Cíl studie: I-gel je relativně novou pomůckou k zajištění dýchacích cest. Některé jeho vlastnosti mohou podmínit větší úspěšnost a nižší výskyt pooperačních komplikací ve srovnání s laryngeální maskou. Typ studie: Prospektivní observační studie (klinický audit). Typ pracoviště: Anesteziologické oddělení oblastního výukového pracoviště. Materiál a metoda: Provedli jsme prospektivní audit použití i-gelu u 96 pacientů a sledovali jsme úspěšnost zavedení, únik dýchací směsi v souvislosti s použitým ventilačním režimem a četnost výskytu pooperačních komplikací. I-gel byl zaváděn na operačním sále pro výkony obecné a cévní chirurgie, urologie a gynekologie. Sledované parametry zahrnovaly demografické údaje pacientů a anesteziologů, zavádění pomůcky, přítomnost krve nebo žaludeční tekutiny na pomůcce po vyjmutí a pooperační komplikace: bolesti v krku, bolesti jazyka, potíže při mluvení, potíže při polykání, nevolnost a zvracení. Srovnáván byl výkon specializovaných anesteziologů s lékaři v tréninku. Výsledky: Spontánní ventilace byla zachována u 35 pacientů (36,5 %) se zavedeným i-gelem, u 61 výkonů (63,5 %) byla použita asistovaná nebo řízená ventilace. I-gel byl zaveden na první pokus u 86,5 % pacientů, na druhý pokus u 9,4 % případů a u 4,2 % pacientů byly nezbytné tři nebo více pokusů o zavedení. Malý únik směsi byl zaznamenán u 15,6 % výkonů. U 17,7 % pacientů byla nutná změna polohy po prvním zavedení i-gelu. Krev byla nalezena na 5,2 % pomůcek po vynětí. 9,4 % pacientů udávalo bolesti v krku po výkonu. Tato komplikace spontánně odezněla u všech pacientů do 48 hodin po operaci. Nebyl zaznamenán žádný rozdíl v úspěšnosti zavedení mezi zkušenými a nezkušenými anesteziology. Únik směsi byl častěji pozorován u řízené ventilace (p = 0,03). Závěr: Pomůcku je relativně snadné zavést, je možné ji použít při spontánní i řízené ventilaci a byla dobře tolerována ze strany pacientů.

Objective: The i-gel supraglottic airway has features that may confer advantage over the standard laryn - geal mask in terms of performance and postoperative complications. Design: Prospective observational study (clinical audit). Setting: Anaesthetic department of district general teaching hospital. Material and methods:We carried out a prospective audit of 96 i-gel insertions in order to assess insertion success rate, airway leak associated with a mode of ventilation and postoperative complications. The i-gel was inserted in theatre settings for general surgery, gynaecology, urology and vascular surgical procedures. Data collected included patient and operator demographics, information about device insertion, the presence of blood or gastric fluid on the device after removal and postoperative complications: sore throat, sore tongue, difficulty speaking, difficulty swallowing, nausea and vomiting. The performances of experienced and inexperienced operators were compared. Results: The i-gel was used with spontaneous ventilation in 35 (36.5%) of patients, while 61 (63.5%) of pa - tients were ventilated with assisted or controlled mode. The device was inserted at the first attempt in 86.5% cases, at the second attempt in 9.4% and in 4.2% of patients three or more attempts were necessary. Aminor leak was noted in 15.6% while in 17.7% of cases repositioning was required after insertion. The presence of blood on the device was noted in 5.2% of the patients and 9.4% of patients described sore throat postoperatively. No patients complained of sore throat at 48 hrs. There was no statistical difference between any variables between experienced and inexperienced operators. A leak was more often seen with controlled ventilation (P = 0.03). Conclusion: The device proved relatively easy to insert, performed well under both spontaneous and controlled ventilation and was well tolerated by patients.

• Klíčová slova
• laryngeální maska, komplikace,
• MeSH
• celková anestezie metody   přístrojové vybavení   MeSH
• dospělí MeSH
• intubace využití   MeSH
• laryngální masky kontraindikace   škodlivé účinky   využití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• pooperační komplikace prevence a kontrola   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statistika jako téma MeSH
• ventilace umělá s přerušovaným přetlakem MeSH
• vybavení k jednorázovému použití MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

Aims. The i-gelTM and the AuraOnce™ laryngeal mask are supraglottic airway devices used for airway management during general anaesthesia. Both devices are cheap, disposable and widely used. They may be used with both spontaneous and controlled ventilation. This study compared differences in the seal and peak pressures, and postoperative complications in these devices when used in paralyzed patients under controlled ventilation. Methods. A prospective randomized trial was designed to compare the i-gelTM and the AuraOnceTM in paralyzed adult patients under conditions of controlled ventilation. Two hundred and four patients (ASA class 1-3, age 18-89, weight 46-115 kg) were enrolled in the study. Standardized anaesthesia (fentanyl, propofol and sevoflurane in air-oxygen) was administered including neuromuscular blockade. The primary outcome measure was the difference in seal airway pressures between the two devices. Secondary outcome measures included peak airway pressures, insertion data and postoperative profiles – the incidence of sore throat, swallowing difficulties, numb tongue, hearing difficulties, neck pain, nausea and vomiting. Results. First time insertions were 85.6% (i-gel) and 82% (AuraOnce) with overall success rates 96.3% (i-gel) and 94.2% (AuraOnce) (p=0.54). Average insertion times were 11.0 s (i-gel) and 11.6 s (AuraOnce) (p=0.19). Seal pressures were 30.4 cmH2O (i-gel) and 27.8 cmH2O (AuraOnce) (p=0.007). Peak pressures were 15.3 cmH2O (i-gel) and 15.6 cmH2O (AuraOnce) (p=0.57). Traumatic insertion occurred in 5.8% of i-gelTM and 2% of AuraOnceTM insertions. The overall incidence of postoperative complications was low, with the i-gelTM causing less sore throat and difficulty swallowing at 24h. Conclusion. Both devices provided effective seals for ventilation under positive pressure. I-gelTM may be a better alternative for the procedures with controlled ventilation because of higher seal pressures and lower incidence of sore throat postoperatively.

• MeSH
• celková anestezie MeSH
• dospělí MeSH
• laryngální masky škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nervosvalová blokáda MeSH
• randomizované kontrolované studie jako téma MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ventilace umělá s přerušovaným přetlakem MeSH
• vybavení k jednorázovému použití MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• srovnávací studie MeSH

Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.

• MeSH
• elektivní chirurgické výkony MeSH
• extubace škodlivé účinky   přístrojové vybavení   MeSH
• faryngitida patologie   MeSH
• farynx patologie   chirurgie   MeSH
• lidé MeSH
• perioperační období MeSH
• pooperační komplikace patofyziologie   MeSH
• poruchy polykání patologie   terapie   MeSH
• zajištění dýchacích cest * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• laryngoskopie * MeSH
• lidé MeSH
• zajištění dýchacích cest * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodní články MeSH
• úvodníky MeSH

• Publikační typ
• abstrakt z konference MeSH

Fibreoptic intubation through a supraglottic airway is an alternative plan for airway management in difficult or failed laryngoscopy. The aim of this study was to compare three supraglottic airways as conduits in patients with at least one predictor for difficult laryngoscopy. The i-gel was compared with the single-use intubating laryngeal mask airway (sILMA) and CTrach laryngeal mask in 120 adult patients scheduled for elective surgeries under general anaesthesia using a prospective, randomized and single-blinded design. Primary outcome was success rate of tracheal intubation through the device, while secondary outcomes were times required for device insertion and tracheal tube placement, fibreoptic scores and the incidence of perioperative complications and postoperative complaints. The success rates showed no statistical difference between devices (i-gel 100%, CTrach 97.5%, ILMA 95%). Insertion time was shortest for the i-gel (12.4 s) compared with ILMA (19.3 s) and CTrach (24.4 s). Intubation time was shorter in the i-gel group (29.4 s) in comparison with the CTrach (39.8 s, p<0.05) and sILMA (51.9 s, p<0.001) groups. Best fibreoptic scores were observed also in the i-gel group. In total, 24 patients (20%) presented with difficult laryngoscopy. The i-gel showed significantly shorter times for insertion and fibreoptic intubation than the other two devices in this group. No difference was observed in the incidence of postoperative complaints. The i-gel is a suitable alternative to the sILMA and CTrach for fibrescope-guided tracheal intubation. Shorter insertion and intubation times with the i-gel may provide advantage in case of difficult oxygenation.

• MeSH
• design vybavení MeSH
• dospělí MeSH
• intratracheální intubace přístrojové vybavení   metody   MeSH
• jednoduchá slepá metoda MeSH
• kardiopulmonální resuscitace přístrojové vybavení   MeSH
• laryngální masky * MeSH
• laryngoskopie metody   MeSH
• laryngoskopy MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• technologie optických vláken * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9-19) vs. 23 s (14.5-37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: The i-gel® Plus is a modified version of the i-gel® supraglottic airway device. It contains a wider drainage port; a longer tip; ramps inside the breathing channel; and an additional port for oxygen delivery. There has been no prospective evaluation of this device in clinical practice. METHODS: This international, multicentre, prospective cohort study aimed to evaluate the performance of the i-gel Plus in adult patients undergoing elective procedures under general anaesthesia. The primary outcome was overall insertion success rate, defined as the ability to provide effective airway management through the device from insertion until the end of the surgical procedure. Secondary outcomes included device performance and incidence of postoperative adverse events. Data from the first 1000 patients are reported. RESULTS: In total, 1012 patients were enrolled; 12 forms were excluded from the final analysis due to incomplete data leaving 1000 included patients (545 female). Overall insertion success rate was 98.6%, with a first-attempt success rate of insertion of 88.2%. A significant difference between females and males was seen for the overall success rate (97.4% vs. 99.6% respectively) but not for first-attempt successful insertion. Mean (SD) oropharyngeal seal pressure was 32 (7) cmH2O. The only independent factor that increased the risk of first-attempt failure was low operator experience. Complications included desaturation < 85% in 0.6%; traces of blood on the device in 7.4%; laryngospasm in 0.5%; and gastric contents inside the bowl in 0.2% of patients. CONCLUSIONS: The i-gel Plus appears to be an effective supraglottic airway device that is associated with a high insertion success rate and a reasonably low incidence of complications.

• MeSH
• celková anestezie MeSH
• design vybavení MeSH
• dospělí MeSH
• elektivní chirurgické výkony * MeSH
• intratracheální intubace * přístrojové vybavení   metody   MeSH
• kohortové studie MeSH
• laryngální masky * MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• zajištění dýchacích cest přístrojové vybavení   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: Bladder stones (BS) are still endemic in children in developing nations and account for a high volume of paediatric urology workload in these areas. The aim of this systematic review is to comparatively assess the benefits and risks of minimally invasive and open surgical interventions for the treatment of bladder stones in children. METHODS: This systematic review was conducted in accordance with Cochrane Guidance. Database searches (January 1970- March 2021) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and non-randomised studies (NRSs) with >10 patients per group. Open cystolithotomy (CL), transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), extracorporeal shock wave lithotripsy (ESWL) and laparoscopic cystolithotomy (LapCL) were evaluated. RESULTS: In total, 3040 abstracts were screened, and 8 studies were included. There were 7 retrospective non-randomised studies (NRS's) and 1 quasi-RCT with 1034 eligible patients (CL: n=637, TUCL: n=196, PCCL: n=138, ESWL: n=63, LapCL n=0). Stone free rate (SFR) was given in 7 studies and measured 100%, 86.6%-100%, and 100% for CL, TUCL and PCCL respectively. CL was associated with a longer duration of inpatient stay than PCCL and TUCL (p<0.05). One NRS showed that SFR was significantly lower after 1 session with outpatient ESWL (47.6%) compared to TUCL (93.5%) and CL (100%) (p<0.01 and p<0.01 respectively). One RCT compared TUCL with laser versus TUCL with pneumatic lithotripsy and found that procedure duration was shorter with laser for stones <1.5cm (n=25, p=0.04). CONCLUSION: In conclusion, CL, TUCL and PCCL have comparable SFRs but ESWL is less effective for treating stones in paediatric patients. CL has the longest duration of inpatient stay. Information gathered from this systematic review will enable paediatric urologists to comparatively assess the risks and benefits of all urological modalities when considering surgical intervention for bladder stones.

• MeSH
• dítě MeSH
• kameny močového měchýře * chirurgie   MeSH
• lidé MeSH
• litotripse * metody   MeSH
• močový měchýř chirurgie   MeSH
• rozvojové země MeSH
• urologie * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

INTRODUCTION: Supraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalisation of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this cohort study is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications. METHODS AND ANALYSIS: This is a multicentre, prospective, interventional cohort study. The enrolment will take place in seven centres in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months. ETHICS AND DISSEMINATION: The cohort study has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences. TRIAL REGISTRATION NUMBER: ISRCTN86233693;Pre-results.

• MeSH
• celková anestezie * škodlivé účinky   MeSH
• dospělí MeSH
• intratracheální intubace metody   MeSH
• kohortové studie MeSH
• laryngální masky * škodlivé účinky   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• prospektivní studie MeSH
• zajištění dýchacích cest metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH