Articles: intubation.
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Anesthesia and analgesia · Feb 2025
Meta Analysis Comparative StudyComparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.
The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. ⋯ Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.
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Paediatric anaesthesia · Feb 2025
ReviewDesign considerations for development of cuffed endotracheal tube for small airways.
Endotracheal tubes (ETTs) are life-supporting devices that are designed to maintain a patent airway in patients who are unable to sustain an airway due to illness or injury. Patients with small airways, such as neonates and pediatrics, have unique structural and functional features, making it essential that ETT design considers and executes on these particular needs. Though uncuffed ETTs have historically been preferred for patients younger than eight years of age, advances in cuffed ETT design and construction can be utilized to manufacture ETTs that are optimized for the smallest, most fragile airways. The purpose of this article is to discuss certain design features of cuffed ETTs in respect to small airways.
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Cochrane Db Syst Rev · Jan 2025
Transtracheal ultrasound for identifying endotracheal intubation in adults.
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of transtracheal ultrasound for detecting endotracheal intubation in adult patients. Secondary objectives Secondary objectives include assessing the diagnostic accuracy of transtracheal ultrasound amongst the following subgroups: setting (e.g. prehospital, emergency department, intensive care unit, operating room) operator specialty (e.g. emergency medicine, non-emergency medicine) operator experience (e.g. attending physician, resident physician, non-physician) ultrasound technique (e.g. static, dynamic) ultrasound transducer (e.g. curvilinear, linear).
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Review Meta Analysis
Preoperative Ketamine Gargle for Prevention of Postoperative Sore Throat After Tracheal Intubation in Adults: A Meta-Analysis.
Objective: This meta-analysis aims to evaluate the impact of preoperative ketamine gargle on postoperative throat pain in patients undergoing general anesthesia with endotracheal intubation (ETI). Methods: A comprehensive search was conducted in databases including PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, ClinicalTrials.gov, and others. Data analysis was performed using RevMan 5.4 and Stata Statistical Software 18 (StataCorp., Texas., United States of America). ⋯ The results demonstrated a significant reduction in the incidence of postoperative sore throat at 0, 2, 4, 8, and 24 h after the operation (0 h: OR: 0.14; 95% CI: 0.04-0.47; p=0.002; I 2 = 67%; 2 h: OR: 0.30; 95% CI: 0.17-0.52; p < 0.0001; I 2 = 31%; 4 h: OR: 0.32; 95% CI: 0.20-0.52; p < 0.00001; I 2 = 0%; 8 h: OR: 0.40; 95% CI: 0.23-0.70; p=0.001; I 2 = 29%; 24 h: OR: 0.36; 95% CI: 0.25-0.51; p < 0.00001; I 2 = 0%) in patients who received ketamine gargle compared to those who received a placebo. In addition, our meta-analysis indicated that ketamine gargle did not result in a reduction in anesthesia time (min) (MD: -1.16; 95% CI: -6.44-4.11; p=0.67). Conclusion: Our meta-analysis demonstrated the efficacy of prophylactic ketamine gargle in reducing the incidence of POST across all studied time intervals in patients requiring tracheal intubation of general anesthesia compared to placebo.
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Review Meta Analysis
Sedation for awake tracheal intubation: A systematic review and network meta-analysis.
Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation. ⋯ To maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.