UNASSIGNED: To evaluate the effect of sevoflurane general anesthesia with laryngeal mask airway in the extraction of teeth.
UNASSIGNED: A retrospective analysis was performed on 88 children who underwent extraction of teeth in the Department of Anesthesiology of our hospital from June 2022 to April 2023, including 44 patients who received traditional anesthesia as the control group and 44 patients who received laryngeal mask airway sevoflurane general anesthesia as the observation group. Anesthesia and operation records of patients in the two groups were analyzed, including intraoperative vital signs, anesthesia induction time, recovery time of spontaneous breathing, first feeding time within 24 h after surgery, postoperative pain score, incidence of adverse reactions, Ramsay score and wake agitation, and other indicators were collected, and statistical analysis was conducted.
UNASSIGNED: The recovery time of the observation group was 7.88 ± 4.95 min, and the recovery time of spontaneous respiration was 10.58 ± 3.64 min, which were significantly shorter than 15.23 ± 5.12 min and 14.41 ± 3.56 min of the control group (P < 0.001). There were no significant differences between the two groups in anesthesia induction, operation duration and first feeding time within 24 h after operation (P > 0.05). There was no significant difference in postoperative pain scores between the two groups (P > 0.05). The overall incidence of adverse reactions was 6.82% in the observation group compared with 22.73% in the control group (χ² = 4.423, P = 0.035). In addition, the Ramsay score of the observation group was significantly improved compared with the control group (P < 0.05), and the incidence of agitation during the recovery period was also significantly decreased (P < 0.05).
UNASSIGNED: Laryngeal mask airway sevoflurane anesthesia can significantly accelerate the recovery process of children after extraction of teeth, and reduce the occurrence of adverse reactions, providing a safer and more efficient choice than traditional anesthesia.

BACKGROUND: Endotracheal intubation is often associated with postoperative complications such as sore throat discomfort and hoarseness, reducing patient satisfaction and prolonging hospital stays. Laryngeal mask airway (LMA) plays a critical role in reducing airway complications related to endotracheal intubation. This meta-analysis was performed to determine the efficacy and safety of LMA in video-assisted thoracic surgery (VATS).
METHODS: The PubMed, Embase, Cochrane Library, Medline and Web of Science databases were searched for eligible studies from inception until October 5, 2023. Cochrane\'s tool (RoB 2) was used to evaluate the possibility biases of RCTs. We performed sensitivity analysis and subgroup analysis to assess the robustness of the results.
RESULTS: Seven articles were included in this meta-analysis. Compared with endotracheal intubation, there was no significant difference in the postoperative hospital stay (SMD = -0.47, 95% CI = -0.98-0.03, P = 0.06), intraoperative minimum SpO2 (SMD = 0.00, 95% CI = -0.49-0.49, P = 1.00), hypoxemia (RR = 1.00, 95% CI = 0.26-3.89, P = 1.00), intraoperative highest PetCO2 (SMD = 0.51, 95% CI = -0.12-1.15, P = 0.11), surgical field satisfaction (RR = 1.01, 95% CI = 0.98-1.03, P = 0.61), anesthesia time (SMD = -0.10, 95% CI = -0.30-0.10, P = 0.31), operation time (SMD = 0.06, 95% CI = -0.13-0.24, P = 0.55) and blood loss (SMD =- 0.13, 95% CI = -0.33-0.07, P = 0.21) in LMA group. However, LMA was associated with a lower incidence of throat discomfort (RR = 0.28, 95% CI = 0.17-0.48, P < 0.00001) and postoperative hoarseness (RR = 0.36, 95% CI = 0.16-0.81, P = 0.01), endotracheal intubation was found in connection with a longer postoperative awake time (SMD = -2.19, 95% CI = -3.49 - -0.89, P = 0.001).
CONCLUSIONS: Compared with endotracheal intubation, LMA can effectively reduce the incidence of throat discomfort and hoarseness post-VATS, and can accelerate the recovery from anesthesia. LMA appears to be an alternative to endotracheal intubation for some specific thoracic surgical procedures, and the efficacy and safety of LMA in VATS need to be further explored in the future.

BACKGROUND: Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy.
METHODS: Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed.
RESULTS: Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67).
CONCLUSIONS: For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.

OBJECTIVE: Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners.
METHODS: This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration.
RESULTS: The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794).
CONCLUSIONS: Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i.

UNASSIGNED: To prospectively determine the median effective dose (ED50) of propofol for inhibiting a response to laryngeal mask airway (LMA) insertion when combined with different doses of esketamine in female patients.
UNASSIGNED: A total of 58 female patients (aged 20-60 years, ASAⅠ-Ⅱ) scheduled for elective hysteroscopy were enrolled and randomly divided into 2 groups, one of which was administered 0.2 mg/kg of esketamine (K1 group, n = 28) and the other 0.3 mg/kg of esketamine (K2 group, n = 30). The 2 groups received the corresponding doses of esketamine intravenously, followed by an intravenous injection of propofol (injection time was 30 s). The initial dose of propofol was 2 mg/kg, and the dose ratio of propofol in the adjacent patients was 0.9. If a positive reaction occurred due to LMA insertion, the dose ratio in the next patient was increased by 1 gradient; if not, the dose ratio was decreased by 1 gradient. The ED50, 95 % effective dose (ED95) and 95 % confidence interval (CI) of propofol for inhibiting a response to LMA insertion in the 2 esketamine groups were calculated using probit analysis.
UNASSIGNED: The ED50 of propofol for inhibiting a response to LMA insertion in female patients was 1.95 mg/kg (95 % CI, 1.82-2.08 mg/kg) in the K1 group and 1.60 mg/kg (95 % CI, 1.18-1.83 mg/kg) in the K2 group. The ED95 of propofol for inhibiting a response to LMA insertion in female patients was 2.22 mg/kg (95 % CI, 2.09-2.86 mg/kg) in the K1 group and 2.15 mg/kg (95 % CI, 1.88-3.09 mg/kg) in the K2 group.
UNASSIGNED: Propofol combined with 0.3 mg/kg of esketamine has low ED50 and ED95 effective doses for inhibiting an LMA insertion response in female patients undergoing hysteroscopy and surgery. There were no significant adverse effects, but the additional dose of propofol and airway pressure were significantly higher than those in the group administered 0.2 mg/kg of esketamine. Based on the results, we recommend the combination of propofol with 0.2 mg/kg esketamine for optimal conditions during LMA insertion in women undergoing hysteroscopy.

Adenoidectomy with or without tonsillectomy remains one of the most routinely performed surgical procedures in children. The duration of the procedure is usually less than half an hour and is done in a day surgery setting. Airway management for adenoidectomy can be especially challenging as the airway is shared between the surgeon and the anesthesiologist. The gold standard for airway management is an endotracheal tube (ETT), even though there has been an increase in the use of laryngeal mask airway (LMA) over the past decade. This retrospective study investigated patient data collected over a 4-year period (2016 to 2020). Data included 210 cases in a day surgery setting. We analyzed the choice of airway device and use of neuromuscular blockers and analgesics for pain management. The use of LMA was noted in 67.62% while endotracheal intubation was performed in 32.38% of cases. LMA resulted in fewer respiratory complications compared to ETT (p=0.006). The need for neuromuscular blockers was also lower in the LMA group (p=0.01). There was no statistically significant difference in the intraoperative dose of opioid analgesia (p=0.09). Flexible LMA is a satisfactory alternative to endotracheal intubation for outpatient pediatric adenoidectomy.

UNASSIGNED: A laryngeal mask airway (LMA) is a simple and non-invasive device used to establish the airway and maintain ventilation and oxygenation during short-duration medical procedures.
UNASSIGNED: This study aimed to compare the placement of an LMA using an innovative technique vs the classic method.
UNASSIGNED: This clinical trial was conducted at Faiz Hospital in Isfahan. Out of 110 candidates for elective eye surgery, 10 patients were excluded from the study as they did not meet the inclusion criteria. Ultimately, 100 patients were randomly allocated to 2 groups of 50 each. One group underwent LMA insertion using the classic method, while the other group underwent insertion using the face-to-face triple maneuver technique (FFTMT). Data, including laryngeal mask insertion conditions, hemodynamic responses, and clinical complications, were collected, entered into SPSS version 26, and analyzed.
UNASSIGNED: There were no significant differences between the 2 groups in terms of laryngeal mask placement time (P = 0.061), number of attempts to place the LMA (P = 0.059), oropharyngeal leak pressure (OLP; P = 0.942), frequency of hoarseness (P > 0.99), or laryngospasm (P > 0.99). However, it is noteworthy that FFTMT appeared to provide easier placement of the LMA (P < 0.0001), required fewer attempts, and offered better quality of ventilation with a lower presence of blood on the cuff (P = 0.038). Conversely, the FFTMT group had a higher frequency of sore throat (P < 0.0001).
UNASSIGNED: The performance of LMA using FFTMT is comparable to the classic method. In procedures under general anesthesia where the surgeon has access to the patient\'s head and neck (such as cataract surgery), airway management with LMA using FFTMT (while maintaining the patient\'s sterile covering) appears to be effective in case of an emergency.

UNASSIGNED: This study aimed to assess and compare the effects of intranasal administration of lidocaine and remifentanil on the condition of LMA insertion and cardiovascular response.
UNASSIGNED: From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg, the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its insertion were investigated.
UNASSIGNED: In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try (p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference was observed.
UNASSIGNED: In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the cardiovascular response to LMA insertion, but it did not outperform lidocaine.

UNASSIGNED: The laryngeal mask airway ProSeal (PLMA) insertion should be easy, fast, and atraumatic. Most studies have been done on adults who cannot be considered as the reflection of pediatric patients. In this study, we compared the first attempt success rate of three techniques of PLMA insertion: introducer, 90° rotation, and pharyngoscopy technique in the pediatric population.
UNASSIGNED: In this prospective comparative randomized study, a total of 135 patients of American Society of Anesthesiology grade I and II, aged three to eleven years, with normal airways scheduled for elective surgery, were randomly allocated into three groups: introducer, 90° rotation, and pharyngoscopy group. Parameters evaluated were: first attempt insertion success rate, insertion time, ease of insertion score, hemodynamic parameters, oropharyngeal seal pressure, manipulations, PLMA blood staining, postoperative sore throat, and hoarseness.
UNASSIGNED: First attempt insertion success rate was higher in the 90° rotation (97.78%) and pharyngoscopy (97.78%) group as compared to the introducer group (93.33%). But the result was not statistically significant. PLMA insertion time was the least in the rotation group, followed by the pharyngoscopy and introducer group (P < 0.0001). Mean arterial pressure and heart rate were significantly raised in the pharyngoscopy versus rotation group and the introducer versus 90° rotation group after PLMA insertion. Oropharyngeal seal pressure was significantly higher in the introducer as compared to the rotation group (P = 0.007).
UNASSIGNED: All three techniques had a high first-attempt insertion success rate. As the rotation technique had the best result in insertion time and hemodynamic response, it may be considered a good alternative to pharyngoscopy and introducer technique in pediatric patients of age three to eleven years with a normal airway.

UNASSIGNED: Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size-based method is a promising new technique for accurate size selection.
UNASSIGNED: A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures.
UNASSIGNED: A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups (P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively (P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y (P = 0.180). The two groups were comparable as per the number of attempts needed for insertion (P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups.
UNASSIGNED: Pinna size-based estimation of LMA size is an effective alternative method to weight-based selection.