Search Results (14)

Background/Objectives: Supraglottic airway devices are commonly used airway management tools, with various second-generation laryngeal masks available for patients undergoing general anesthesia. These devices offer improved sealing, gastric suction capabilities, and the potential for tracheal intubation. This study compared the recently introduced Singularity^TM Air laryngeal mask with two well-established devices, Ambu^® AuraGain^TM and i-GEL^®, under clinical conditions. Methods: We prospectively included 98 adult patients scheduled for elective surgery requiring general anesthesia. Patients were randomized to one of three laryngeal mask groups, and data on insertion success, ventilation efficiency, and postoperative complications, such as sore throat and dysesthesia, were collected. The primary endpoint was oropharyngeal sealing pressure, with additional assessments of insertion ease and bronchoscopic glottic visibility. Results: Median initial oropharyngeal leak pressure was lowest with i-GEL^® (22 cm H₂O) as opposed to Ambu^® AuraGain^TM (25 cm H₂O) and Singularity^TM Air (25 cm H₂O) [p = 0.0138], but this difference equalized after 15–30 min. I-GEL^® showed higher insertion success (88%, p = 0.001) and shorter time-to-first ventilation (29 s, p = 0.0106). Conversely, the gastric tube insertion rate was lower (70% versus >90% in the other masks). The Ambu^® AuraGain^TM and Singularity^TM Air performed similarly for most parameters. No significant differences were observed in tracheal intubation potential or postoperative adverse events among the three groups. Conclusions: The Singularity^TM Air performed comparably to Ambu^® AuraGain^TM and i-Gel laryngeal masks in oropharyngeal sealing pressure. I-Gel^® had the highest successful insertion rate. Most of the differences detected were not statistically significant, with all three masks providing effective airway management. Full article

Introduction: Supraglottic airway devices play an important role in airway management in both pre-hospital as well as in-hospital settings. They are a well-recognised alternative to definitive airways in current medical practice. However, despite their wide use in clinical practice, little is known about their performance in patients with restricted access. This study aims to evaluate the time required to insert a supraglottic airway device and achieve a successful ventilation of four different devices in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. The ease-of-use and first-attempt success rate were also assessed. Methods: Fully qualified paramedics participated in this randomised, controlled manikin trial. A manikin with the cervical collar on was placed on the driver’s seat of a passenger car. Access to the manikin was only allowed from the front. The I-gel, the SLIPA, the LMA Supreme, and the Ambu AuraGain were evaluated. The time required to insert the device and achieve successful ventilation was recorded. The first-attempt success rate and the ease-of-use by the operator were also assessed. Results: The LMA Supreme required the shortest mean time to insert and ventilate the manikin, 10.5 s (±1.7) vs. 16.4 s (±8.4), p < 0.001. The use of the LMA Supreme was associated with the highest first-attempt success rate—88%. The SLIPA device outperformed all other studied devices with regard to ease-of-use and user-friendliness. Its mean score was 8.3 out of 10. Conclusions: The LMA Supreme was superior in terms of both the insertion-to-ventilation time as well as the first-attempt success rate. The SLIPA device was found to be easier to use and more user-friendly. Full article

Supraglottic airway devices such as laryngeal masks and i-gels are useful for airway management. The i-gel is a relatively new device that replaces the air-inflated cuff of the laryngeal mask with a gel-filled cuff. It remains unclear which device is more effective for neonatal resuscitation. We aimed to evaluate the dependence of successful airway management in neonatal simulators on the device type and providers’ backgrounds. Ninety-one healthcare providers performed four attempts at airway management using a laryngeal mask and i-gel in two types of neonatal manikins. The dependence of successful insertions within 16.7 s (75th percentile of all successful insertions) on the device type and providers’ specialty, years of healthcare service, and completion of the neonatal resuscitation training course was assessed. Successful insertion (p = 0.001) and insertion time (p = 0.003) were associated with using the i-gel vs. laryngeal mask. The providers’ backgrounds were not associated with the outcome. Using the i-gel was associated with more successful airway management than laryngeal masks using neonatal manikins. Considering the limited effect of the provider’s specialty and experience, using the i-gel as the first-choice device in neonatal resuscitation may be advantageous. Prospective studies are warranted to compare these devices in the clinical setting. Full article

(1) Background: The physiological and pharmacological variations between men and women are known to influence drug efficacy. The objective of this study was to determine the 50% and 95% effective doses (ED₅₀ and ED₉₅) of remimazolam required for i-gel supraglottic airway (ISA) insertion under remifentanil infusion without neuromuscular blocking agents (NMBAs) in both males and females. (2) Methods: Patients aged 19–65 years, scheduled for general anesthesia using ISA, were enrolled in this study. Patients were divided into two groups based on their sex. The anesthesia process began with a remifentanil infusion targeting an effect-site concentration of 3.0 ng/mL, accompanied by a remimazolam injection. The initial remimazolam dose was 0.25 mg/kg, and it was adjusted with a step size of 0.05 mg/kg based on the outcome of ISA insertion in the preceding patient. (3) Results: The ED₅₀ of remimazolam (mean ± standard error) was 0.28 ± 0.02 mg/kg in the male group and 0.18 ± 0.02 mg/kg in the female group (p < 0.001). Additionally, ED₉₅, which was calculated using the isotonic regression method, was significantly comparable between the male and female groups (male: 0.35 mg/kg, 95% confidence interval [CI] = 0.34–0.35; female: 0.29 mg/kg, 95% CI = 0.25–0.30). (4) Conclusions: This study showed that both the ED₅₀ and the ED₉₅ of remimazolam for successful ISA insertion was higher for men than that for women. Therefore, while using remimazolam alongside remifentanil infusion without NMBAs for ISA insertion, one should consider the patient’s sex for appropriate dosing. Full article

Background and Objectives: Supraglottic airway devices (SADs) are known to be useful in eliminating the drawbacks of laryngoscopy and tracheal intubation, especially ocular pressure and stress responses. The ultrasonographic measurement of optic nerve sheath diameter (ONSD) reflects increases in intracranial pressure (ICP). In our study, we aimed to compare the effects of SADs on hemodynamic response and ONSD. Materials and Methods: Our prospective study included 90 ASA I–II patients over the age of 18 who did not have a history of difficult intubation or ophthalmic pathology. The patients were randomly divided into three groups based on the laryngeal mask airway (LMA) devices used: ProSeal LMA (pLMA, n = 30), LMA Supreme (sLMA, n = 30), and I-gel (n = 30). The bilateral ONSD measurements and hemodynamic data of the patients who underwent standard anesthesia induction and monitoring were recorded before induction (T0) and 1 min (T1), 5 min (T5), and 10 min (T10) after SAD placement. Results: At all measurement times, the hemodynamic responses and ONSD values of the groups were similar. In all three groups, intergroup hemodynamic changes at T0 and T1 were similar and higher than those at other times of measurement (p < 0.001). The ONSD values of all groups increased at T1, and they tended to return to baseline values afterward (p < 0.001). Conclusions: We concluded that all three SADs could be used safely because they preserved both hemodynamic stability and ONSD changes in their placement processes, and they did not cause elevations in ONSD to an extent that would lead to increased ICP. Full article

Most pediatric out-of-hospital cardiac arrests (OHCAs) are caused by hypoxia, which is generally consecutive to respiratory failure. To restore oxygenation, prehospital providers usually first use basic airway management techniques, i.e., bag-valve-mask (BVM) devices. These devices present several drawbacks, most of which could be avoided using supraglottic airway devices. These intermediate airway management (IAM) devices also present significant advantages over tracheal intubation: they are associated with higher success and lower complication rates in the prehospital setting. There are, however, few data regarding the effect of early IAM in pediatric OHCA. This paper details the protocol of a trial designed to evaluate the impact of this airway management strategy on ventilation parameters through a simulated, multicenter, randomized, crossover trial. The hypothesis underlying this study protocol is that early IAM without prior BVM ventilations could improve the ventilation parameters in comparison with the standard approach, which consists in BVM ventilations only. Full article

Prehospital airway devices are often classified as either basic or advanced, with this latter category including both supraglottic airway (SGA) devices and instruments designed to perform endotracheal intubation (ETI). Therefore, many authors analyze the impact of SGA and ETI devices jointly. There are however fundamental differences between these instruments. Indeed, adequate airway protection can only be achieved through ETI, and SGA devices all have relatively low leak pressures which might compromise both oxygenation and ventilation when lung compliance is decreased. In addition, there is increasing evidence that SGA devices reduce carotid blood flow in case of cardiac arrest. Nevertheless, SGA devices might be particularly useful in the prehospital setting where many providers are not experienced enough to safely perform ETI. Compared to basic airway management (bag-valve-mask) devices, SGA devices enable better oxygenation, decrease the odds of aspiration, and allow for more reliable capnometric measurement by virtue of their enhanced airtightness. For all these reasons, we strongly believe that SGA devices should be categorized as “intermediate airway management devices” and be systematically analyzed separately from devices designed to perform ETI. Full article

There is considerable controversy regarding the optimal airway management strategy in the case of out-of-hospital cardiac arrest. Registry-based studies yield contradicting results and the actual impact of using supraglottic devices on survival and neurological outcomes remains unknown. In a recent simulation study, the use of an i-gel^® device was associated with significantly shallower chest compressions. It was hypothesized that these shallower compressions could be linked to the provision of chest compressions in an over-the-head position, to the cumbersome airway management apparatus, and to a shallower i-gel^® insertion depth in the manikin. To test this hypothesis, we carried out a post hoc analysis, which is described in this report. Briefly, no association was found between the over-the-head position and compression depth. Full article

Over the past century, the demand for petroleum products has increased rapidly, leading to higher oil extraction, processing and transportation, which result in numerous oil spills in coastal-marine environments. As the spilled oil can negatively affect the coastal-marine ecosystems, its transport and fates captured a significant interest of the scientific community and regulatory agencies. Typically, the environment has natural mechanisms (e.g., photooxidation, biodegradation, evaporation) to weather/degrade and remove the spilled oil from the environment. Among various oil weathering mechanisms, biodegradation by naturally occurring bacterial populations removes a majority of spilled oil, thus the focus on bioremediation has increased significantly. Helping in the marginal recognition of this promising technique for oil-spill degradation, this paper reviews recently published articles that will help broaden the understanding of the factors affecting biodegradation of spilled oil in coastal-marine environments. The goal of this review is to examine the effects of various environmental variables that contribute to oil degradation in the coastal-marine environments, as well as the factors that influence these processes. Physico-chemical parameters such as temperature, oxygen level, pressure, shoreline energy, salinity, and pH are taken into account. In general, increase in temperature, exposure to sunlight (photooxidation), dissolved oxygen (DO), nutrients (nitrogen, phosphorous and potassium), shoreline energy (physical advection—waves) and diverse hydrocarbon-degrading microorganisms consortium were found to increase spilled oil degradation in marine environments. In contrast, higher initial oil concentration and seawater pressure can lower oil degradation rates. There is limited information on the influences of seawater pH and salinity on oil degradation, thus warranting additional research. This comprehensive review can be used as a guide for bioremediation modeling and mitigating future oil spill pollution in the marine environment by utilizing the bacteria adapted to certain conditions. Full article

Hedgehogs held a special place in ancient Egyptian life like many other desert- and marsh-dwelling animals. Their natural defensive qualities were admired by ancient Egyptians and their bodily parts, notably their hardened spines, were used as ingredients in medico-magical prescriptions. In tomb reliefs of the late 3rd Millennium BCE, hedgehogs are represented being carried alive by offering bearers or as background participants in desert hunting scenes. In later periods of Egyptian history, rattles, small unguent vessels, and scaraboid amulets were made in their shape, all of which are presumed to have had apotropaic purposes. A particular votive object of the Old Kingdom (c. 2686–2181 BCE) is a palm-sized modelled boat with a prow in the shape of a hedgehog head, which has been discovered at sites throughout Egypt. A similar representation of this motif is the so-called ‘Henet’-boat (from the word ḥnt[j]) with a hedgehog head at the prow facing inwards, which is found in late Old Kingdom art. This article reassesses the role of hedgehogs as protective or apotropaic entities and their association with boats, considering how ancient Egyptians understood their ecology and their predation of snakes, scorpions, and similar stinging creatures. An updated list is provided of known representations of hedgehog-head boats, including petroglyphs and as yet unpublished examples from tombs at Giza and Saqqara. The meaning of the ancient Egyptian word ḥnt(j) is also rexamined in relation to the representation of riverine and marsh-water boats in Old Kingdom tombs. Full article

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel^® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel^® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel^® group, even after the 30:2 alternation had been resumed. In the i-gel^® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered. Full article

The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel^® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load. Full article

Supraglottic airway devices have been increasingly used because of their several advantages. Previous studies showed that the small-sized i-gel provides effective ventilation for young pediatric patients; however, few studies have reported the use of AuraGain in these patients. Herein, we compared the clinical performance of AuraGain and i-gel in young pediatric patients aged between 6 months and 6 years old and weighing 5–20 kg, who were scheduled to undergo extremity surgery under general anesthesia. In total, 68 patients were enrolled and randomly allocated into two groups: AuraGain group and i-gel group. The primary outcome was the requirement of additional airway maneuvers. We also analyzed insertion parameters, fiberoptic bronchoscopic view, oropharyngeal leak pressure, and peri-operative adverse effects. Compared with the AuraGain group, the i-gel group required more additional airway maneuvers during the placement of the device and maintenance of ventilation. The fiberoptic view was better in the AuraGain group than in the i-gel group. However, the oropharyngeal leak pressure was higher in the i-gel group. AuraGain might be a better choice over i-gel considering the requirement of additional airway maneuvers. However, when a higher oropharyngeal leak pressure is required, the i-gel is more beneficial than AuraGain. Full article

The poor bioavailability and therapeutic response exhibited by conventional ophthalmic preparations due to rapid precorneal elimination, dilution and nasolacrimal drainage of the drug may be vanquished by the use of in situ gelling systems that are instilled as drops in to the eye and undergo a sol-gel transition in the cul-de-sac. Timolol eye drops may cause systemic side effects in glaucoma patients due to absorption of the drug into systemic circulation. In situ gelling system of this drug can provide localized effect with reduced contraindications, improved patient compliance and better therapeutic index. The present work describes the formulation and evaluation of an ophthalmic delivery system of an antiglaucoma drug, timolol maleate (TM) based on the concept of pH-triggered in situ gelation. Polyacrylic acid (carbopol) was used as the gelling agent in combination with chitosan (amine polysaccharide), which was acted as a viscosity-enhancing agent. Formulations were evaluated for pH, viscosity, gelling capacity and drug content. The 0.4% w/v carbopol/0.5% w/v chitosan based in situ gelling system was in liquid state at room temperature and at the pH formulated (pH 6.0) and underwent rapid transition into the viscous gel phase at the pH of the tear fluid (lacrimal fluid) (pH 7.4). The in vitro drug release and in vivo effects of the developed in situ gelling system were compared with that of Glucomol® (a 0.25% TM ophthalmic solution), 0.4% w/v carbopol solution as well as liposomal formulation. The results clearly demonstrated that developed carbopol-chitosan based formulation was therapeutically efficacious and showed a fickian (diffusion controlled) type of release behaviour over 24 h periods. The developed system is thus a viable alternative to conventional eye drops and can also prevent the rapid drainage as in case of liposomes. Full article