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      Comparative study of Baska mask with proseal LMA in adult patients undergoing elective surgery under general anesthesia with controlled ventilation

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          Abstract

          Background and Aims:

          Several supraglottic airway devices (SGD) are available nowadays. But none has been found to be better than Proseal laryngeal mask (PLMA) in terms of oropharyngeal leak pressure (OLP). We aimed to compare OLP of newly introduced Baska® Mask with PLMA in patients undergoing elective surgical procedures under general anesthesia.

          Material and Methods:

          Totally, 80 consecutive adult patients of either sex requiring general anesthesia were randomized into two groups Group B (Baska mask, n = 40) or Group P (PLMA. n = 40). After standardized induction with propofol 2 − 2.5 mg/kg -1 and fentanyl 2 mgkg -1, and muscle relaxation with vecuronium 0.1 mgkg -1 one of the two devices was placed. OLP (primary outcome) was measured 5 minutes and 30 minutes post induction. The time needed to achieve effective airway, anatomical alignment of the device, number of attempts, leak fraction, and postoperative laryngopharyngeal morbidity were noted.

          Results:

          Both the devices could be inserted in first attempt in all the patients, but the time needed to achieve effective airway was significantly less in Group B (12.58 ± 1.81 sec vs 17.92 ± 2.45 sec, P < 0.001). The mean OLP was better in Group B at 5 min (37.6 ± 2.43 cm H 2O vs 30.82 ± 3.96 cm H 2O) and at 30 min (38.83 ± 1.72 cm H 2O vs 30.82 ± 3.96 cm H 2O; P < 0.001). Anatomical alignment of SGD with glottis (FOB grade 3 or 4 view) was significantly better in group B (34/40) as compared to group P (25/40) (p = 0.009). There was no difference in laryngopharyngeal morbidity in the two groups.

          Conclusion:

          Baska mask provided higher OLP, better alignment to the glottis and faster placement time as compared to PLMA.

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          Most cited references21

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          Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff.

          The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.
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            A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position.

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              The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent.

              We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H2O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (P < 0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study.
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                Author and article information

                Journal
                J Anaesthesiol Clin Pharmacol
                J Anaesthesiol Clin Pharmacol
                JOACP
                J Anaesthesiol Clin Pharmacol
                Journal of Anaesthesiology, Clinical Pharmacology
                Wolters Kluwer - Medknow (India )
                0970-9185
                2231-2730
                Apr-Jun 2022
                31 May 2022
                : 38
                : 2
                : 184-190
                Affiliations
                [1]Department of Anaesthesia and Intensive Care, VMMC and Safdarjung Hospital, Delhi, India
                [1 ]Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, Delhi, India
                Author notes
                Address for correspondence: Dr. Anju Gupta, Room No. 6, Porta Cabin, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India. E-mail: dranjugupta2009@ 123456rediffmail.com
                Article
                JOACP-38-184
                10.4103/joacp.JOACP_204_20
                9511871
                36171917
                8294dd82-7607-4981-96e3-6d050bcd6c6b
                Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 29 April 2020
                : 11 April 2021
                : 13 April 2021
                Categories
                Original Article

                Anesthesiology & Pain management
                anesthesia,baska mask,elective surgical procedures,general,laryngeal masks,oropharyngeal leak pressure

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