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 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.

 Airway problems are among the most important causes of anesthesia related mortalities and morbidities. Laryngeal Mask Airway (LMA) could provide a reliable airway during anesthesia; moreover, muscle relaxation is not mandatory for its insertion so it could be a proper alternative for Endotracheal Tube (ETT). In this study we compared the outcomes of LMA and ETT.Methods and Materials: Seventy two patients aged 30 to 72 with ASA classification I and II, candidates for vitrectomy, entered this single blinded study and allocated into two groups of LMA (32 patients) and ETT (40 patients). Premedication, induction and maintenance was the same for both groups. Blood pressure and heart rate recorded before induction and every five minutes afterward. Nausea, vomiting, sore throat, cough and hoarseness evaluated and recorded in recovery room. Pain measured using Numerical Rating Scale (NRS).Results: Heart rate, blood pressure and coughing were not statistically different between two groups. Sore throat and hoarseness was less in LMA group and nausea was more in ETT group which were statistically meaningful.Conclusion: LMA could provide a safe and reliable airway in vitrectomy patients with less side effects.

Introduction: Laryngeal spasm is the narrowing or complete closure of the glottis due to the reflex contraction of thelaryngeal muscles. The present study reports a case of upper airway obstruction following long-term use of a laryngeal mask airway in surgery.Case Presentation: A 45-year-old female patient who referred to a urologist due to urological problems with complaints of urinary bleeding and pain in the urogenital area. Based on trusting the surgeon's words about the shortness of the surgery, a Laryngeal mask airway was used for the patient, and propofol was used to anesthetize the patient during the operation. The patient's surgery gradually took longer due to suspicion of malignancy in the urinary tract and bladder, and the surgeon extended the surgery almost every 15 minutes. Finally, the surgery was completed after nearly three hours, and despite the fact that the patient had not taken any special medicine except propofol an hour before the end of the operation, but when he woke up, he had difficulty breathing. Although the patient was completely relaxed with neostigmine and atropine, he had airway obstruction, especially in the upper part of the airway, just like asthma patients. Because the patient's breathing was severely disturbed, salbutamol spray, hydrocortisone ampoule (100 mg + 100 mg), aminophylline and finally epinephrine 5 micrograms were used for three doses, but the patient's breathing was still difficult and the patient had to be intubated after We received propofol and atracurium. After about 30 minutes passed and the conditions were suitable, we extubated the patient with special precautions and transferred him to the intensive care unit for recovery and for further assurance.Conclusion: Based on the results of the present study, long-term use of Laryngeal mask airway is associated with the occurrence of laryngospasm after surgery, which can be considered as a result of long-term stimulation of the upper airway by the Laryngeal mask airway.

2Background: Respiratory support during the patient's anesthesia is done in different ways, such as endotracheal intubation and laryngeal mask. Endotracheal intubation is inevitably used for respiratory support in general anesthesia patients. The use of alternative methods for respiratory support during the process of general anesthesia is one of the most significant ways to control anesthesia complications. The laryngeal mask is placed around the larynx to allow spontaneous and controlled ventilation. Both of the respiratory support methods can cause complications. The purpose of this study is to compare the side effects of sore throat and hoarseness caused by two methods in surgical patients. Methods: This study was conducted in the period from September to November 2022 on patients who were referred and underwent surgery at Baqiyatallah Hospital. The study is a cohort study that was conducted retrospectively on 60 patients who underwent any surgery with two methods of anesthesia by ETI and LMA. In order to evaluate hoarseness, the standard Voice Handicap Index (VHI-10) questionnaire was used. In order to evaluate the complication of sore throat caused by the respiratory support method, a 4-point pain checklist was used for 24 hours and 14 days after the surgery. Results: The findings of our study showed that the average amount of sore throat 24 hours after surgery in the LMA and ETI groups was 2.13 and 2.2, respectively, and these values 14 days later were 1.17 and 1.07, respectively. The average level of hoarseness in the 24 hours after surgery in LMA and ETI groups was 2.66 and 3.13, respectively. The statistical comparison of the severity of side effects between the two groups showed that in the LMA method, the amount of sore throat and hoarseness is less than the ETI method, although this reduction does not have a significant difference. Conclusion: The results of this study showed that the rate of complications of sore throat and hoarseness in the laryngeal mask group is reduced compared to the endotracheal intubation group, although this difference is not significant.

Background: Flexible LMA offers the advantage of providing a better surgical field without being compressed compared to other LMAs in surgeries around the oral cavity. The insertion of flexible LMA is comparatively difficult as the shaft is flexible. The aim of this study is to compare the index-finger guided technique, two-finger guided technique, and 90° rotation technique for the success and time of insertion of flexible LMA in pediatric patients. Methods: After obtaining consent from parents,84 patients aged between 3 to 12 years of either gender were randomized into 3 groups. After administration of general anesthesia, flexible LMA of appropriate size as per manufacturer recommendations was inserted. In the index finger guided method (Group A), the LMA was held like a pen and the mask was pushed backward pressing against the palate. In the two-finger guided method (Group B), the anesthetist stood by the side facing the patient. LMA was fixed in between the index and middle fingers, held facing the lower jaw, and pushed along the palatopharyngeal curve. In the 90° rotation method (Group C), the LMA was rotated 90° anticlockwise in the oral cavity and was advanced through the right side of the tongue till resistance was felt and then turned back. The time from insertion of LMA and the number of attempts taken for successful insertion were noted. The data were analyzed using ANOVA. Results: The mean time of insertion was the least in Group B and highest in Group C. The first attempt success rate was highest in Group B and least in Group C. However, the mean time of insertion and the first attempt success rates were not significantly different between Group A and Group B. Conclusion: The LMA insertion by the two-finger guided method is the easiest and most efficient method and a good alternative to the standard method (index finger guided) for insertion of flexible LMA.

Background: In this study we have compared hemodynamic responses due to endotracheal intubation (ETT) and insertion of laryngeal mask airway (LMA) in normotensive patients. Materials and Methods: In a randomized double blinded clinical trial sixty patients, (20-40 yrs) with physical status ASA I. who were candidated for elective short time orthopedic .surgeries were divided In two groups of thirty, LMA and ETT. Heart rate (HR), systolic (SBP) and diastolic blood pressure (OBP), before induction of anesthesia (basic amounts) and 1st, 5th and 10th minutes after intubation had been measured. Results: The HR increased after intubation in both groups (p<0.05), and remained elevated at ETT group longer than LMA group (p<0.004). Mean arterial pressure, SBP and OBP increased immediately after intubation in both groups (p<0.05). No significant difference were observed in OBP changes between two groups (p>0.05). Rising of arterial blood pressure was not significant in LMA group. Hemodynamic changes in ETT group were more severe than LMA group (p<0.05). Conclusion: Regarding to less hemodynamic changes in LMA technique compared with ETT, we recommend using LMA, especially in patients suffering from hypertension and ischemic heart disease.