Sheetal, Seema Jindal, G. Sidhu, S. Jindal, Sandeep Kaur
Background and Aims: Baska Mask® is a new third-generation supraglottic airway device (SGAD). The placement of Baska Mask® using the standard technique causes posterior displacement of the tongue, leading to incorrect positioning and insertion failure. The rotation technique may alleviate this obstacle during insertion by decreasing resistance between the airway and tongue. The primary objective of this study was to compare the insertion time between the standard versus rotational technique of Baska Mask®, and the secondary outcome measures were ease of insertion, number of attempts and postoperative airway morbidity with both techniques. Methods: One hundred consenting adults of the American Society of Anaesthesiologists I-II, aged 20–65 years of either gender scheduled for a variety of surgical procedures under general anaesthesia in a tertiary care hospital (May 2019 to November 2020), were included in the study. The patients were randomly allocated to Group S and Group R using the standard and rotation techniques, respectively. All statistical analyses were done using the SPSS (Statistical Package for the Social Sciences) software. The comparison of quantitative variables between the study groups was done using the Student's t-test and Mann–Whitney test. For comparing categorical data, the Chi-square χ2 test was performed. Results: The mean insertion time was significantly higher with the standard compared to the rotation technique of Baska Mask (20.90 ± 3.13 vs. 14.84 ± 1.11 s, P = 0.000). Device insertion was easy in rotation compared to the standard technique (P = 0.031). The number of attempts required for insertion was more with the standard technique than with the rotation technique (P = 0.011). Conclusion: Although the standard technique of Baska Mask® remains the first choice, the rotational technique of Baska Mask® has a higher success of insertion with fewer complications than the standard technique; hence, it can be accepted as an alternative.
背景与目的:Baska Mask®是一种新型第三代声门上气道设备(SGAD)。使用标准技术放置Baska Mask®会导致舌头后侧移位，导致定位错误和插入失败。旋转技术可以通过减少气道和舌间的阻力来减轻插入时的障碍。本研究的主要目的是比较Baska Mask®标准技术与旋转技术的插入时间，次要结局指标是两种技术的插入难易程度、尝试次数和术后气道发病率。方法:研究纳入了100名来自美国麻醉师协会I-II的成年人，年龄在20-65岁，男女皆可，计划在三级医院(2019年5月至2020年11月)进行全身麻醉下的各种外科手术。采用标准技术和旋转技术将患者随机分为S组和R组。所有统计分析均使用SPSS (statistical Package for the Social Sciences)软件进行。各研究组间定量变量的比较采用学生t检验和Mann-Whitney检验。分类资料比较采用χ2检验。结果:与Baska Mask旋转技术相比，采用标准技术的平均插入时间显著增加(20.90±3.13 s vs. 14.84±1.11 s, P = 0.000)。与标准技术相比，旋转装置插入容易(P = 0.031)。标准技术插入所需的尝试次数多于旋转技术(P = 0.011)。结论:虽然Baska Mask®标准技术仍然是首选，但Baska Mask®旋转技术比标准技术置入成功率高，并发症少;因此，它可以被接受为一种替代方案。
{"title":"Standard technique versus rotational technique of insertion of Baska mask®","authors":"Sheetal, Seema Jindal, G. Sidhu, S. Jindal, Sandeep Kaur","doi":"10.4103/arwy.arwy_1_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_1_23","url":null,"abstract":"Background and Aims: Baska Mask® is a new third-generation supraglottic airway device (SGAD). The placement of Baska Mask® using the standard technique causes posterior displacement of the tongue, leading to incorrect positioning and insertion failure. The rotation technique may alleviate this obstacle during insertion by decreasing resistance between the airway and tongue. The primary objective of this study was to compare the insertion time between the standard versus rotational technique of Baska Mask®, and the secondary outcome measures were ease of insertion, number of attempts and postoperative airway morbidity with both techniques. Methods: One hundred consenting adults of the American Society of Anaesthesiologists I-II, aged 20–65 years of either gender scheduled for a variety of surgical procedures under general anaesthesia in a tertiary care hospital (May 2019 to November 2020), were included in the study. The patients were randomly allocated to Group S and Group R using the standard and rotation techniques, respectively. All statistical analyses were done using the SPSS (Statistical Package for the Social Sciences) software. The comparison of quantitative variables between the study groups was done using the Student's t-test and Mann–Whitney test. For comparing categorical data, the Chi-square χ2 test was performed. Results: The mean insertion time was significantly higher with the standard compared to the rotation technique of Baska Mask (20.90 ± 3.13 vs. 14.84 ± 1.11 s, P = 0.000). Device insertion was easy in rotation compared to the standard technique (P = 0.031). The number of attempts required for insertion was more with the standard technique than with the rotation technique (P = 0.011). Conclusion: Although the standard technique of Baska Mask® remains the first choice, the rotational technique of Baska Mask® has a higher success of insertion with fewer complications than the standard technique; hence, it can be accepted as an alternative.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"57 1","pages":"17 - 22"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85958747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence in airway management and anaesthesia","authors":"S. Solanki","doi":"10.4103/arwy.arwy_4_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_4_23","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"76 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78388257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Senthilkumar Praveenkumar, H. Kapoor, Deepika Malapaka
Patients with ankylosing spondylitis present with airway difficulties. There are various techniques to secure a definitive airway for general anaesthesia in these patients. We report the case of an ankylosing spondylitis patient with fixed neck deformity for laparoscopic bilateral inguinal hernia repair surgery managed with an Ambu® AuraGain™ laryngeal mask (LM) insertion and followed by a fibreoptic bronchoscopic-aided endotracheal tube insertion for definitive airway through the LM airway according to the All India Difficult Airway Association guidelines.
{"title":"Bronchoscopic guided intubation through laryngeal mask airway in a patient with ankylosing spondylitis","authors":"Senthilkumar Praveenkumar, H. Kapoor, Deepika Malapaka","doi":"10.4103/arwy.arwy_38_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_38_22","url":null,"abstract":"Patients with ankylosing spondylitis present with airway difficulties. There are various techniques to secure a definitive airway for general anaesthesia in these patients. We report the case of an ankylosing spondylitis patient with fixed neck deformity for laparoscopic bilateral inguinal hernia repair surgery managed with an Ambu® AuraGain™ laryngeal mask (LM) insertion and followed by a fibreoptic bronchoscopic-aided endotracheal tube insertion for definitive airway through the LM airway according to the All India Difficult Airway Association guidelines.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"10 1","pages":"29 - 31"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89047751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neck masses may distort the airway and make even fibreoptic intubation difficult. A large mass may prevent the negotiation of a flexible bronchoscope beyond the obstruction. A combined direct laryngoscopy-assisted flexible bronchoscopy must be considered an option that can help intubation in select difficult airway situations and may prove lifesaving as it did in this case.
{"title":"Direct laryngoscopy-assisted flexible bronchoscopic intubation in a difficult airway","authors":"H. Wagh","doi":"10.4103/arwy.arwy_47_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_47_22","url":null,"abstract":"Neck masses may distort the airway and make even fibreoptic intubation difficult. A large mass may prevent the negotiation of a flexible bronchoscope beyond the obstruction. A combined direct laryngoscopy-assisted flexible bronchoscopy must be considered an option that can help intubation in select difficult airway situations and may prove lifesaving as it did in this case.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"32 1","pages":"26 - 28"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88273874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Airway management in an infant with congenital laryngeal web and subglottic stenosis","authors":"D. Singla, Barkha Bharati, Priya T Kandy","doi":"10.4103/arwy.arwy_2_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_2_23","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"22 1","pages":"36 - 37"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75564518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karthik Lakshmikanth, Ankur Sharma, B. Paliwal, Harshavardhan Kuri
{"title":"Difficult airway management in a case of Lemierre's syndrome with diabetic ketoacidosis","authors":"Karthik Lakshmikanth, Ankur Sharma, B. Paliwal, Harshavardhan Kuri","doi":"10.4103/arwy.arwy_34_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_34_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"34 1","pages":"40 - 41"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78357357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pooja Subbiah, J. Bapat, Manju Butani, Arpit Sharma
{"title":"Unanticipated difficult intubation due to tracheal stenosis in an adult patient posted for Whipple's surgery","authors":"Pooja Subbiah, J. Bapat, Manju Butani, Arpit Sharma","doi":"10.4103/arwy.arwy_49_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_49_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"2 1","pages":"32 - 33"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87035314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Machine learning is artificial intelligence (AI) which can predict the output variable with the fed input features. This allows computers to learn from experience without being programmed. The outcome variable in machine learning algorithm may be continuous variable or categorical variable. Supervised machine learning is commonly applied artificial intelligence (AI) in medical field. Decision tree, gradient boost machine (GBM) learning, extreme GBM (XGBM), Support vector machine, K nearest neighbour and multi-layer perceptron are few machine learning algorithms which are being utilised to address the classification and regression problems. Though the incidence of difficult intubation (DI) is rare, occurrence of such event in an unanticipated situation can result in development of arrhythmias due to desaturation and cardiac arrest if not intervened on time. It is preferred to choose the physical parameters that can predict the difficult airway more accurately in clinical scenario and train the algorithm rather than including all the non-specific parameters. Body mass index (BMI) [>30 kg.m-2: anticipated difficult mask ventilation (DMV), direct laryngoscopy (DL) and DI], inter-insicor distance (IID) (<2 cm: anticipated DL), modified Mallampati (MMP) (Grade 1 and 2: Ease of intubation; Grade 3 and 4: anticipated DI), temporomandibular distance (TMD) (<6.5 cm - anticipated DI), restriction of neck extension (if present: anticipated DL and DI), receded mandible (if present: anticipated DL and DI), and poor submandibular space compliance (if present: anticipated DL and DI) parameters which are used to predict DA by clinical assessment, can be used to feed to train the machine learning algorithm. Despite using these sophisticated tools, extubation may fail and patients require reintubation in ICU. It is very challenging to assess the lung compliance in spontaneously breathing patients as compliance will be overestimated due to generation of negative pressure. Cause for which patient has been placed on mechanical ventilation is resolved/resolving, BMI (>30 kg.m-2), intact sensorium (absence of delirium), absence of consolidation, absence of copious secretions, oxygenation status (PaO2/FiO2: >250), ventilation status (paCO2: 30-45 mmHg), measure of work of breathing (respiratory rate, rapid shallow breathing index), heart rate and blood pressure during spontaneous breathing trial (SBT) and diaphragmatic thickness fraction can be used as input features to predict the success of extubation in critically ill patients. With widespread utility of applications in medical fraternity, applications for prediction of difficult airway (or for weaning success) can be programmed which can be accessed by the clinicians to predict DA, thereby all the preparations for managing DA may be done to prevent adverse consequences of unanticipated difficult airway.
{"title":"Predictive machine learning algorithms in anticipating problems with airway management","authors":"M. Senthilnathan, P. Kundra","doi":"10.4103/arwy.arwy_3_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_3_23","url":null,"abstract":"Machine learning is artificial intelligence (AI) which can predict the output variable with the fed input features. This allows computers to learn from experience without being programmed. The outcome variable in machine learning algorithm may be continuous variable or categorical variable. Supervised machine learning is commonly applied artificial intelligence (AI) in medical field. Decision tree, gradient boost machine (GBM) learning, extreme GBM (XGBM), Support vector machine, K nearest neighbour and multi-layer perceptron are few machine learning algorithms which are being utilised to address the classification and regression problems. Though the incidence of difficult intubation (DI) is rare, occurrence of such event in an unanticipated situation can result in development of arrhythmias due to desaturation and cardiac arrest if not intervened on time. It is preferred to choose the physical parameters that can predict the difficult airway more accurately in clinical scenario and train the algorithm rather than including all the non-specific parameters. Body mass index (BMI) [>30 kg.m-2: anticipated difficult mask ventilation (DMV), direct laryngoscopy (DL) and DI], inter-insicor distance (IID) (<2 cm: anticipated DL), modified Mallampati (MMP) (Grade 1 and 2: Ease of intubation; Grade 3 and 4: anticipated DI), temporomandibular distance (TMD) (<6.5 cm - anticipated DI), restriction of neck extension (if present: anticipated DL and DI), receded mandible (if present: anticipated DL and DI), and poor submandibular space compliance (if present: anticipated DL and DI) parameters which are used to predict DA by clinical assessment, can be used to feed to train the machine learning algorithm. Despite using these sophisticated tools, extubation may fail and patients require reintubation in ICU. It is very challenging to assess the lung compliance in spontaneously breathing patients as compliance will be overestimated due to generation of negative pressure. Cause for which patient has been placed on mechanical ventilation is resolved/resolving, BMI (>30 kg.m-2), intact sensorium (absence of delirium), absence of consolidation, absence of copious secretions, oxygenation status (PaO2/FiO2: >250), ventilation status (paCO2: 30-45 mmHg), measure of work of breathing (respiratory rate, rapid shallow breathing index), heart rate and blood pressure during spontaneous breathing trial (SBT) and diaphragmatic thickness fraction can be used as input features to predict the success of extubation in critically ill patients. With widespread utility of applications in medical fraternity, applications for prediction of difficult airway (or for weaning success) can be programmed which can be accessed by the clinicians to predict DA, thereby all the preparations for managing DA may be done to prevent adverse consequences of unanticipated difficult airway.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"51 1","pages":"4 - 9"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81675457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Rudingwa, Rajasekar Ramadurai, Banupriya Ravichandrane, K. Madhanagopal
Spasmodic dysphonia (SD) is a voice disorder resulting from involuntary laryngeal muscle movements. An anaesthesiologist might encounter patients with SD arriving for surgical treatment of the primary pathology or other surgical procedures. One must exercise caution while providing anaesthesia to such patients and consider any factor that may precipitate airway obstruction. Symptoms might get exacerbated following anaesthesia involving airway intervention that might warrant immediate airway control. Airway techniques that have minimal manipulation and vigilant observation of the patient for any symptom of airway compromise postextubation are recommended. SD, though manifesting just as a voice change, has a significant impact on anaesthesia management, and as an anaesthesiologist, one should be aware of its implications while handling these patients.
{"title":"Anaesthetic concerns in a case of spasmodic dysphonia","authors":"P. Rudingwa, Rajasekar Ramadurai, Banupriya Ravichandrane, K. Madhanagopal","doi":"10.4103/arwy.arwy_48_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_48_22","url":null,"abstract":"Spasmodic dysphonia (SD) is a voice disorder resulting from involuntary laryngeal muscle movements. An anaesthesiologist might encounter patients with SD arriving for surgical treatment of the primary pathology or other surgical procedures. One must exercise caution while providing anaesthesia to such patients and consider any factor that may precipitate airway obstruction. Symptoms might get exacerbated following anaesthesia involving airway intervention that might warrant immediate airway control. Airway techniques that have minimal manipulation and vigilant observation of the patient for any symptom of airway compromise postextubation are recommended. SD, though manifesting just as a voice change, has a significant impact on anaesthesia management, and as an anaesthesiologist, one should be aware of its implications while handling these patients.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"9 1","pages":"23 - 25"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81684495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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