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• W2897942683 abstract "INTRODUCTION 1Dr. Archie Brain developed a new way of linking artificialand anatomical airway, between 1981 and 1987. This new concept called Laryngeal Mask Airway combined the advantages of a noninvasive face mask and the more invasive tracheal tube.Originally LMA was recommended as a better alternative tothe face mask. But ever since its development the LMA haschallenged the assumption that tracheal intubation is the only acceptable way to maintain a clear airway and provide positive pressure ventilation.Though LMA provided all the above advantages, the risk ofgastric distension, pulmonary aspiration of gastric contents and fear of inadequate ventilation acted as a deterrent to the widespread use of LMA.To overcome the above complications, Dr. Archie Braindesigned the Proseal Laryngeal Mask Airway (PLMA) in 2000,with modifications designed to enable separation ofgastrointestinal and respiratory tract, improve airway seal, enable positive pressure ventilation and diagnose mask displacement. A Drain Tube (DT) enables diagnosis of mask misplacement, reduces risk of gastric insufflation, regurgitation and aspiration of gastric contents. The PLMA (when placed by the classical digital technique) also posed occasional problems during placement,leading to risk of inadequate ventilation. To overcome theseproblems, newer placement techniques were described including the thumb placement, Introducer tool placement and GEB (Gum Elastic Bougie) aided placement. All these new techniques touted higher success rates and better placement of the PLMA.With this background, this study was conceptualized tocompare the classical digital placement technique of the PLMA against the GEB aided placement techniqueAIM OF THE STUDY:To compare Bougie guided insertion of Proseal LaryngealMask Airway (PLMA) with Digital technique in adults with respect to1. Number of attempts to successful placement.2. Effective Airway time.3. Airway trauma during insertion.4. Hemodynamic response to insertion.5. Postoperative airway morbidity.MATERIALS AND METHODS: STUDY DESIGN:This study was a randomized, prospective, comparative study.STUDY SETTING AND POPULATION:After obtaining patient’s written informed consent andInstitutional Ethical committee clearance, the study was carried out in General Surgery Operation Theatre, Madras Medical College & Government General Hospital, Chennai from March 2007 to July 2007.The study was conducted in 60 adult patients of either sex, in the age group of 18-80 years belonging to ASA I & II posted for elective minor surgeries at Government General Hospital, Chennai.INCLUSION CRITERIA:· Adults of either Sex,· > 18 Years,· ASA PS I / II,· Modified Mallampati Score I / II.EXCLUSION CRITERIA:· Age < 18 Years,· Obesity,· Pregnancy,· Inter incisor distance < 2cm, · Potential full stomach patients,· Patients with risk of aspiration like hiatus hernia, reflux oesophagitis, GERD.· Modified Mallampatti Score 3 & 4,· Pre-existing lung disease.STUDY METHOD:Patients were randomized into 2 groups using the sealedenvelope technique.i. Group D - Digital technique for PLMA insertion,ii. Group G - Gum Elastic Bougie Guided techniquefor PLMA insertion.All patients were fasted overnight. They were givenaspiration prophylaxis with Inj. Ranitidine 50mg IV and Inj.Metoclopromide 10mg IV 1 hour before surgery. Patients werepremedicated with Inj. Glycopyrrolate 0.2 mg IV 1 hr beforesurgery. After the placement of standard minimum monitoringdevices [ ECG, SpO2 ,NIBP, Capnography] and preoxygenation, all the patients were induced with Inj.Fentanyl 2 mcg / kg IV, Inj.Lignocaine 1.5 mg/ kg, Inj.Propofol 3 mg / kg I.V. PLMA was inserted with Digital / GEB technique according to the study group.OBSERVATION AND RESULTS:This prospective, randomized, blinded comparative studycompared the classical digital insertion technique of PLMA with the GEB guided, laryngoscope aided insertion technique in 60 adult patients undergoing minor surgical procedures under General Anaesthesia.All data were collected, tabulated and expressed as Mean +/-Standard deviation. Appropriate statistical analysis was conducted using SSPC 13.0 version. All quantitative data were compared using Unpaired student’s t test. All qualitative data were compared using Chi square test. P values were calculated for all tests. A p value </= 0.05 was considered significant.SUMMARY:This prospective, randomized, blinded, comparative studycompared the classical digital insertion technique of PLMA with the GEB guided laryngoscope aided PLMA insertion technique in 60 adults undergoing surgical procedures under GeneralAnaesthesia.The following conclusions were deduced from the study1. The first attempt success rate with digital technique and GEB technique were 86.7% and 96.7% respectively. The successrates after second attempt were comparable (96.7% vs 100%).2. The effective airway time with GEB (36.87 + 11.2 sec) wassignificantly longer than the digital technique (22.32 + 12.09 sec).3. Both the techniques had comparable and insignificantincidence of PLMA malposition.4. The commonest presentation of PLMA malposition wasNegative suprasternal notch tap test.5. Oropharyngeal leak pressure with GEB technique (30.63 +4.716mm Hg) was significantly greater than digital technique(23.13 + 3.693 mm Hg).6. Blood staining on the PLMA and other airway devices wascomparable between the two groups and was not statisticallysignificant.7. Airway trauma was not statistically different between the two techniques. 8. Sore throat was more frequent with the digital techniquewhile dysphagia was more frequent with the GEB technique.9. Hemodynamically there was no significant differencebetween the two insertion techniques with regard to Heartrate, Systolic blood pressure, Diastolic blood pressure andMean arterial pressure.Hence, GEB guided laryngoscope aided PLMA insertion is anexcellent alternative technique to the classical digital PLMA insertion technique.CONCLUSION:The Gum elastic Bougie guided, laryngoscope aided insertionof Proseal Laryngeal Mask Airway is an excellent alternativetechnique to Digital technique in adults with respect to number of attempts to successful placement, effective airway time, hemodynamic response to insertion, airway trauma and post operative airway morbidity." @default.
• W2897942683 created "2018-10-26" @default.
• W2897942683 creator A5057044421 @default.
• W2897942683 date "2008-03-01" @default.
• W2897942683 modified "2023-09-27" @default.
• W2897942683 title "A Comparative Evaluation of Bougie Guided Insertion of Proseal Laryngeal Mask Airway with Digital Technique in Adults" @default.
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