SummaryThe Laryngeal Mask Airway Flexible TM (LMA Flexible) has been widely utilised for dental, ophthalmology and otorhinolaryngology-related procedures. Our study evaluates two different techniques of inserting the LMA Flexible for patients undergoing day-case dental surgery. One hundred and eight patients were randomly assigned into two groups based on the LMA Flexible insertion technique -either laryngoscopy-guided (n = 54) or digital manipulation (standard technique; n = 54). Patient and airway characteristics were recorded before induction of anaesthesia. The primary outcome was success rate at first insertion. Other outcomes assessed included fibreoptic assessment of laryngeal mask airway placement, haemodynamic changes, need for airway adjustment during surgery and sore throat. The success rate of insertion on the first attempt was higher for the laryngoscopy-assisted technique compared with the standard technique (96.3% vs 81.5%, respectively, p < 0.05). Fibreoptic assessment showed that the former group had better placement of the laryngeal mask airway than the latter (59.3% vs 37% p < 0.05). There were no significant differences between the two groups for haemodynamic changes. Sore throat was more common in the group with the standard technique (35.2% vs 16.7%, p < 0.05). Our study suggests the use of the laryngoscope to guide insertion of the LMA Flexible for dental surgery is a better option compared with the standard technique of digital manipulation. Laryngeal Mask Co. Limited, Mahe, Seychelles) has been widely used for dental, head and neck-related surgery [1][2][3]. The cuff portion is identical to the classic version of the LMA, but the LMA Flexible has a long and nonrigid flexometallic tube, which may make insertion more challenging. This unique design allows greater movement of the tube without displacement of the cuff or loss of seal. The head and neck may be turned with a decreased risk of airway dislodgement during surgery. Studies have detailed its usefulness compared with tracheal intubation in dental day surgery patients [4,5], but few studies have examined different techniques of insertion. Therefore, we evaluated the use of a laryngoscopy-guided technique as an alternative to the standard technique of digital manipulation for insertion of the LMA Flexible, in adult patients presenting for day-case dental surgery.
This study was undertaken to compare laryngoscopic-guided LMA insertion with a standard insertion technique. A total of 149 patients undergoing elective general surgical and orthopaedic procedures were randomly divided into two groups. Study endpoints included ease of insertion, haemodynamic changes, local trauma bleeding, and postoperative sore throat. There were no statistically significant differences found. The laryngoscope may aid laryngeal mask airway insertion in some circumstances. FIGURE 1: Blood pressure and heart rate changes between the two groups during induction and at 1 and 5 minutes after LMA insertion.
Background and Aims:Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety.Methods:This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications. Statistical analysis was done using Chi-square test.Results:Three hundred and eighteen patients (94%) successfully underwent surgery using CSA. Twenty cases (6%) had failed CSA, of which five of them had CSA insertion failure, while the rest failed to complete the operation under CSA, thus requiring conversion to general anaesthesia. Patients who have had an initial intrathecal local anaesthetic (LA) volume ≥1.5 ml had higher odds (odds ratio (OR) 2.78; 95% confidence interval [CI], 1.70–4.57) of developing hypotension compared to those who had <1.5 ml (P < 0.001). There were no reported post-dural puncture headache, neurological sequelae or infection.Conclusion:CSA is a useful anaesthetic technique with low failure rate. The key to achieving haemodynamic stability is by giving a small initial bolus, then titrating the block up to required height using aliquots of 0.5 ml of intrathecal LA through the catheter.
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