Comparison of the effects of paratracheal pressure and cricoid pressure on placement of the i-gel^® supraglottic airway: a randomized clinical trial.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2024-07-01 Epub Date: 2024-03-20 DOI:10.1007/s12630-024-02741-1

Dongwook Won, Hyerim Kim, Jee-Eun Chang, Jung-Man Lee, Tae Kyong Kim, Honghyeon Kim, Seong-Won Min, Jin-Young Hwang

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引用次数: 0

Abstract

Purpose: Anesthesiologists can use supraglottic airway devices as a rescue technique for failed intubation even in patients with an increased risk of gastric regurgitation. In this randomized study, we aimed to evaluate the effects of cricoid pressure and paratracheal pressure on placement of the i-gel^® (Intersurgical Ltd., Wokingham, Berkshire, UK).

Methods: After induction of anesthesia in 76 adult patients, we inserted the i-gel under paratracheal or cricoid pressure, and assessed the success rate of i-gel insertion, resistance during insertion, time required for insertion, accuracy of the insertion location, tidal volumes, and peak inspiratory pressure with or without each maneuver after i-gel insertion.

Results: The overall success rate of insertion was significantly higher under paratracheal pressure than under cricoid pressure (36/38 [95%] vs 27/38 [71%], respectively; difference, 24%; 95% confidence interval [CI], 8 to 40; P = 0.006]. Resistance during insertion was significantly lower under paratracheal pressure than under cricoid pressure (P < 0.001). The time required for insertion was significantly shorter under paratracheal pressure than under cricoid pressure (median [interquartile range], 18 [15-23] sec vs 28 [22-38] sec, respectively; difference in medians, -10; 95% CI, -18 to -4; P < 0.001). Fibreoptic examination of the anatomical alignment of the i-gel in the larynx revealed no significant difference in the accuracy of the insertion location between the two maneuvers (P = 0.31). The differences in tidal volume and peak inspiratory pressure with or without the maneuvers were significantly lower with paratracheal pressure than with cricoid pressure (P = 0.003, respectively).

Conclusions: Insertion of the i-gel supraglottic airway was significantly more successful, easier, and faster while applying paratracheal pressure than cricoid pressure.

Study registration: ClinicalTrials.gov (NCT05377346); first submitted 11 May 2022.

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气管旁压力和环状舌骨压力对放置 i-gel® 声门上通气道的影响比较：随机临床试验。

目的：麻醉医师可以使用声门上气道装置作为插管失败的抢救技术，即使是在胃反流风险增加的患者中也是如此。在这项随机研究中，我们旨在评估环状舌骨压力和气管旁压力对放置 i-gel® （Intersurgical Ltd., Wokingham, Berkshire, UK）的影响：方法：在对 76 名成年患者进行麻醉诱导后，我们在气管旁或环状舌骨压力下插入 i-gel，并评估了 i-gel 插入的成功率、插入过程中的阻力、插入所需时间、插入位置的准确性、潮气量以及插入 i-gel 后进行或不进行各种操作时的吸气峰压：气管旁压力下的总体插入成功率明显高于环状压力下（分别为 36/38 [95%] vs 27/38 [71%]；差异为 24%；95% 置信区间 [CI]，8 至 40；P = 0.006]）。气管旁压力下的插入阻力明显低于环甲膜压力下的插入阻力（P 结论：气管旁压力下的插入阻力明显低于环甲膜压力下的插入阻力）：插入 i-gel 声门上气道时，气管旁加压明显比环状舌骨加压更成功、更容易、更快速：研究注册：ClinicalTrials.gov（NCT05377346）；2022 年 5 月 11 日首次提交。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.