Search

Background and Aims: The second-generation supraglottic airway device is conventionally inserted blindly, which might result in suboptimal placement. Limited literature exists on under-vision insertion techniques, particularly in paediatric patients. The primary objective of this study was to compare the oropharyngeal leak pressure (OPLP) between the blind insertion of the LMA Blockbuster ® and the Miller laryngoscope-guided insertion in children. Secondary outcomes included the number of insertion attempts, haemodynamic disturbances, insertion time and airway complications., Methods: This randomised controlled trial study enroled 100 patients aged 1-4 years undergoing elective surgery. Patients were randomised into blind insertion (Group A) or Miller laryngoscope-guided insertion (Group B) of the LMA Blockbuster ® . The primary outcome measure was OPLP. Insertion time, haemodynamic changes and postoperative complications were also assessed. The Chi-square, Fisher's exact and t -test were applied appropriately, with the significance level set at P < 0.05., Results: Significantly higher mean OPLP was observed in Group B compared to Group A - 27.9 [standard deviation (SD): 1.58] cmH 2 O versus 25.94 (SD: 0.63) cmH 2 O [mean difference (MD): 1.96 (95% confidence interval {CI}: 1.48, 2.44; P < 0.001)]. Mean insertion time was longer in Group B, that is, 11.9 (SD: 1.91) s versus 8.7 (SD: 0.6) s [MD: 3.2 s; (95% CI: 2.63, 3.76; P < 0.001)]; however, the difference was not clinically relevant. First-attempt insertion, haemodynamic stability and postoperative complications were comparable ( P > 0.05)., Conclusion: Miller laryngoscope-guided under-vision insertion of LMA Blockbuster ® improves alignment with epiglottic structures compared to blind insertion., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Anaesthesia.)

Background and Aims: Supraglottic airway (SGA) devices are a boon to paediatric airway management. The clinical performances of the BlockBuster ® laryngeal mask airway (LMA) and Ambu® AuraGain™ in preschool children were compared in this study., Methods: After ethical approval and trial registration, this randomised controlled study was conducted on 50 children, aged 1-4 years, randomised into two groups. Appropriate sized Ambu® AuraGain™ (group A) and LMA BlockBuster ® (group B) were placed as per the manufacturer's recommendation under general anaesthesia. Appropriate size of the endotracheal tube was then chosen and inserted through the device. Primary objective of the study was to compare the oropharyngeal seal pressure (OSP), and secondary objectives were the first attempt intubation success rate, overall intubation success rate, SGA insertion time, intubation time, haemodynamic changes and postoperative pharyngolaryngeal complications. The Chi-square test was used to analyse the categorical variables, while the intragroup comparison of mean changes in outcomes was evaluated by the unpaired t -test. The level of significance was set at P < 0.05., Results: Demographic parameters were uniformly distributed in both the groups. The mean OSP in group A was 26.6 ± 0.95 cm H 2 O and in group B was 29.08 ± 0.75 cm H 2 O. Both the devices were successfully inserted in all the patients. The success rate of blind endotracheal intubation through the device in first attempt was 4% in group A and 80% in group B. Postoperative pharyngolaryngeal complications were relatively less in group B., Conclusion: LMA BlockBuster ® provides higher OSP and provides a higher success rate of blind endotracheal intubation in paediatric patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Anaesthesia.)

Background and Aims: This study was designed to compare the efficacy of Macintosh laryngoscope-guided insertion of I-gel™ with the conventional blind insertion technique., Methods: A total of 156 adult patients scheduled to undergo elective surgery under general anaesthesia were included. All participants were randomly divided into two groups; I-gel™ was inserted with conventional blind and Macintosh laryngoscopic-guided technique in group A and B respectively. The primary objective of the study was to determine the incidence of optimal positioning in both the groups based on fibreoptic bronchoscope score of the glottic view. Oropharyngeal leak pressure, haemodynamic parameters and insertion characteristics were also compared. Categorical data were presented as ratio or percentage, continuous data were presented as mean ± standard deviation or median (95% confidence interval). The strength of association between insertion technique and the anatomical fit of the device was calculated by relative risk ratio., Results: Fibreoptic scores were significantly better in laryngoscope-guided insertion group when compared to the blind insertion group ( P < 0.0001). The incidence of malposition was 3.85% in the laryngoscopic insertion group and 39.4% in the blind insertion ( P < 0.0001). Oropharyngeal leak pressure was higher in laryngoscope-guided insertion group than in blind insertion group (26.89 ± 3.37 cm H 2 O versus 24.42 ± 3.00 cm H 2 O; P < 0.0001). Other insertion characteristics except time taken to insert the device were comparable in both groups., Conclusion: When compared to the standard blind insertion technique, laryngoscope-guided insertion of I-gel™ results in better alignment with the laryngeal inlet providing a proper anatomical fit and better airway seal pressure., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Anaesthesia.)

Competing Interests: There are no conflicts of interest.