Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway

Shi

et al. 2018

J Int Med Res

ObjectivesA failed first attempt at laryngeal mask airway (LMA) insertion could increase the risk of laryngospasm, hypoxemia, and postoperative sore throat. This study was performed to investigate the risk factors for failed first-attempt LMA placement.MethodsIn total, 461 patients who underwent general anesthesia with a Supreme LMA (Teleflex Medical, Shanghai, China) and who had an American Society of Anesthesiologists (ASA) physical status of I to III were prospectively enrolled. The LMA was inserted after anesthetic induction. We recorded the insertion conditions and each patient’s age, ASA status, body weight, body mass index (BMI), duration of anesthesia, size of LMA, and cuff pressure; the years of work experience of the anesthesiologists; and the use or nonuse of lidocaine gel as a lubricant.ResultsSuccessful first-attempt placement of the Supreme LMA was achieved in 438 (95.10%) patients, while first-attempt placement failed in 23 (4.99%). Significant risk factors for failure of first-attempt LMA insertion included high age, high body weight, BMI of <20 kg/m2, and insertion without using lidocaine gel.ConclusionsA patient age of >61 years, high body weight, BMI of <20 kg/m2, and insertion without lidocaine gel could significantly increase the risk of failed first-attempt Supreme LMA insertion.

Section: Introductionmentioning

confidence: 99%

Predictive risk factors of failed laryngeal mask airway insertion at first attempt

Shi

et al. 2018

J Int Med Res

“…The administration of 200% of the ED95 values of cis-Atracurium, producing an onset duration of 5.2 min, and the duration of the time to 25% of T1 recovery at 45 min have been reported [25,37]. Tulgar [38] demonstrated that the use of subclinical doses of muscle relaxants does not affect anaesthesia recovery time. In this study, the airway peak pressure (mean Paw pressure) insignificantly differed between the 50 μg•kg -1 group and the 30 μg•kg -1 group at each timepoint.…”

Section: Discussionmentioning

confidence: 97%

The Median Effective Dose (ED50) of cis-Atracurium for Laryngeal Mask Airway Insertion during General Anaesthesia for Patients Undergoing Urinary Surgery

Huang

Yan

et al. 2019

Preprint

Background In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis- atracurium dosage for laryngeal mask insertion is not standardised. We aimed to determine the optimal dose of cis- atracurium using a sequential method for successful laryngeal mask insertion. Method s : The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered doses (μg· kg -1 ) of cis- atracurium as follows: 150, 100, 70, 50, 30, and 20. The main outcome was the response to laryngeal mask airway insertion: ≥16 points and <16 points indicated “satisfactory” and “unsatisfactory” responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from “satisfactory” and “unsatisfactory” responses. The primary outcome was to determine the median effective dose (ED50) of cis- atracurium for laryngeal mask airway insertion. Result s : The median effective dose of cis- atracurium was 26.5 μg·kg -1 (95% CI 23.6-29.8) using the sequential method. The heart rate was decreased in the 50μg·kg -1 group compared to the 30μg·kg -1 group at timepoints T7, T8, and T10 ( P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference with 20 μg·kg -1 group. The systolic blood pressure was decreased in the 50 μg·kg -1 group compared to the 20 μg·kg -1 group at timepoints T2, T3, T4 ( P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg -1 group than in the 30 μg·kg -1 group at timepoint T3( P = 0.0326). Conclusion s : The ED50 of cis- atracurium was 26.5 μg·kg -1 for laryngeal mask airway insertion.

“…The administration of 200% of the ED95 values of cis-atracurium, producing an onset duration of 5.2 min, and the time to 25% of T1 recovery at 45 min have been reported [25,37]. Tulgar [38] demonstrated that the use of subclinical doses of muscle relaxants does not affect the anaesthetic recovery time. In this study, the airway peak pressure (mean Paw pressure) was insignificantly different between the 50 μg•kg -1 group and the 30 μg•kg -1 group at each timepoint.…”

Section: Discussionmentioning

confidence: 98%

The Median Effective Dose (ED50) of cis-Atracurium for Laryngeal Mask Airway Insertion during General Anaesthesia for Patients Undergoing Urinary Surgery

Huang

Yan

et al. 2020

Preprint

Background In clinical practice, the laryngeal mask airway is an easy-to-use supraglottic airway device. However, the cis- atracurium dosage for laryngeal mask insertion is not standardised. We aimed to determine the optimal dose of cis- atracurium using a sequential method for successful laryngeal mask insertion. Methods : The cohort study protocol is registered at clinicaltrial.gov (NCT-03668262). Twenty-three patients undergoing elective urinary surgery were sequentially administered doses (μg· kg -1 ) of cis- atracurium as follows: 150, 100, 70, 50, 30, and 20. The main outcome was the response to laryngeal mask airway insertion: ≥16 points and <16 points indicated “satisfactory” and “unsatisfactory” responses, respectively. The median effective dose was estimated using the mean of the seven crossovers from “satisfactory” and “unsatisfactory” responses. The primary outcome was to determine the median effective dose (ED50) of cis- atracurium for laryngeal mask airway insertion. Results : The median effective dose of cis- atracurium was 26.5 μg·kg -1 (95% CI 23.6-29.8) using the sequential method. The heart rate was decreased in the 50μg·kg -1 group compared to the 30μg·kg -1 group at timepoints T7, T8, and T10 ( P = 0.0482, P = 0.0460, and P = 0.0236, respectively), but no difference with 20 μg·kg -1 group. The systolic blood pressure was decreased in the 50 μg·kg -1 group compared to the 20 μg·kg -1 group at timepoints T2, T3, T4 ( P = 0.0159, P = 0.0233, and P = 0.0428, respectively). The train-of-four value was significantly lower in the 50 μg·kg -1 group than in the 30 μg·kg -1 group at timepoint T3( P = 0.0326). Conclusions : The ED50 of cis- atracurium was 26.5 μg·kg -1 for laryngeal mask airway insertion.