OBJECTIVES: Cricothyrotomy is a rescue procedure in "cannot intubate, cannot oxygenate" scenarios where other methods of nonsurgical airway management have failed. We compared 2 cuffed cricothyrotomy sets, bougie-assisted cricothyrotomy (BACT) and novel percutaneous TracheoQuick Plus, on a live porcine model in a simulated periarrest situation. METHODS: Thirty-four anesthetized minipigs were randomly allocated into two groups: BACT technique (n = 17) and TracheoQuick Plus (n = 17). The primary outcome was duration of cricothyrotomy while secondary outcomes were total success rate, number of attempts, location of incision, changes in heart rate, oxygen saturation, and the incidence of complications. RESULTS: BACT was significantly faster than TracheoQuick Plus cricothyrotomy, with a median time of 69 sec (IQR 56-85) versus 178 sec (IQR 152-272). The total success rate was without difference. 94% of BACT was performed successfully on the first attempt, while in the TracheoQuick Plus group, it was only 18% (P < 0.001). Trauma to the posterior tracheal wall was observed once in the BACT group and 5 times in the TracheoQuick Plus group. Oxygen saturation was significantly higher in the BACT group both during and after the procedure. CONCLUSIONS: BACT is superior to TracheoQuick Plus cricothyrotomy on a live animal model.

• MeSH
• Cricoid Cartilage surgery   MeSH
• Time Factors MeSH
• Intubation, Intratracheal * adverse effects   instrumentation   methods   statistics & numerical data   MeSH
• Oxygen blood   MeSH
• Swine, Miniature MeSH
• Models, Animal MeSH
• Random Allocation MeSH
• Swine MeSH
• Heart Rate physiology   MeSH
• Tracheotomy * adverse effects   instrumentation   methods   statistics & numerical data   MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Oxygen MeSH

Recent years have witnessed an increased use of ultrasound in evaluation of the airway and the lower parts of the respiratory system. Ultrasound examination is fast and reliable and can be performed at the bedside and does not carry the risk of exposure to ionizing radiation. Apart from use in diagnostics it may also provide safe guidance for invasive and semi-invasive procedures. Ultrasound examination of the oral cavity structures, epiglottis, vocal cords, and subglottic space may help in the prediction of difficult intubation. Preoperative ultrasound may diagnose vocal cord palsy or deviation or stenosis of the trachea. Ultrasonography can also be used for confirmation of endotracheal tube, double-lumen tube, or laryngeal mask placement. This can be achieved by direct examination of the tube inside the trachea or by indirect methods evaluating lung movements. Postoperative airway ultrasound may reveal laryngeal pathology or subglottic oedema. Conventional ultrasound is a reliable real-time navigational tool for emergency cricothyrotomy or percutaneous dilational tracheostomy. Endobronchial ultrasound is a combination of bronchoscopy and ultrasonography and is used for preoperative examination of lung cancer and solitary pulmonary nodules. The method is also useful for real-time navigated biopsies of such pathological structures.

• MeSH
• Epiglottis diagnostic imaging   MeSH
• Vocal Cords diagnostic imaging   pathology   MeSH
• Intubation, Intratracheal MeSH
• Laryngeal Masks MeSH
• Humans MeSH
• Tracheal Diseases diagnostic imaging   pathology   surgery   MeSH
• Perioperative Care * MeSH
• High-Energy Shock Waves MeSH
• Trachea diagnostic imaging   pathology   surgery   MeSH
• Tracheostomy MeSH
• Ultrasonography MeSH
• Mouth diagnostic imaging   pathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review 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
• Elective Surgical Procedures MeSH
• Airway Extubation adverse effects   instrumentation   MeSH
• Pharyngitis pathology   MeSH
• Pharynx pathology   surgery   MeSH
• Humans MeSH
• Perioperative Period MeSH
• Postoperative Complications physiopathology   MeSH
• Deglutition Disorders pathology   therapy   MeSH
• Airway Management * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

OBJECTIVES: Five different second-generation supraglottic airway devices, ProSeal LMA, Supreme LMA, i-gel, SLIPA, and Laryngeal Tube Suction-D, were studied. Operators were inexperienced users with a military background, combat lifesavers, nurses, and physicians. METHODS: This was a prospective, randomized, single-blinded study. Devices were inserted in the operating room in low light conditions after induction of general anesthesia. Primary outcome was successful insertion on the first attempt while secondary aims were insertion time, number of attempts, oropharyngeal seal pressure, ease of insertion, fibre optic position of device, efficacy of ventilation, and intraoperative trauma or regurgitation of gastric contents. RESULTS: In total, 505 patients were studied. First-attempt insertion success rate was higher in the Supreme LMA (96%), i-gel (87.9%), and ProSeal LMA (85.9%) groups than in the Laryngeal Tube Suction-D (80.6%) and SLIPA (69.4%) groups. Insertion time was shortest in the Supreme LMA (70.4 ± 32.5 s) and i-gel (74.4 ± 41.1 s) groups (p < 0.001). Oropharyngeal seal pressures were higher in the Laryngeal Tube Suction-D and ProSeal LMA groups than in other three devices. CONCLUSIONS: Most study parameters for the Supreme LMA and i-gel were found to be superior to the other three tested supraglottic airway devices when inserted by novice military operators.

• MeSH
• Equipment Failure Analysis MeSH
• Equipment Design MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Clinical Competence statistics & numerical data   MeSH
• Laryngeal Masks * MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Military Personnel education   statistics & numerical data   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Military Medicine education   instrumentation   MeSH
• Treatment Outcome MeSH
• Airway Management instrumentation   methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH