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A new supraglottic airway device: LMA‐Supreme™, comparison with LMA‐Proseal™

Background and objective: The LMA‐Supreme™ (S‐LMA™) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA‐Proseal™ (P‐LMA™) and S‐LMA™.

The LMA-Supreme versus the I-gel in simulated difficult airway in children: a randomised study.

BACKGROUND Supraglottic airway devices such as the LMA-Supreme (LMA-S) and I-gel, which have an additional lumen for the insertion of a gastric tube, can be useful in the management of the difficult airway. OBJECTIVE To test the performance of these two devices in the difficult paediatric airway. DESIGN Randomised double-blind study. SETTING Anaesthesia department, university hospital. PATIENTS Sixty American Society of Anesthesiologists (ASA) I-II children undergoing elective surgery. INTERVENTION After obtaining ethical approval and written informed consent from the parents, we compared the size 2 LMA-S with the I-gel in a simulated airway scenario made more difficult by using a cervical collar to limit mouth opening and neck movement. MAIN OUTCOME MEASURES The primary aim was to compare the oropharyngeal leak pressure of the LMA-S and the I-gel. The secondary aims were to compare success rate, insertion time, time to pass a gastric tube and fibreoptic view of the larynx. RESULTS Oropharyngeal leak pressure (mean ± SD) for the LMA-S was significantly higher than with the I-gel (20.9 ± 3.2 versus 18.9 ± 3.2 cmH2O, P = 0.019). First attempt success rate for the LMA-S was 100 and 90% for the I-gel (P > 0.05). Insertion time of the LMA-S was shorter than I-gel (11.2 ± 1.8 versus 13.5 ± 2.4 s, P = 0.001). Gastric tube placement was possible in all patients. The mean insertion time of the gastric tube was shorter with the LMA-S than with the I-gel (10.3 ± 3.6 versus 12.7 ± 3.2 s, P = 0.009). Fibreoptic laryngeal views were similar in both groups. CONCLUSION In the simulated difficult airway in children, both airway devices provided effective ventilation. Paediatric size 2 LMA-S sustained a higher airway pressure before leaking and was quicker to insert than the I-gel equivalent. These differences may not be clinically significant.

Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery

BackgroundVarious types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA) is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops.Methods and Results30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia) of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD) of IMA (0.67677 ± 0.09985) were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894) and postoperative (0.70477 ± 0.07523) measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA.ConclusionsIMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.

Surgical Experience in a Baby With Congenital Broncho-Biliary Fistula

Congenital tracheobiliary and bronchobiliary fistulae are rare malformations in which patent communications exist between the respiratory system and biliary tract, respectively. We present a newborn who was admitted with respiratory distress and bilious tracheal discharge. Investigation revealed a bronchobiliary fistula originating from the left main bronchus, as well as biliary atresia. Excision of the bronchobiliary fistula was successful and the connection between biliary tract and gastrointestinal system was established by performance of a Roux-en-Y cholecysto-jejunostomy. Diagnostic tools, differential diagnosis, and surgical correction strategies are discussed.

A case of pneumonia caused by Bacillus anthracis secondary to gastrointestinal anthrax.

We present herein an unusual case of anthrax pneumonia secondary to gastrointestinal infection. In this case, severe abdominal pain occurred during the course of a stent placement procedure. The patient had undergone surgery with the prediagnosis of intestinal ischemia. On the second postoperative day, pneumonia developed and B. anthracis grew as the etiologic agent. Pathological examination of small-bowel sections revealed findings in accordance with anthrax.

A Comparison of the EZ-Blocker With a Cohen Flex-Tip Blocker for One-Lung Ventilation

OBJECTIVES The EZ-Blocker (IQ Medical Ventures BV, Rotterdam, Netherlands) is a newly designed device for one-lung ventilation. The aim of this study was to compare the effectiveness of the Cohen Flex-Tip bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung ventilation during thoracic surgery. DESIGN Randomized and prospective. SETTING A university hospital. PARTICIPANTS This study included 40 patients undergoing thoracic surgical procedures. INTERVENTIONS Patients were assigned to 2 study groups: Patients who received the Cohen Flex-Tip blocker were assigned to the Cohen group, and patients who received the EZ-Blocker were assigned to the EZ group. In both groups, fiberoptic guidance was used during placement of the bronchial blockers. Comparisons between the groups included the time to correct placement, the incidence of malpositioning, and the satisfaction level of the surgeon (good, fair, poor). MEASUREMENTS AND MAIN RESULTS One-lung ventilation was achieved successfully for all patients. The time to correct placement (mean±SD) was significantly shorter in the EZ group (146±56 seconds) compared with the Cohen group (241±51 seconds; p=0.01). The incidence of malpositioning was significantly lower in the EZ group compared with the Cohen group (p=0.018). Surgeon satisfaction was similar in both groups. CONCLUSIONS In this study, both bronchial blockers provided similar surgical exposure during thoracic procedures. The EZ-Blocker had a shorter time to correct positioning and less frequent intraoperative malpositioning.

Anesthesia for Seckel syndrome.

deficit and further depress the cardiac output. It is plausible that in our patient the use of propofol as induction agent and the addition of positive pressure ventilation may have provided the setting for peripheral vasodilatation, alterations in preload, and finally, the decrease in cardiac output, enough to decrease coronary perfusion pressure. Unrecognized delayed dilated cardiomyopathy has important anesthetic implications, awareness of the potential for this pathophysiology to occur, recognition of its existence and a well-thought anesthetic plan is warranted. Luis M. Zabala M D Tariq Parray M D Pediatric anesthesia and Pain Medicine, Arkansas Children’s Hospital, Little Rock, AR, USA Correspondence to: Dr Luis Zabala, Pediatric anesthesia and Pain Medicine, Arkansas Children’s Hospital, Little Rock, AR, USA (email: zabalaluis@uams.edu)

[Comparison of ultrasound-guided supraclavicular and infraclavicular approaches for brachial plexus blockade].

OBJECTIVES Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supraclavicular or infraclavicular blocks. METHODS 110 patients were randomized into two groups: supraclavicular (Group S) and infraclavicular (Group I). All the patients were given a mixture of 20 ml 0.5% levobupivacaine and 10 ml 2% lidocaine as local anesthetics. The sensory score of the seven terminal nerves was assessed every 10 min for 30 min. RESULTS Block success (Group I: 92.7%; Group S: 83.6%) and block onset time (Group I: 12.5 ± 4.8; Group S: 11.6 ± 3.9 min) were similar between the groups. Block performance time was shorter in Group I, than Group S (194.4 ± 65; 226.3 ± 59 sec, P<0.05). The number of needle advancements were lower in Group I than Group S (p<0.05). The Group I patients had a significantly improved block of the median and ulnar nerves than Group S, and Group S patients had a better block of the medial cutaneous nerve, than Group I (p<0.05). Horner syndrome was observed in 9 patients (16.3%) and paresthesia in one patient (1.8%) in Group S. CONCLUSION Similar block features were observed with infraclavicular and supraclavicular approaches, but infraclavicular block may be preferable to supraclavicular block due to the lower incidence of transient adverse events.

Aspiration of a Cigarette Filter From a Bronchodilator Inhaler

The majority of foreign-body aspirations are seen in children. In adults, neurological dysfunction, trauma, alcohol abuse, or psychological disorders can lead to aspiration, but normal adults can also suffer foreign body aspiration. The symptoms include acute asphyxiation, with or without complete airway obstruction, cough, dyspnea, choking, and fever, which also occur in many other medical conditions. Bronchoscopic removal of the foreign body is necessary, and flexible bronchoscopy is effective in the diagnosis and removal. We saw a patient with COPD who aspirated a plastic cigarette filter while using his bronchodilator inhaler.

Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy.

OBJECTIVE This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. MATERIAL AND METHODS Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. RESULTS Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH2O; P-LMA, 27.0±4.7 cmH2O; p=0.42) and did not change during the induction of and throughout pneumoperitoneum. The first attempt success rates were 93% with both S-LMA and P-LMA. Mean airway device insertion time was significantly shorter with S-LMA than with P-LMA (12.5±4.1 seconds versus 15.6±6.0 seconds; p=0.02). The first attempt success rates for the drainage tube insertion were similar (P-LMA, 93%; S-LMA 100%); however, drainage tubes were inserted more quickly with S-LMA than with P-LMA (9.0±3.2 seconds versus 14.7±6.6 seconds; p=0.001). In the PACU, vomiting was observed in five patients (three females and two males) in the S-LMA group and in one female patient in the P-LMA group (p=0.10). CONCLUSION Both airway devices can be used safely in laparoscopic cholecystectomies with suitable patients and experienced users. However, further studies are required not only for comparing both airway devices in terms of postoperative nausea and vomiting but also for yielding definitive results.