Advertisement

Topics

Removal of the laryngeal mask airway in the post-anesthesia care unit : A means of process optimization?

Summary of "Removal of the laryngeal mask airway in the post-anesthesia care unit : A means of process optimization?"


BACKGROUND:
Removal of the laryngeal mask airway in the post-anesthesia care unit could potentially contribute to a faster turnover from one operation to the next. The aim of this study was, therefore, to obtain an insight into the potential time saving and the safety of planned removal of the ProSeal™-LMA (PLMA) in the post-anesthesia care unit.
METHODS:
In this study 120 adult patients with American Society of Anesthesiologists (ASA) classification I-II, age range 18-85 years, undergoing a surgical procedure under general anesthesia in which the PLMA was used were randomly assigned to one of two groups. In group I, the PLMA was removed in the awake patient in the operating room close to the end of the procedure. In group II, the anesthetised but spontaneously breathing patients were moved to the recovery room and the PLMA removed when the patient was awake. The anesthesia technique was standardized [balanced, sevoflurane, fentanyl, bispectral index-guided (BIS) target value=35 ± 5] and identical in both groups until randomization. Patients were breathing room air during transport to the recovery room. Different time intervals as well as the incidence of critical incidents were compared between groups. An oxygen saturation (S(p)O(2)) value  < 95% was considered a clinically relevant and S(p)O(2) values  < 90% as clinically critical O(2)-desaturation.
RESULTS:
Removal of the PLMA took place after an average of 4.9 ± 5.1 min in group I and after 19.5 ± 9.6 min in group II. There was no difference in the availability of the anesthetist in the operating room for the following procedure between groups (group 
I:
12 ± 5.6 min vs. group 
II:
10.7 ± 4.2 min, p > 0.05) despite the fact that patients of group II left the operating room faster (4.9 ± 3.9 min) than patients of group I (7.1 ± 5.1 min, p < 0.01). In group II patients were ready for discharge (White score=12) from the recovery room later (13.2 ± 8.2 min) than in group I (3.6 ± 4.8 min, p < 0.01). There were no significant differences in other process related time intervals between group I and group 
II:
duration of the operation (113.2 ± 45.9 min vs. 105.3 ± 42.6 min), duration of dressing (5.1 ± 3.7 min vs. 4.6 ± 2.8 min), duration of transport to the recovery room (3.9 ± 1.3 min vs. 3.6 ± 1.3 min) and information at end of surgery by the surgeon (22.5 ± 9.3 min vs. 22.4 ± 10.5 min). The incidence of clinically relevant as well as clinically critical O(2) desaturation at the time of recovery room arrival (S(p)O(2)  ≤ 90%) was increased in group II with 33.3% vs. 56.6% and 13.3% vs. 6.7%, p < 0.01, respectively.
CONCLUSION:
Planned PLMA removal in the recovery room after BIS-guided balanced anesthesia did not enable the anesthetist to be available earlier for induction of anesthesia in the following patient. Hence the anesthetist could not contribute to a faster turnover of cases. Obviously, with the type of close communication between surgeon and anesthetist dictated by the study protocol (announcement of expected end of surgery by the surgeon 20 min before end of surgery) it is possible for the patient to regain consciousness within a very small time window following the end of surgery. Following this kind of protocol, postponement of removal of the LMA in the recovery room does not seem to be attractive neither from a clinical nor an economic point of view. In contrast, removal of LMA in the recovery room should be restricted to occasional cases with an abrupt end of the operation or prolonged emergence from anesthesia. The obvious risk of hypoxemia necessitates continuous O(2) application and S(p)O(2) monitoring during transport to the recovery room.

Affiliation

Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen-Marburg, Marburg, Deutschland, kgoldmann@dha.gov.ae.

Journal Details

This article was published in the following journal.

Name: Der Anaesthesist
ISSN: 1432-055X
Pages:

Links

DeepDyve research library

PubMed Articles [21938 Associated PubMed Articles listed on BioPortfolio]

A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates.

To compare the short-term efficacy of surfactant administration by laryngeal mask airway (LMA) versus endotracheal tube (ETT).

Effect of intravenous infusion with lidocaine on rapid recovery of laparoscopic cholecystectomy.

Objective: To investigate the effect of intravenous infusion with lidocaine on rapid recovery of laparoscopic cholecystectomy. Methods: This study was a prospective randomized controlled trial. From F...

Tracheal intubation in patients immobilized by a rigid collar: a comparison of GlideScope and an intubating laryngeal mask airway.

Intubation must be rapidly performed with the utmost care in cervical trauma patients. We present the first comparison of GlideScope and an intubating laryngeal mask airway (ILMA) regarding insertion ...

Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient with Sjögren's Syndrome.

Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and ...

The i-gel Supraglottic Airway as a Conduit for Fibreoptic Tracheal Intubation - A Randomized Comparison with the Single-use Intubating Laryngeal Mask Airway and CTrach Laryngeal Mask in Patients with Predicted Difficult Laryngoscopy.

Fibreoptic intubation through a supraglottic airway is an alternative plan for airway management in difficult or failed laryngoscopy. The aim of this study was to compare three supraglottic airways as...

Clinical Trials [9610 Associated Clinical Trials listed on BioPortfolio]

Timing of Withdrawal of the Laryngeal Mask Airway (LMA) in Children

The purpose of this prospective, randomized study was to compare the incidence of adverse events associated with removal of the LMA either in deeply anesthetised or awake patients.

Comparative Evaluation of Ambu AuraGain Laryngeal Mask and Proseal Laryngeal Mask Airway

Comparison of two different supraglottic airway devices i.e., the ProSeal Laryngeal Mask Airway (PLMA) and Ambu AuraGain, a third generation laryngeal mask Airway.

Relationship Between Optimal Laryngeal Mask Airway Cuff Volume and Physical Examination of Head and Neck

Overinflation of laryngeal mask airway cuff increase side effect like hoarseness, vocal cord paralysis, sorethroat. The investigators will study correlation between laryngeal mask airway c...

Use of Laryngeal Mask Airway in Pediatric Adenotonsillectomy

The aim of the current study is to compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) in pediatric adenotonsillectomy. The primary objective is to assess the incid...

Laryngeal Mask Airway for Adenoidectomies (LMAA)

The current study retrospectively assesses laryngeal mask airway use during pediatric adenoidectomies in terms of patient safety, comfort, complications and surgeon satisfaction levels.

Medical and Biotech [MESH] Definitions

A type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anesthesia in certain patients. It is introduced into the hypopharynx to form a seal around the larynx thus permitting spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. It is used in place of a facemask in routine anesthesia. The advantages over standard mask anesthesia are better airway control, minimal anesthetic gas leakage, a secure airway during patient transport to the recovery area, and minimal postoperative problems.

Congenital anomalous dilitation of the laryngeal saccule that may extend internally into the airway or externally through the thyrohyoid membrane.

Cancers or tumors of the LARYNX or any of its parts: the GLOTTIS; EPIGLOTTIS; LARYNGEAL CARTILAGES; LARYNGEAL MUSCLES; and VOCAL CORDS.

A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).

Removal of an endotracheal tube from the patient.

Quick Search
Advertisement
 


DeepDyve research library

Relevant Topics

Anesthesiology
An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. Anesthesiologists are physicians who provide medical care to patients in a wide variety of (usually acute) situations. ...

Anesthesia
Anesthesia is the loss of feeling or sensation in all or part of the body. It may result from damage to nerves or can be induced by an anesthetist (a medical professional) using anesthetics such as thiopental or propofol or sevoflurane during a surgical ...