Muscle relaxant facilitates i-gel insertion by novice doctors: A prospective randomized controlled trial

Hattori, Kazuo; Komasawa, Nobuyasu; Miyazaki, Yu; Kido, Haruki; Deguchi, Shiho; Minami, Toshiaki

doi:10.1016/j.jclinane.2016.03.058

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…The increase in airway dilation after succinylcholine administration was temporary during initial pharyngeal fasciculation [22]. Nevertheless, some studies reported that muscle relaxants facilitated LMA insertion in anesthetized adult patients [8–10]. Since the pediatric airway differs anatomically from the airway of adults [4–7], LMA insertion in children can also differ from that in adults.…”

Section: Discussionmentioning

confidence: 99%

“…There are pros and cons, however, for the efficacy of muscle relaxants in LMA insertion. Recently, several studies have reported that muscle relaxants may facilitate the insertion of LMAs by enabling higher successful insertion rates, higher sealing pressure, lower leakage volume, and lower difficulty of insertion in anesthetized adult patients [8–10]. Conversely, Chen and colleagues showed that sealing pressure, airway pressure, insertion rates, and sore throats did not differ based on muscle relaxant administration [11].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial

Byun

Kim²,

Kim

2019

Trials

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BackgroundThe insertion of a laryngeal mask airway (LMA) is difficult in children due to the unique features of their airways. Muscle relaxants have been reported to facilitate LMA insertion in adults; however, there is a lack of evidence supporting this in children. This trial is designed to assess the feasibility of LMA insertion with and without the use of muscle relaxants in pediatric patients under general anesthesia.Methods/designThis is a prospective, double-blind, single-center, parallel-arm, non-inferiority, randomized controlled trial to be conducted with participants aged 2–7 years who are undergoing elective ophthalmic surgery under general anesthesia. Participants are randomly assigned to one of two groups based on whether muscle relaxants are used (MR group, n = 64) or not used (Saline group, n = 64) prior to LMA insertion. The primary outcome is the oropharyngeal leak pressure (OLP) at a fixed gas flow of 3 L/min. The secondary outcomes are intubation time for successful insertion, ease of insertion and mask bagging, intubation attempt for successful insertion, successful insertion rate on the first attempt, fiberoptic view of the LMA position, postoperative complications, and changes in hemodynamic and ventilatory parameters.DiscussionWe will compare the OLPs to determine whether the muscle relaxant provides better conditions for the manipulation of the LMA. This is the first randomized controlled trial to investigate whether muscle relaxants are beneficial to the clinical performance of LMA insertion in pediatric patients under general anesthesia. This trial will be a resource for improving the process and safety of pediatric LMA insertion under general anesthesia.Trial registrationClinicalTrials.gov, NCT03487003. Registered on 18 April 2018.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3141-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial

Byun

Kim²,

Kim

2019

Trials

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“…Although we expected that the neuromuscular blockade would increase the sealing pressure secondary to a collapse of the upper airway, activation of the soft palate muscles that maintain the patency of the upper airway is known to be reduced during sleep and anaesthesia 22 . It has previously been reported that higher sealing pressures are observed in patients who receive rocuronium before insertion compared to control patients 3,11 . The studies also demonstrated that rocuronium facilitated insertion of supraglottic devices 3,11 .…”

Section: Discussionmentioning

confidence: 97%

“…Sealing pressure was defined as the pressure indicated by airway pressure manometer at equilibrium after closing the adjustable pressure limiting valve during a fresh gas flow of 3 L/min. Reportedly, the sealing pressure of the i‐gel® was approximately 20 cmH 2 O 10,11 . To prevent bradycardia, hypotension and barotrauma caused by excessive intrathoracic pressure, we decided the maximum pressure allowed was 30 cmH 2 O.…”

Section: Methodsmentioning

confidence: 99%

The effect of rocuronium on ventilatory leak and sealing pressure using a supraglottic airway device: A randomized clinical trial

Fujimoto¹,

Kubota²,

Yamamoto

2020

Acta Anaesthesiol Scand

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Supraglottic airway devices are established tools in clinical anaesthesia practice, and short surgeries that do not require tracheal intubation is a relevant indication for the use of such devices. They can be inserted without the use of neuromuscular blocking agents and even used during mechanical ventilation. Although avoidance of neuromuscular blockade is one of the specific advantages of supraglottic devices, 1 neuromuscular blockade is sometimes required during the intraoperative period to improve surgical conditions (eg to prevent the obturator jerk during transurethral resection of bladder tumours). When neuromuscular blocking agents were administered

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“…We began the measurements after confirming the zero count response of thumb adduction to train-of-four ulnar nerve stimulation using the TOF-Watch TM (Nihon Kohden, Tokyo, Japan). 10 Tidal volume was averaged for the eight measurements taken during a one-minute period of ventilation. Measurements were performed in a standardized ascending order of pressure-controlled volumes (10, 15, 20 cm H 2 O); however, ventilation with or without nasal passage occlusion was randomly assigned for each pressure.…”

Section: Methodsmentioning

confidence: 99%

Contribution of the nasal passage to face mask ventilation: a prospective blinded randomized crossover trial

Yamasaki

Komasawa

Kido

et al. 2017

Can J Anesth/J Can Anesth

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Muscle relaxant facilitates i-gel insertion by novice doctors: A prospective randomized controlled trial

Cited by 18 publications

References 20 publications

Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial

Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial

The effect of rocuronium on ventilatory leak and sealing pressure using a supraglottic airway device: A randomized clinical trial

Contribution of the nasal passage to face mask ventilation: a prospective blinded randomized crossover trial

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