Brief Communications
IPPV through naso‑tracheal tube was resumed. The surgeon then tied the remaining sutures anteriorly. Emergence and extubation was potentially the most critical period of management. After neuromuscular blockade was completely reversed, endotracheal tube was maintained in position with cuff deflated for 24 h. As extra tracheal soft tissue oedema is one of the anticipated sequelae of extensive oncological surgeries. The neck of the patient was kept flexed with the help of a chin stitch. Stich was left for 7–10 days to avoid traction to anastomosis. Neck flexion was maintained with special care when transferring the patient with pillows kept the head. Post‑operatively, humidified oxygen was delivered.After 24 h, patients were extubated with the tube exchanger in situ in the operation theatre None of the patients required re‑intubation or tracheostomy.
CONCLUSION Tracheal resection and reconstruction is a challenging operation for anaesthesiologist largely because the airway itself is abnormal and precariously controlled during anaesthetic induction, during construction of the anastomosis and at emergence. Distal tracheal intubation and IPPV is a simple technique which provides a good control of airway, clear surgical field and adequate oxygenation with minimum complications.
Namrata Ranganath, BHR Arathi, PV Ramamani, VB Gowda Department of Anaesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India Address for correspondence: Dr. Namrata Ranganath, 202, Shankari Apartment, Ittamadu Cross, Banashankari 3rd Stage, Bengaluru ‑ 560 085, Karnataka, India. E‑mail: [email protected]
REFERENCES 1. 2. 3.
4.
5.
190
Hobai IA, Chhangani SV, Alfille PH. Anesthesia for tracheal resection and reconstruction. Anesthesiol Clin 2012;30:709‑30. Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth 1999;46:439‑55. 6. Cho JW, Jeong MA, Choi JH, Cho JW, Lee HJ, Kim DW, et al. Anaesthetic consideration for patients with severe tracheal obstruction caused by thyroid cancer – A report of 2 cases. Korean J Anaesthesiol 2010;58:396‑400. Shimizu J, Arano Y, Yachi T, Tabata S, Tsunamura Y, Murata T, et al. A 90‑year‑old woman with trachea‑invading thyroid cancer requiring four‑ring resection of cervical trachea because of airway stenosis. Ann Thorac Cardiovasc Surg 2007;13:341. Sandberg W. Anesthesia and airway management for tracheal resection and reconstruction. Thorac Anesth 2000;38:55‑75.
6. 7.
Morgan E, Mikhail MS, Murray MJ. Anaesthesia for Thoracic Surgery, Clinical Anaesthesiology. 4th ed. United States: McGraw Hill; 2008. Magnusson L, Lang FJ, Monnier P, Ravussin P. Anaesthesia for tracheal resection: Report of 17 cases. Can J Anaesth 1997;44:1282‑5. Access this article online Quick response code Website: www.ijaweb.org
DOI: 10.4103/0019-5049.153043
Survey of supraglottic airway devices usage in anaesthetic practice in South Indian State INTRODUCTION Safe, effective airway management is the foundation of quality anaesthetic practice. The classic laryngeal mask airway (LMA) is one of the airway equipments, which revolutionised airway management in the anaesthetic history. The popularity of the LMA stems from perceived benefits over other airway devices.[1] Following success and popularity of Classic™ LMA, many different variants of this device have been designed and marketed. There is no survey of supraglottic airway device (SGAD) usage done in India. Considering the widespread usage of the LMA and its variants in India we decided to get the first‑hand user details about the practice of SGADs here.
METHODS The survey was conducted during State anaesthesia conference during 2012. Participants were informed about this survey and encouraged to participate. They were provided survey form for filling (Appendix 1: Survey on the use of laryngeal mask ariway). Inclusion criterion was all qualified anaesthesiologists participating in the conference. Trainees were excluded from the survey. Sample size was calculated as 100 assuming usage and awareness of 80% among practicing anaesthesiologists with an error of 10%. Indian Journal of Anaesthesia | Vol. 59 | Issue 3 | Mar 2015
Brief Communications
RESULTS
DISCUSSION
Totally 400 anaesthesiologists including 75 trainees attended the conference. One hundred and fifteen questionnaires were filled up by the attending anaesthesiologists. Fifteen questionnaires were not taken into consideration for the analysis since they were filled up by the anaesthesia resident trainees. Hence, a total of 100 questionnaires (30% response) were analysed for the results. (Table 1: Results of Survey regarding use of SGAD)
The previously published surveys of LMA usage have been done in teaching hospitals in Western countries.[2,3] Our survey was conducted among the anaesthesiologists who work in wide spectrum of practice ranging from small nursing home to tertiary care referral centres. The most common SGAD used was classic LMA. Majority of practitioners preferred SGAD whenever possible. There is growing body of evidence that the LMA has very high success rates and low complication rates.[2,3] However, 69% of users in this survey
The overwhelming majority of respondents (83%) used reusable SGADs in preference to disposabe ones. The most common SGAD used was classic™ LMA (28%), followed by ProSeal (20%) and i‑gel (18%), Fastrach (17%) and Flexible type (15%). Propofol was the agent of choice for SGAD insertion for majority of the respondents. Eleven percentage of the respondents used thiopentone sodium as an induction agent for insertion. 23% of the respondents used classic LMA not more than 40 times. Rest of the respondents used more than 40 times, sometimes until it was no longer usable [Figure 1]. 62% of the respondents who used i‑gel reused it more than once. Some used it until it was no longer usable.
Figure 1: Reuse of laryngeal mask airway
Table 1: Results of survey (regarding use of SGAD) Survey participant profile Gender Qualification Male Female MD DA DNB 68% 32% 48% 39% 13% Hospital profile: Where participants of survey work Academic Management
Age (in years) 200
IPPV through naso‑tracheal tube was resumed. The surgeon then tied the remaining sutures anteriorly. Emergence and extubation was potentially the most critical period of management. After neuromuscular blockade was completely reversed, endotracheal tube was maintained in position with cuff deflated for 24 h. As extra tracheal soft tissue oedema is one of the anticipated sequelae of extensive oncological surgeries. The neck of the patient was kept flexed with the help of a chin stitch. Stich was left for 7–10 days to avoid traction to anastomosis. Neck flexion was maintained with special care when transferring the patient with pillows kept the head. Post‑operatively, humidified oxygen was delivered.After 24 h, patients were extubated with the tube exchanger in situ in the operation theatre None of the patients required re‑intubation or tracheostomy.
CONCLUSION Tracheal resection and reconstruction is a challenging operation for anaesthesiologist largely because the airway itself is abnormal and precariously controlled during anaesthetic induction, during construction of the anastomosis and at emergence. Distal tracheal intubation and IPPV is a simple technique which provides a good control of airway, clear surgical field and adequate oxygenation with minimum complications.
Namrata Ranganath, BHR Arathi, PV Ramamani, VB Gowda Department of Anaesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India Address for correspondence: Dr. Namrata Ranganath, 202, Shankari Apartment, Ittamadu Cross, Banashankari 3rd Stage, Bengaluru ‑ 560 085, Karnataka, India. E‑mail: [email protected]
REFERENCES 1. 2. 3.
4.
5.
190
Hobai IA, Chhangani SV, Alfille PH. Anesthesia for tracheal resection and reconstruction. Anesthesiol Clin 2012;30:709‑30. Pinsonneault C, Fortier J, Donati F. Tracheal resection and reconstruction. Can J Anaesth 1999;46:439‑55. 6. Cho JW, Jeong MA, Choi JH, Cho JW, Lee HJ, Kim DW, et al. Anaesthetic consideration for patients with severe tracheal obstruction caused by thyroid cancer – A report of 2 cases. Korean J Anaesthesiol 2010;58:396‑400. Shimizu J, Arano Y, Yachi T, Tabata S, Tsunamura Y, Murata T, et al. A 90‑year‑old woman with trachea‑invading thyroid cancer requiring four‑ring resection of cervical trachea because of airway stenosis. Ann Thorac Cardiovasc Surg 2007;13:341. Sandberg W. Anesthesia and airway management for tracheal resection and reconstruction. Thorac Anesth 2000;38:55‑75.
6. 7.
Morgan E, Mikhail MS, Murray MJ. Anaesthesia for Thoracic Surgery, Clinical Anaesthesiology. 4th ed. United States: McGraw Hill; 2008. Magnusson L, Lang FJ, Monnier P, Ravussin P. Anaesthesia for tracheal resection: Report of 17 cases. Can J Anaesth 1997;44:1282‑5. Access this article online Quick response code Website: www.ijaweb.org
DOI: 10.4103/0019-5049.153043
Survey of supraglottic airway devices usage in anaesthetic practice in South Indian State INTRODUCTION Safe, effective airway management is the foundation of quality anaesthetic practice. The classic laryngeal mask airway (LMA) is one of the airway equipments, which revolutionised airway management in the anaesthetic history. The popularity of the LMA stems from perceived benefits over other airway devices.[1] Following success and popularity of Classic™ LMA, many different variants of this device have been designed and marketed. There is no survey of supraglottic airway device (SGAD) usage done in India. Considering the widespread usage of the LMA and its variants in India we decided to get the first‑hand user details about the practice of SGADs here.
METHODS The survey was conducted during State anaesthesia conference during 2012. Participants were informed about this survey and encouraged to participate. They were provided survey form for filling (Appendix 1: Survey on the use of laryngeal mask ariway). Inclusion criterion was all qualified anaesthesiologists participating in the conference. Trainees were excluded from the survey. Sample size was calculated as 100 assuming usage and awareness of 80% among practicing anaesthesiologists with an error of 10%. Indian Journal of Anaesthesia | Vol. 59 | Issue 3 | Mar 2015
Brief Communications
RESULTS
DISCUSSION
Totally 400 anaesthesiologists including 75 trainees attended the conference. One hundred and fifteen questionnaires were filled up by the attending anaesthesiologists. Fifteen questionnaires were not taken into consideration for the analysis since they were filled up by the anaesthesia resident trainees. Hence, a total of 100 questionnaires (30% response) were analysed for the results. (Table 1: Results of Survey regarding use of SGAD)
The previously published surveys of LMA usage have been done in teaching hospitals in Western countries.[2,3] Our survey was conducted among the anaesthesiologists who work in wide spectrum of practice ranging from small nursing home to tertiary care referral centres. The most common SGAD used was classic LMA. Majority of practitioners preferred SGAD whenever possible. There is growing body of evidence that the LMA has very high success rates and low complication rates.[2,3] However, 69% of users in this survey
The overwhelming majority of respondents (83%) used reusable SGADs in preference to disposabe ones. The most common SGAD used was classic™ LMA (28%), followed by ProSeal (20%) and i‑gel (18%), Fastrach (17%) and Flexible type (15%). Propofol was the agent of choice for SGAD insertion for majority of the respondents. Eleven percentage of the respondents used thiopentone sodium as an induction agent for insertion. 23% of the respondents used classic LMA not more than 40 times. Rest of the respondents used more than 40 times, sometimes until it was no longer usable [Figure 1]. 62% of the respondents who used i‑gel reused it more than once. Some used it until it was no longer usable.
Figure 1: Reuse of laryngeal mask airway
Table 1: Results of survey (regarding use of SGAD) Survey participant profile Gender Qualification Male Female MD DA DNB 68% 32% 48% 39% 13% Hospital profile: Where participants of survey work Academic Management
Age (in years) 200
