports." Baylor University Medical Center Proceedings 18, no. 3 (July 2005): 220–27. http://dx.doi.org/10.1080/08998280.2005.11928072.
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