Supraglottic Airway Devices: Present State and Outlook for 2050.

Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents.

Anesthesia and perioperative pain relief in the frail elderly patient.

Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques.

Features of new vision-incorporated third-generation video laryngeal mask airways.

Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip.

The case for a 3rd generation supraglottic airway device facilitating direct vision placement.

Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements.

Measuring endotracheal tube intracuff pressure: no room for complacency.

Tracheal intubation constitutes a routine part in the care of critically ill and anaesthetised patients. Prolonged use of endotracheal with inflated cuff is one of the major multifactorial causes of complications. Both under-inflation and over-inflation of cuff are associated with complications.

A randomized comparison between intravenous and perineural dexamethasone for ultrasound-guided axillary block.

Background: This randomized double-blinded trial compared the effect of intravenous and perineural dexamethasone (8 mg) on the duration of motor block for ultrasound (US)-guided axillary brachial plexus block (AXB).

Methods: Patients undergoing upper limb surgery with US-guided AXB were randomly allocated to receive preservative-free dexamethasone (8 mg) via intravenous (n = 75) or perineural (n = 75) administration. The local anesthetic agent, 1% lidocaine -0.

Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients.

Study Objective: The study objective is to determine whether extraglottic airway devices (EADs) with or without mask aperture bars (MABs) result in similar anatomical positions in patients undergoing surgery.

Design: Prospective, randomized, crossover comparison of four extraglottic airway devices.

Setting: Operating theatre at a large teaching hospital.

Primary Failure of Thoracic Epidural Analgesia in Training Centers: The Invisible Elephant?

In teaching centers, primary failure of thoracic epidural analgesia can be due to multiple etiologies. In addition to the difficult anatomy of the thoracic spine, the conventional end point-loss-of-resistance-lacks specificity. Furthermore, insufficient training compounds the problem: learning curves are nonexistent, pedagogical requirements are often inadequate, supervisors may be inexperienced, and exposure during residency is decreasing.

A Multicenter Randomized Comparison Between Intravenous and Perineural Dexamethasone for Ultrasound-Guided Infraclavicular Block.

Background And Objectives: This multicenter, randomized trial compared intravenous (IV) and perineural (PN) dexamethasone for ultrasound (US)-guided infraclavicular brachial plexus block. Our research hypothesis was both modalities would result in similar durations of motor block.

Methods: One hundred fifty patients undergoing upper limb surgery with US-guided infraclavicular block were randomly allocated to receive IV or PN dexamethasone (5 mg).

A Randomized Comparison Between Conventional and Waveform-Confirmed Loss of Resistance for Thoracic Epidural Blocks.

Background And Objectives: Epidural waveform analysis (EWA) provides a simple confirmatory adjunct for loss of resistance (LOR): when the needle tip is correctly positioned inside the epidural space, pressure measurement results in a pulsatile waveform. In this randomized trial, we compared conventional and EWA-confirmed LOR in 2 teaching centers. Our research hypothesis was that EWA-confirmed LOR would decrease the failure rate of thoracic epidural blocks.

The anatomy of the thoracic spinal canal in different postures: a magnetic resonance imaging investigation.

Background And Objectives: The goal of this study was to investigate,with magnetic resonance imaging, the human anatomic positions of the spinal canal (eg, spinal cord, thecal tissue) in various postures and identify possible implications from different patient positioning for neuraxial anesthetic practice.

Method: Nine volunteers underwent magnetic resonance imaging in supine, laterally recumbent, and sitting (head-down) positions. Axial and sagittal slices of the thoracic and lumbar spine were measured for the relative distances between anatomic structures, including dura mater and spinal cord.