The distance between the glottis and the cuff of a tracheal tube placed through three supraglottic airway devices in children

Lee, Ji Hyun; Park, Seoyeong; Jang, Young Eun; Kim, Eun Hee; Kim, Hee Soo; Kim, Jin Tae

doi:10.1097/eja.0000000000001070

Cited by 6 publications

(13 citation statements)

References 22 publications

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“…The patients in six studies underwent elective surgery, and three-dimensional magnetic resonance imaging of the head and neck was performed in one study. None of the studies administered neuromuscular blocking agents before laryngeal mask insertion, except for one trial[ 14 ]. Among the seven included RCTs, two studies did not report any funding sources[ 9 , 22 ]; one was not funded[ 13 ]; and the other four were sponsored by King Saud University[ 17 , 18 ], Asan Medical Center[ 15 ], or Seoul National University Hospital[ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies administered neuromuscular blocking agents before laryngeal mask insertion, except for one trial[ 14 ]. Among the seven included RCTs, two studies did not report any funding sources[ 9 , 22 ]; one was not funded[ 13 ]; and the other four were sponsored by King Saud University[ 17 , 18 ], Asan Medical Center[ 15 ], or Seoul National University Hospital[ 14 ]. Further descriptions of the included trials are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have compared the efficacy and safety of i-gel and Ambu laryngeal masks in paediatric patients[ 14 - 18 ]; however, the results have been inconsistent. To our knowledge, no previous systematic review has been sufficiently comprehensive to draw a clinically meaningful conclusion about the use of the two devices in paediatric patients[ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Bao¹,

Yu²,

Wang³

et al. 2022

WJCC

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BACKGROUND Paediatric supraglottic airway devices (SGAs) are widely used in routine anaesthesia and serve as primary or back-up devices for difficult airway management. The inflatable Ambu laryngeal masks and non-inflatable i-gel are two improvements of SGAs based on classic laryngeal masks. The clinical performance and safety of these two devices in paediatric patients are still unclear and warrant further investigation. AIM To perform a systematic review and meta-analysis on the clinical performance and safety of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients. METHODS MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched from inception dates to April 2020. We identified published randomised controlled trials (RCTs) in which the intervention involved the use of Ambu laryngeal masks and i-gel in anaesthetised paediatric patients (age < 18 years). We assessed the oropharyngeal leak pressure (OLP) as the primary outcome. The secondary outcomes were insertion time, success rate of insertion on the first attempt, and incidence of adverse events. RESULTS After searching for all relevant trials published up to April 2020, data from seven RCTs with a total of 667 paediatric patients (323 and 344 participants in the i-gel and Ambu groups, respectively) were evaluated. The mean OLP in anaesthetised paediatric patients was lower in the Ambu group [21.82 cmH 2 O for Ambu vs 23.98 cmH 2 O for i-gel, P = 0.003, 95% confidence interval (CI): -3.58 to -0.75, I 2 = 68%, Mantel-Haenszel random model]. We did not find any clear evidence of differences between the devices in terms of insertion time, success rate of insertion, and incidence of adverse events except for blood staining (risk ratio 5.86, 95%CI: 1.76 to 19.46, P = 0.004, I 2 = 0, fixed-effect model). CONCLUSION The i-gel airway may provide a better seal and is therefore probably more suitable than the Ambu laryngeal mask airway in anaesthetised paediatric patients. However, the evidence is insufficient to allow making firm conclusions or to guide clinical practice, owing to the small number of relevant published studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Bao¹,

Yu²,

Wang³

et al. 2022

WJCC

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“…Finally, a ''perfect'' SGA-TT combination for flexible bronchoscope intubation is a balance of optimal TT length and SGA length, since, on the one hand, longer TTs include the risk of reduced maneuverability of the flexible bronchoscope above the SGA connector and, on the other hand, shorter TTs entail the risk of the cuff being placed in the subglottic region or even between the vocal cords. 24 It is important to remember that the original technique described by the manufacturer for flexible bronchoscope-guided intubation through the LMAÒ Fastrach TM (Teleflex Medical, Athlone, Ireland) was by placing the TT through the tube of the SGA until the tip of the TT was near the exiting aperture of the SGD. 25 The TT subsequently was inserted into the trachea under flexible bronchoscopic control.…”

Section: Discussionmentioning

confidence: 99%

“…Since flexible bronchoscopes are rarely longer than 600 mm, the TT may be inserted into the SGA without protruding from the distal SGA lumen tube and the flexible bronchoscope can then be manipulated from above the TT connector. 24 The difficulty caused by not having enough space in which to guide the flexible bronchoscope will be increased with greater SGA length, mostly from first-generation SGAs, as seen in Table 2 . Finally, a “perfect” SGA-TT combination for flexible bronchoscope intubation is a balance of optimal TT length and SGA length, since, on the one hand, longer TTs include the risk of reduced maneuverability of the flexible bronchoscope above the SGA connector and, on the other hand, shorter TTs entail the risk of the cuff being placed in the subglottic region or even between the vocal cords.…”

Section: Discussionmentioning

confidence: 99%

Dimensional compatibility and limitations of tracheal intubation through supraglottic airway devices: a mannequin-based in vitro study

Moser

Kemper

Kleine‐Brueggeney

et al. 2021

Can J Anesth/J Can Anesth

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Background Flexible bronchoscope-guided tracheal intubation through supraglottic airway devices (SGAs) is a well-established element of difficult intubation algorithms. Success can be limited by dimensional incompatibilities between tracheal tubes (TTs) and SGAs. Methods In this in vitro study, we tested the feasibility of TT passage through SGAs, removal of SGAs over TTs, and the ability to guide the flexible bronchoscope with 13 TT brands (internal diameter, 6.5-8.0 mm) and ten different SGAs (#4 and #5) in an intubation mannequin. Results We tested 1,040 combinations of SGAs and TTs. Tracheal tube passage failed in 155 (30%) combinations of the five tested first-generation SGAs (117 [46%] with SGA Electronic supplementary material The online version of this article (

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Airway management with novel intubating laryngeal tubes has no influence on cerebral oxygenation in cardiac surgery patients: A prospective observational study

Kriege¹,

Rissel²,

Heid³

et al. 2022

Front. Anesthesiol.

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BackgroundA laryngeal tube is often used as an alternative to intubation with direct laryngoscopy during cardiopulmonary resuscitation. However, in a study with piglets undergoing simulated cardiac arrest, reduced carotid artery blood flow was associated with the insertion of different supraglottic airway devices, such as a laryngeal tube. Limited by its construction, secondary tracheal intubation through a laryngeal tube was difficult or impossible in contrast to a second generation laryngeal mask. The new disposable intubating laryngeal tube with suction (iLTS-D®) seems to facilitate tracheal intubation. We hypothesized that iLTS-D, when inflated to the recommended air volume, does not reduce cerebral oxygenation in patients with cardiovascular diseases undergoing elective cardiac surgery.MethodsThis single-center prospective, controlled observational study was approved by the local ethics committee (Ethical Committee No. 2018-13716). Forty adult patients undergoing elective cardiac surgery requiring tracheal intubation were included in this study. The exclusion criteria were age <18 years and a high risk of aspiration, inability to consent, height <155 cm, or pregnancy. Prior to insufflation and deflation of the cuffs, we performed cerebral oximetry via near-infrared spectroscopy. The primary outcome was a significant reduction in NIRS in the context of the preinduction baseline value after inflation of the cuffs with the recommended air volume, defined as a ≥25% decrease from baseline or an absolute value ≤ 50%. The secondary endpoints were differences in time points, insertion success rates, and complications.ResultsThere was no significant reduction in cerebral oximetry after inflation with the recommended cuff volume and an initially measured cuff pressure of >120 cmH2O. Overall, tracheal intubation was achieved in a median of 20 s [interquartile range 15-23 s] and enabled sufficient ventilation and tracheal intubation through the iLTS-D in all patients. Traces of blood on the cuffs (after removing the iLTS-D) and a sore throat (evaluated 2 h after removing the tracheal tube) were observed in one patient.ConclusionOur results showed no association between the insertion of the iLTS-D and reduced cerebral oxygenation in patients undergoing elective cardiac surgery.Trial registrationClinicalTrials.gov, NCT03942809.

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The distance between the glottis and the cuff of a tracheal tube placed through three supraglottic airway devices in children

Cited by 6 publications

References 22 publications

Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Comparison of the clinical performance of i-gel and Ambu laryngeal masks in anaesthetised paediatric patients: A meta-analysis

Dimensional compatibility and limitations of tracheal intubation through supraglottic airway devices: a mannequin-based in vitro study

Airway management with novel intubating laryngeal tubes has no influence on cerebral oxygenation in cardiac surgery patients: A prospective observational study

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