martes, 6 de marzo de 2018

Mascarilla i-gel® / i-gel® LM

Marzo 5, 2018. No. 3013
Dosis óptima de propofol para la inserción de mascarilla i-gel® en pacientes sanos paralizados
Optimal propofol dosage for i-gel® insertion in healthy paralyzed patients.
Korean J Anesthesiol. 2018 Feb;71(1):22-29. doi: 10.4097/kjae.2018.71.1.22. Epub 2017 Jul 4.
BACKGROUND: Propofol is used for supraglottic airway device insertion, often with the i-gel. However, the propofol requirement for i-gelinsertion has not been explored in paralyzed patients. This study was performed to explore hemodynamic changes and sedation level with different propofol doses in healthy paralyzed patients when the i-gel was inserted. METHODS: A total of 141 patients undergoing a urologic operation were randomly allocated to three groups depending on the propofol dose (1.5, 2, and 2.5 mg/kg; Groups P1.5, P2, and P2.5, respectively). After patients had been administered each propofol dose and rocuronium, the i-gel was inserted and changes in hemodynamic parameters and bispectral index were evaluated. RESULTS: Group P2 showed a lower incidence of complications (17%) such as hemodynamic instability and inadequate sedation than Group P1.5 (55.3%, P < 0.001) or Group P2.5 (40.4%, P = 0.012). The incidence and dose of additional propofol increased in Group P1.5 (51%, median [range]; 20 [0-50]) compared with those in the other groups (0%, 0 [0-0] in Group P2 and 8.5%, 0 [0-50] in Group P2.5, all P < 0.001), and the incidence and dose of additional ephedrine were significantly higher in Group P2.5 (31.9%; 0 [0-20]) than in Group P1.5 (10.6%, P = 0.012; 0 [0-5], P = 0.007, respectively). CONCLUSIONS: For the stable maintenance of hemodynamic parameters and proper sedation level during i-gel insertion, 2 mg/kg propofol has an advantage over 1.5 mg/kg or 2.5 mg/kg propofol in healthy paralyzed patients.
KEYWORDS: Hemodynamics; Propofol; Rocuronium; i-gel
Los efectos del tubo endotraqueal y el dispositivo supraglótico de vía aérea i-gel® en la impedancia respiratoria: un estudio observacional prospectivo.
The Effects of Endotracheal Tube and i-gel® Supraglottic Airway Device on Respiratory Impedance: A Prospective Observational Study.
Anesth Pain Med. 2016 Nov 22;7(1):e42964. doi: 10.5812/aapm.42964. eCollection 2017 Feb.
BACKGROUND: The forced oscillation technique (FOT) is a non-invasive means of measuring respiratory resistance and reactance. We tested our hypothesis that endotracheal intubation would cause more substantial preoperative increases in FOT parameters than a supraglottic airway device (SGD). METHODS: Forty patients requiring general anesthesia and mechanical ventilation for transurethral bladder tumor resection underwent spirometry the day before surgery. Forced oscillation was measured using a MostGraph-01 device the day before surgery and immediately after removal of the airway adjunct. Changes in respiratory resistance and reactance were compared between those intubated and those who used SGD. RESULTS: The trachea was intubated in 23 patients and SGD was used in the remaining 17 patients. Both airway adjuncts caused significant increases in preoperative respiratory resistance and reactance; however, the magnitude of the changes was significantly greater in the intubated patients. CONCLUSIONS: The SGD appears to cause less pulmonary injury than tracheal intubation. Further study is needed to illuminate the influence of mechanical ventilation, and longer-term consequences and clinical significance of the changes we found in this study. Spontaneous ventilation through an SGD may be preferable in patients with severe respiratory disease.
KEYWORDS: Endotracheal Intubation; Forced Oscillation Technique; Respiratory Impedance; Supraglottic Airway Device
Comparación de la presión de fuga orofaríngea y el rendimiento clínico de LMA ProSeal ™ e i-gel® en adultos: metanálisis y revisión sistemática.
Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and i-gel® in adults: Meta-analysis and systematic review.
J Int Med Res. 2016 Jun;44(3):405-18. doi: 10.1177/0300060515607386. Epub 2016 Mar 23.
BACKGROUND: A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSeal™ (Teleflex® Inc., Wayne, PA, USA) and i-gel® (Intersurgical Ltd, Wokingham, UK) in adults undergoing general anesthesia...... CONCLUSION: LMA ProSeal™ provides superior airway sealing compared to i-gel®.
KEYWORDS: Airway sealing; equipment; i-gel®; laryngeal mask airway proseal; leak; meta-analysis
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