BackgroundThe aim of this study was to compare the streamlined liner of the pharynx airway (SLIPA), a new supraglottic airway device (SGA), with the laryngeal mask airway ProSeal™ (PLMA) during general anesthesia.MethodsSixty patients were randomly allocated to two groups; a PLMA group (n = 30) or a SLIPA group (n = 30). Ease of use, first insertion success rate, hemodynamic responses to insertion, ventilatory efficiency and positioning confirmed by fiberoptic bronchoscopy were assessed. Lung mechanics data were collected with side stream spirometry at 10 minutes after insertion. We also compared the incidence of blood stain, incidence and severity of postoperative sore throat and other complications.ResultsFirst attempt success rates were 93.3% and 73.3%, and mean insertion time was 7.3 sec and 10.5 sec in PLMA and SLIPA. There was a significant rise in all of hemodynamic response from the pre-insertion value at one minute following insertion of SLIPA. But, insertion of PLMA was no significant rise in hemodynamic response. There was no statistically significant difference in the mean maximum sealing pressure, gas leakage, lung mechanics data, gastric distension, postoperative sore throat and other complication between the two groups. Blood stain were noted on the surface of the device in 40% (n = 12) in the SLIPA vs. 6.7% (n = 2) in the PLMA.ConclusionsThe SLIPA is a useful alternative to the PLMA and have comparable efficacy and complication rates. If we acquire the skill to use, SLIPA may be considered as primary SGA devices during surgery under general anesthesia.

The administration of ketamine with concurrent noxious stimulation results in the attenuation of the neuroapoptotic response. These findings suggest that concurrent surgery and procedural pain attenuates ketamine-induced neuroapoptosis.

Purpose The aim of this study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA TM ) with the ProSeal Laryngeal Mask Airway (LMA-ProSeal TM ) in mechanically ventilated paralyzed patients undergoing laparoscopic gynecologic surgery. Methods One hundred and one patients were allocated randomly to SLIPA (n = 50) or to LMA-ProSeal (n = 51) treatment groups. After induction of general anesthesia and insertion of the assigned supralaryngeal airway (SLA) device, we made note of the occurrence of any gastric insufflation and perilaryngeal leakage. We then evaluated the anatomical fit of the SLA device using a fibreoptic bronchoscope, and we assessed the airway sealing pressure and respiratory mechanics with change in head position and during peritoneal insufflation. After surgery, we evaluated the severity of postoperative sore throat and the presence of blood or regurgitated fluid on the SLA device. Results The insertion success rate, gastric insufflation, perilaryngeal leakage, anatomical fit, airway sealing pressure, respiratory mechanics, severity of sore throat, and incidence of blood and regurgitated fluid on the device were similar between the two groups. The incidence of perilaryngeal leakage with changes in the patient's head position was lower with the SLIPA group than with the LMA-ProSeal group (3/50 vs 11/51, respectively; P = 0.026). During peritoneal insufflation, perilaryngeal leakage did not occur with the SLIPA but occurred in four cases with the LMA-ProSeal (P = 0.045). Conclusion Both the SLIPA and the LMA-ProSeal can be used effectively and without severe complications in paralyzed patients undergoing laparoscopic gynecological surgery. However, the SLIPA offers the advantage of less perilaryngeal gas leakage than the LMA-ProSeal with change in head position and during insufflation of the peritoneal cavity. This trial is registered with ANZCTR (ACTRN12609000914268). RésuméObjectif L'objectif de cette e´tude e´tait de comparer le masque SLIPA TM (Streamlined Liner of the Pharynx Airway) et le masque LMA-ProSeal TM (ProSeal Laryngeal Mask Airway) chez des patientes curarise´es recevant une ventilation me´canique et subissant une chirurgie gyne´cologique par laparoscopie. Méthode Cent une patientes ont e´te´ale´atoirement re´parties en deux groupes de traitement, soit SLIPA (n = 50) et LMA-ProSeal (n = 51). Apre`s l'induction de l'anesthe´sie ge´ne´rale et l'insertion du masque supralaryngeá ttribue´, nous avons note´la survenue de toute insufflation gastrique ou fuite pe´rilarynge´e. Nous avons ensuite e´valueĺ 'ajustement anatomique du masque supralarynge´a`l'aide d'un bronchoscope a`fibres optiques, la pression de fermeture des voies ae´riennes et la me´canique respiratoire suite a`des changements de position de la teˆte et pendant l'insufflation pe´ritone´ale. Apre`s la chirurgie, nous avons e´value´la gravite´des maux de gorge postope´ratoires et la pre´sence de sang ou de liquides re´gurgite´s sur le masque supralarynge´.

Intravenous lidocaine injection is as effective as intraperitoneal instillation for reducing pain and fentanyl consumption. The major benefit of intravenous injection is that this is an easily and universally applicable procedure compared to that of intraperitoneal instillation. Lidocaine intravenous administration is a better alternative for reducing the pain of patients who are undergoing laparoscopic surgery.

Although DEX is neuroprotective at clinical doses, high cumulative doses and concentrations induce neuroapoptosis, in vivo and in vitro, respectively. Because the current dosing schedules used in humans yield plasma levels that are substantially below concentrations that induce neurotoxicity, low-dose DEX should not be neurotoxic and has the potential to be a neuroprotective adjuvant.