Aims The study aimed to compare endotracheal intubation with i-gel and LMA (laryngeal mask airway) supreme supraglottic airway devices in orbital osteosynthesis surgery. Materials & Methods This comparative perspective single-center randomized study was conducted in Yekaterinburg Clinical Hospitals, Russia, in 2021. The number of 134 patients undergoing orbital plasty after fracture were enrolled in the study and were randomized into three groups: 43 in the endotracheal intubation group, 42 in the LMA-Supreme group, and 49 patients were included in the i-gel group. Hemodynamic parameters, respiratory mechanics, respiration, oropharyngeal leak pressure at different stages of surgical intervention, as well as the time of airway device insertion, the number of attempts, and the need for additional maneuvers to insert the airway device were assessed. For statistical processing, the EZR 1. 37 on R commander 3. 4. 1 was used with the Kruskal-Wallis h-criterion and Pearson’, s χ, ²,-test. Findings In the postoperative period, the assessment of complications associated with the insertion of airway devices was implemented. We did not receive clinically significant differences in mechanical ventilation parameters between groups at the study stages (p>0. 05). A reliable difference in oropharyngeal leak pressure at the beginning and the end of the surgical intervention was obtained (p<0. 05). The number of complications was minimal and did not differ between the groups (p>0. 05). Conclusion LMA-S and i-gel supraglottic airway devices allow to provide normal lung ventilation and gas exchange and can be an alternative to endotracheal intubation during orbital osteosynthesis surgery.

As anaesthetists, we may constantly be in the learning curve of the management of difficult airway scenario. It can have a disastrous outcome if one is not adequately prepared with the right equipment. Over time there has been multiple ways to tackle difficult airway scenarios. Needless to say, appropriate airway gadgets are carefully chosen according to the surgery and patient characteristics. But what if these certain techniques fail? Then, what next? The inability to efficiently manage a difficult airway is the major cause of morbidity and mortality in anaesthetic practice. Here, we discuss 4 different case scenarios of difficult airway management. Case reports: Case 1 was a pediatric patient with TMJ ankylosis, with mouth opening 4mm, in whom we used the fibreoptic technique. Case 2-A failed fibreoptic attempt in a case of recurrent Ca oral cavity where we secured the airway using Airtraq video laryngoscope. Case 3-A patient with post burn contracture over front of neck and anterior shoulder where we decided to use intubating laryngeal mask airway (LMA) for securing airway and Case 4-An obese female patient posted for hysterolaparoscopy where we used the laryngeal mask airway supreme. Conclusion: Effective usage of newer drugs, equipment and airway gadgets by technically skilled personnel, with sound clinical judgement are essential factors in reducing airway related adverse scenario and it is of utmost importance to keep these alternate gadgets handy and to be proficient with its usage.

Background: Supraglottic airway devices (SADs) offer an alternative airway with improved airway seal, enabling higher airway pressures during positive pressure ventilation (PPV). We compared the safety and efficacy of laryngeal mask airway (LMA) Proseal and LMA Supreme in laparoscopic cholecystectomy. Materials and Methods: Eighty patients, 18-60 years, ASA grade 1 and 2 were randomly allocated into two groups of 40 each. After induction of anesthesia, LMA Supreme or LMA Proseal of appropriate size was then inserted randomly. Parameters like the ease of LMA insertion, OGT insertion,oropharyngeal leak pressure (OLP),hemodynamics, adequacy of ventilation were recorded. Complications, if any, were also recorded. Results: LMA Supreme was easier to insert than LMA Proseal. Gastric tube insertion was comparatively easier in LMA Supreme than LMA Proseal. The mean oropharyngeal leak pressure was higher with LMA Proseal (31. 98 ±,2. 49cmH2O) than with LMA Supreme (30. 23 ±,3. 65 cmH2O). Peak airway pressures were comparable for the two groups. There was comparatively more airway trauma (mucosal injury, sore throat) in LMA Proseal than LMA Supreme. Conclusion: A higher oropharyngeal leak pressure makes LMA Proseal a better choice than LMA Supreme in procedures with raised intragastric pressure.

Introduction: The aim of this study is to compare two methods of LMA insertion, "classic" versus "simplified" (AIRWAY), due to factors such as: time to insertion, number of attempts, blood stained LMA, air leak around LMA, and gastric inflation. The word "AIRWAY" refers to the similarity of this method to or pharyngeal airway insertion.Material and Methods: One hundred ASA Class I and II patients elected for lower limb orthopedic surgery but without any head and face injury or head and neck abnormality, having their tooth intact, were selected and divided to two groups of fifty; classic and simplified. In the classic group, the index finger used as a guide, pushes the back of LMA towards the hard palate, inserting it into the pharynx till a resistance is felt and the LMA is then fixed it its place. In the AIRWAY group, the deflated LMA is entered into the mouth in a 180 degree inside-out position compared to the classic method without using fingers and is proceeded until it enters the pharynx (sudden loss of resistance) and then returned 180 degree back to its normal position to be fixed in the right place. The attempt numbers, time to insertion, complications such as laryngospasm, blood stained LMA and gastric inflation is being investigated. The data collected was analyzed be SPSS ver 10 and compared in two groups with unpaired T-Test or Mann Whitney U test by case. Again Chi-square test was used to analyze numerical data and p<0.05 was considered as meaningful.Results: Demographic data such as age, sex and ASA Class, demonstrate no meaningful statistic difference between the two groups. Successful first attempt in AIRWAY group (86%) had no meaningful statistic difference with the classic group (80%) (p>0.05). The overall success rate in LMA insertion (within two attempts) was 100% and 82% in AIRWAY and classic groups respectively (p>0.05) and 11 patients with failed insertion attempts, were excluded from the study. The time for successful insertion was meaningfully less in the AIRWAY group compared to the classic one (p<0.0001). In the classic group 32% of LMAs became blood stained compared to 16% in the AIRWAY group, which the difference was not meaningful. No other complications such as laryngospasm or oxygen desaturation occurred.Conclusion: Comparison of the whole advantages and disadvantages of both groups, mention that, by putting the LMA insertion time together with the low complication rates, the AIRWAY method can be assumed as a preferred simplified method with few complications for inserting LMA.

Background: Laryngoscopy and tracheal intubation can cause serious cardiovascular responses in patients such as hypertension, tachycardia, and arrhythmias. Alternative airway maintenance techniques may attenuate these hemodynamic stress responses.Objectives: This study aimed to compare the immediate hemodynamic effects of the insertion of laryngeal mask airway supreme (LMA-S) and classic (LMA-C) with laryngoscopy and Endotracheal Intubation (ETT).Patients and Methods: This study was a prospective, double-blind, and randomized clinical trial conducted on 150 patients aged 18 to 50 years with ASA I (American Society of Anesthesiologists), in the general operating room of Shahid Mohammadi hospital, Hormozgan university of medical sciences, Bandar Abbas, Iran. In the ETT group, endotracheal intubation was performed using the Macintosh laryngoscope; while for the LMA-C and LMA-S groups, LMA Classic and LMA Supreme were inserted, respectively. The induction and maintenance of anesthesia were similar in all patients. The hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before (baseline) and after induction of anesthesia at 4 different time points. The statistical analysis was done and P value less than 0.05 was considered significant.Results: Participants in all groups were similar in terms of gender, age, weight, height, and Mallampati class. The mean±SD of SBPs (105.62±12.12, 112.90±12.2, and 112.48±15.14 mm Hg, respectively for ETT, LMA-C, and LMA-S) and DBPs (64.64±10.23, 73.78±9.70, and 71.20±12.27 mm Hg, respectively for ETT, LMA-C, and LMA-S) were significantly lower in the ETT group compared to LMA groups 5 minutes after device insertion (P<0.01 for SBPs and P<0.001 for DBPs); however these values were lower than the baseline values in all groups. There were no differences in the mean SBP and DBPs between the three groups at the other time points. The mean ± SD heart rates in the ETT group, compared to the LMA-C and LMA-S groups, were considerably higher in the first minute (100.06±18.27, 82.50±10.52, and 82.00±13.60 bpm, respectively for ETT, LMA-C, and LMA-S), third minute (91.04±17.12, 78.84±11.23, and 78.90±13.41 bpm, respectively for ETT, LMA-C, and LMA-S) and fifth minute (85.82±16.01, 75.78±11.73, and 75.04±13.90 bpm, respectively for ETT, LMA-C, and LMA-S) after intubation (P<0.001). There were no significant differences between the LMA-C and LMA-S groups in terms of hemodynamic parameters.Conclusions: Maintaining the airway using laryngeal mask airway is associated with less cardiovascular responses compared to direct laryngoscopy and tracheal intubation.

Background and Objective: Laryngeal Mask Airway (LMA) is commonly used in short-term surgical anesthesia. Intravenous lidocaine is used for better patient tolerance after LMA insertion. Regarding the side effects of intravenous lidocaine, the aim of this study is to compare the effect of lidocaine spray versus intravenous lidocaine on blood pressure, heart rate, sore throat, cough, laryngospasm, and other side effects including nausea, vomiting, and convulsions after LMA insertion. Methods: This double-blind randomized clinical trial was conducted on 120 patients aged 18-65 years with indications for short-term elective eye surgery, in 2 equal groups of 60 people. The first group was given 1% intravenous lidocaine at the rate of 1.5 mg/kg, and the second group was administered with 5 puffs of 10% lidocaine spray in the throat. Then, blood pressure by a sphygmomanometer, heart rate by a heart rate monitoring system, sore throat intensity based on VAS criteria, and cough intensity based on mild, moderate and severe were measured and compared in the two groups. Findings: 79 men (65.8%) and 41 women (42.2%) participated in this study. Clinically, there was no significant change in blood pressure in the two groups. The mean intensity of sore throat two and three hours after waking up in lidocaine spray group (0.51±1.33 and 0.41±1.07) compared to intravenous lidocaine (1.15±2.02 and 1.9±1.08) showed a significant decrease (p<0.05). Also, there were no significant changes in heart rate, cough and laryngospasm between the two groups. In addition, no cases of nausea, vomiting and seizures were found in the two groups. Conclusion: Based on the results of this study, lidocaine spray can be suggested to reduce the severity of sore throat caused by LMA insertion.

Background and Objectives: The laryngeal mask airway supreme (LMA-S) is a new airway device designed to minimize the risk of aspiration. We studied the success rates of the LMA-S insertion and the incidence of any complications compared with the conventional LMA in orthopedic surgery patients with normal airways.Materials and Methods: In a randomized clinical trial, 122 patients undergoing elective lower limb orthopedic surgery were studied in two study and control groups. Airway management in the study and control groups was with LMA-S and conventional LMA, respectively. The collected data including the success rate of insertion and ventilation, and the incidence of any complications associated with the use of the device were analyzed between two groups.Results: The LMA-S was easily inserted in 96.8% of 62 patients in the study group and in 81.7% of 60 patients in the control group (P=0.02). Nausea was observed in 6.5% of the study group and 20% in the control group (P=0.02). There was no difference in incidence of postoperative sore throat and abdominal pain between the two studied groups (P>0.05). The mean sealing pressure significantly differed between two groups (P=0.04).Conclusion: Our report indicates that the LMA-S is a valuable addition to airway devices for patients with normal airways.