jueves, 11 de diciembre de 2014

I-gel

i-gel™ en cirugía ambulatoria. Comparación cpn ML- ProSeal™ en pacientes relajados 


i-gel™ in Ambulatory Surgery: A Comparison with LMA-ProSeal™ in Paralyzed Anaesthetized Patients.
Das A, Majumdar S, Mukherjee A, Mitra T, Kundu R, Hajra BK, Mukherjee D, Das B.
J Clin Diagn Res. 2014 Mar;8(3):80-4. doi: 10.7860/JCDR/2014/7890.4113. Epub 2014 Mar 15.
Abstract
INTRODUCTION: Supraglottic devices have mostly eliminated the need of hemodynamically stressful routine endotracheal intubation for ambulatory surgeries. We aimed to compare hemodynamics- like blood pressure (BP) and heart rate (HR) alterations caused by stress response due to i-gel™ and LMA-ProSeal™ usage in Day care surgeries. Secondary outcomes included ease of insertion, time and number of attempts for the placement of devices. MATERIALS AND METHODS: From April 2008 to July 2009, Sixty adult ASA I-II patients of either sex, aged 20-30, were randomly allocated into two groups (Group i-gel (n=30) receiving i-gel and Group PLMA (n=30) receiving LMA-ProSeal for airway maintenance) undergoing day care surgical procedures under general anaesthesia (GA).The ease of insertion and time taken for placement of device, postoperative complications were assessed. Haemodynamic parameters (HR, BP) were noted. It was a prospective, double blinded, and randomized controlled study. Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (+ SD). p <0.05 was considered statistically significant. RESULTS: Demographically both the groups were similar. i-gel was more easily inserted than LMA-ProSeal (90% vs. 83.33% respectively). i-gel insertion time was shorter than PLMA (14.9 vs. 20.0 sec respectively) and was statistically significant. Hemodynamics (HR, BP) were less altered ini-gel than PLMA and the results were statistically significant (p <0.05). CONCLUSION: i-Gel; a relatively newer and cheap supraglottic device; insertion is easier and quicker as well as hemodynamically less stressful when compared with LMA-ProSeal in a day care setting.
KEYWORDS: ASA (American Society of Anaesthesiologists); Ambulatory (day care surgery); Blood pressure (BP) and Heart rate (HR); LMA-ProSeal™ (PLMA); i-gel™ (i-gel)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003694/pdf/jcdr-8-80.pdf




Comparación de I-gel con ML proseal en adultos de cirugía electiva bajo anestesia general sin relajantes. Estudio randomizado prospectivo



Comparison of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study.
Kini G, Devanna GM, Mukkapati KR, Chaudhuri S, Thomas D.
J Anaesthesiol Clin Pharmacol. 2014 Apr;30(2):183-7. doi: 10.4103/0970-9185.130008.
Abstract
BACKGROUND: We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. MATERIALS AND METHODS: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. RESULTS: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H2O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable. CONCLUSION: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H2O were more in PLMA group which indicates its better suitability for controlled ventilation.
KEYWORDS: Airway leak pressure; PLMA; i-gel; time for insertion

http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=2;spage=183;epage=187;aulast=Kini;type=2


Uso de dispositivos extraglóticos en pacientes de cirugía laparoscópica ambulatoria sin necesidad de intubación traqueal




Use of extraglottic airways in patients undergoing ambulatory laparoscopic surgery without the need for tracheal intubation.
Suhitharan T, Teoh WH.
Saudi J Anaesth. 2013 Oct;7(4):436-41. doi: 10.4103/1658-354X.121081.
Abstract
BACKGROUND: Second generation extraglottic airway devices with gastric access and separate breathing channels have ushered in a new era where their use is increasingly prevalent in surgical patients who would have been traditionally intubated for general anesthesia. New innovations like the i-gel, which is constructed of a thermoplastic elastomer, provide an airtight seal around patient's perilaryngeal anatomy without the inflatable cuff mechanism found in the laryngeal mask airway supreme (LMAS). METHODS: We conducted a randomized controlled trial comparing the LMAS with the i-gel in 70 anesthetized paralyzed patients undergoing laparoscopic female sterilization. Our primary outcome measure was the oropharyngeal leak pressure (OLP). We studied secondary outcomes of successful first attempt insertion rates, time and ease of the airway and gastric tube insertion, leak fractions and pharyngeal morbidity. RESULTS: We found no difference in the OLP between LMAS and i-gel, 25.9 (4.2) versus 24.4 (4.3) s, P=0.153. Both devices had similar first attempt insertion rates (LMAS 94% vs. i-gel 91%) with similar ease and comparable times to achieve an effective airway, LMAS 14.7 (2.7) versus i-gel 16.5 (9.6) s, P=0.306, although gastric tube insertion was easier and faster for the LMAS, 7.9 (1.9) versus i-gel 14.8 (7.7) s, P<0.005. Intraoperatively, there was a significantly greater leak fraction with the i-gel of 0.06 (0.03) versus 0.04 (0.02) with the LMAS, P=0.013. Three patients (8.6%) with LMAS had mild sore throat; one patient (2.9%) had mucosal injury. No complications were documented in the i-gel group. CONCLUSIONS: Both these extraglottic airway devices offer similar OLPs, high insertion success rates at the first attempt with similar ease and insertion times (albeit longer gastric tube insertion with i-gel). Both provided effective ventilation despite a higher leak fraction with i-gel that was clinically inconsequential.
KEYWORDS: Extraglottic airway devices; i-gel; laparoscopic surgery; laryngeal mask airway supreme; leak fraction; leak pressures
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2013;volume=7;issue=4;spage=436;epage=441;aulast=Suhitharan;type=2



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Anestesiología y Medicina del Dolor
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