The Experts below are selected from a list of 9906 Experts worldwide ranked by ideXlab platform
C Keller - One of the best experts on this subject based on the ideXlab platform.
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stability of the lma proseal and standard laryngeal mask airway in different head and neck positions a randomized crossover study
European Journal of Anaesthesiology, 2005Co-Authors: Joseph Brimacombe, C KellerAbstract:SummaryBackground and objective:The LMA-ProSeal® laryngeal mask airway is a new laryngeal mask airway with a modified cuff and Drainage Tube. We compared oropharyngeal leak pressure, intracuff pressure and anatomical position (assessed fibreoptically) for the Size 5 LMA-ProSeal® laryngeal mask airwa
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Gum-elastic bougie-guided insertion of the ProSeal laryngeal mask airway: a new technique.
Anaesthesia and intensive care, 2002Co-Authors: A Howath, Joseph Brimacombe, C KellerAbstract:We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1-2 aged 18 to 80 years) were studied. The ProSeal LMA Drainage Tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the Drainage Tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric Tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17-40) cmH2O and ventilation was possible without leak in all patients at 9.5 ml x kg(-1) tidal volume. There were no Drainage Tube or gastric air leaks. Gastric Tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.
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does the proseal laryngeal mask airway prevent aspiration of regurgitated fluid
Anesthesia & Analgesia, 2000Co-Authors: C Keller, Axel Kleinsasser, Joe Brimacombe, Alex LoeckingerAbstract:In this randomized, cross-over cadaver study, we determined whether a new airway device, the ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK), prevents aspiration of regurgitated fluid. We studied five male and five female cadavers (6-24 h postmortem). The infusion set of a pressure-controlled, continuous flow pump was inserted into the upper esophagus and ligated into place. Esophageal pressure (EP) was increased in 2-cm H(2)O increments. This was performed without an airway device (control) and over a range of cuff volumes (0-40 mL) for the classic laryngeal mask airway (LMA), the PLMA with the Drainage Tube clamped (PLMA clamped) and unclamped (PLMA unclamped). The EP at which fluid was first seen with a fiberoptic scope in the hypopharynx (control), above or below the cuff, or in the Drainage Tube, was noted. Mean EP at which fluid was seen without any airway device was 9 (range 8-10) cm H(2)O. EP at which fluid was seen was always higher for the PLMA clamped and LMA compared with the control (all, P<0.0001). The mean EP at which fluid was seen for the PLMA unclamped was similar to the control at 10 (range 8-13) cm H(2)O. For the PLMA unclamped, fluid appeared from the Drainage Tube in all cadavers at 10-40 mL cuff volume and in 8 of 10 cadavers at zero cuff volume. Mean EP at which fluid was seen above the cuff was similar for the PLMA clamped and LMA at 0-30 mL cuff volume, but was higher for PLMA clamped at 40-mL cuff volume (81 vs 48 cm H(2)O, P = 0.006). Mean EP at which fluid was seen below the cuff was similar at 0-10 mL cuff volume, but was higher for the PLMA clamped at 20, 30, and 40 mL cuff volume (62, 68, 73 vs. 46, 46, 46 cm H(2)O, respectively, P<0.04). For the PLMA clamped and the LMA, fluid appeared simultaneously above and below the cuff at all cuff volumes. We concluded that in the cadaver model, the correctly placed PLMA allows fluid in the esophagus to bypass the pharynx and mouth when the Drainage Tube is open. Both the LMA, and PLMA with a closed Drainage Tube, attenuate liquid flow between the esophagus and pharynx. This may have implications for airway protection in unconscious patients.
Alex Loeckinger - One of the best experts on this subject based on the ideXlab platform.
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does the proseal laryngeal mask airway prevent aspiration of regurgitated fluid
Anesthesia & Analgesia, 2000Co-Authors: Christian Keller, Axel Kleinsasser, Joe Brimacombe, Alex LoeckingerAbstract:In this randomized, cross-over cadaver study, we determined whether a new airway device, the ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK), prevents aspiration of regurgitated fluid. We studied five male and five female cadavers (6 ‐24 h postmortem). The infusion set of a pressurecontrolled, continuous flow pump was inserted into the upper esophagus and ligated into place. Esophageal pressure (EP) was increased in 2-cm H2O increments. This was performed without an airway device (control) and over a range of cuff volumes (0 ‐ 40 mL) for the classic laryngeal mask airway (LMA), the PLMA with the Drainage Tube clamped (PLMA clamped) and unclamped (PLMA unclamped). The EP at which fluid was first seen with a fiberoptic scope in the hypopharynx (control), above or below the cuff, or in the Drainage Tube, was noted. Mean EP at which fluid was seen without any airway device was 9 (range 8 ‐10) cm H2O. EP at which fluid was seen was always higher for the PLMA clamped and LMA compared with the control (all, P , 0.0001). The mean EP at which fluid was seen for the PLMA unclamped was similar to the control at 10 (range 8 ‐13) cm H2O. For the PLMA unclamped, fluid appeared from the Drainage Tube in all cadavers at 10 ‐ 40 mL cuff volume and in 8 of 10 cadavers at zero cuff volume. Mean EP at which fluid was seen above the cuff was similar for the PLMA clamped and LMA at 0 ‐30 mL cuff volume, but was higher for PLMA clamped at 40-mL cuff volume (81 vs 48 cm H2O, P 5 0.006). Mean EP at which fluid was seen below the cuff was similar at 0 ‐10 mL cuff volume, but was higher for the PLMA clamped at 20, 30, and 40 mL cuff volume (62, 68, 73 vs 46, 46, 46 cm H2O, respectively, P , 0.04). For the PLMA clamped and the LMA, fluid appeared simultaneously above and below the cuff at all cuff volumes. We concluded that in the cadaver model, the correctly placed PLMA allows fluid in the esophagus to bypass the pharynx and mouth when the Drainage Tube is open. Both the LMA, and PLMA with a closed Drainage Tube, attenuate liquid flow between the esophagus and pharynx. This may have implications for airway protection in unconscious patients. (Anesth Analg 2000;91:1017‐20)
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does the proseal laryngeal mask airway prevent aspiration of regurgitated fluid
Anesthesia & Analgesia, 2000Co-Authors: C Keller, Axel Kleinsasser, Joe Brimacombe, Alex LoeckingerAbstract:In this randomized, cross-over cadaver study, we determined whether a new airway device, the ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK), prevents aspiration of regurgitated fluid. We studied five male and five female cadavers (6-24 h postmortem). The infusion set of a pressure-controlled, continuous flow pump was inserted into the upper esophagus and ligated into place. Esophageal pressure (EP) was increased in 2-cm H(2)O increments. This was performed without an airway device (control) and over a range of cuff volumes (0-40 mL) for the classic laryngeal mask airway (LMA), the PLMA with the Drainage Tube clamped (PLMA clamped) and unclamped (PLMA unclamped). The EP at which fluid was first seen with a fiberoptic scope in the hypopharynx (control), above or below the cuff, or in the Drainage Tube, was noted. Mean EP at which fluid was seen without any airway device was 9 (range 8-10) cm H(2)O. EP at which fluid was seen was always higher for the PLMA clamped and LMA compared with the control (all, P<0.0001). The mean EP at which fluid was seen for the PLMA unclamped was similar to the control at 10 (range 8-13) cm H(2)O. For the PLMA unclamped, fluid appeared from the Drainage Tube in all cadavers at 10-40 mL cuff volume and in 8 of 10 cadavers at zero cuff volume. Mean EP at which fluid was seen above the cuff was similar for the PLMA clamped and LMA at 0-30 mL cuff volume, but was higher for PLMA clamped at 40-mL cuff volume (81 vs 48 cm H(2)O, P = 0.006). Mean EP at which fluid was seen below the cuff was similar at 0-10 mL cuff volume, but was higher for the PLMA clamped at 20, 30, and 40 mL cuff volume (62, 68, 73 vs. 46, 46, 46 cm H(2)O, respectively, P<0.04). For the PLMA clamped and the LMA, fluid appeared simultaneously above and below the cuff at all cuff volumes. We concluded that in the cadaver model, the correctly placed PLMA allows fluid in the esophagus to bypass the pharynx and mouth when the Drainage Tube is open. Both the LMA, and PLMA with a closed Drainage Tube, attenuate liquid flow between the esophagus and pharynx. This may have implications for airway protection in unconscious patients.
Joseph Brimacombe - One of the best experts on this subject based on the ideXlab platform.
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stability of the lma proseal and standard laryngeal mask airway in different head and neck positions a randomized crossover study
European Journal of Anaesthesiology, 2005Co-Authors: Joseph Brimacombe, C KellerAbstract:SummaryBackground and objective:The LMA-ProSeal® laryngeal mask airway is a new laryngeal mask airway with a modified cuff and Drainage Tube. We compared oropharyngeal leak pressure, intracuff pressure and anatomical position (assessed fibreoptically) for the Size 5 LMA-ProSeal® laryngeal mask airwa
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Gum-elastic bougie-guided insertion of the ProSeal laryngeal mask airway: a new technique.
Anaesthesia and intensive care, 2002Co-Authors: A Howath, Joseph Brimacombe, C KellerAbstract:We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1-2 aged 18 to 80 years) were studied. The ProSeal LMA Drainage Tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the Drainage Tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric Tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17-40) cmH2O and ventilation was possible without leak in all patients at 9.5 ml x kg(-1) tidal volume. There were no Drainage Tube or gastric air leaks. Gastric Tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.
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gastric insufflation with the proseal laryngeal mask
Anesthesia & Analgesia, 2001Co-Authors: Joseph Brimacombe, Christian Keller, Alison BerryAbstract:T he ProSeal laryngeal mask airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, UK) is a new airway device with a large double cuff that forms a better seal than the standard laryngeal mask airway; it also has a Drainage Tube designed to protect against regurgitation, facilitate passage of a gastric Tube, reduce the risk of gastric insufflation, and facilitate the detection of malposition (1). The test for malposition involves placing a small volume of a water-based lubricating jelly in the proximal end of the Drainage Tube, applying positive pressure to the airway Tube, and observing the meniscus of the jelly to determine whether there is an air leak up the Drainage Tube. The presence of an air leak suggests that the distal end of the Drainage Tube and the airway Tube are not isolated and that the PLMA is malpositioned. We describe a patient undergoing laparoscopic cholecystectomy who developed gastric insufflation despite a negative malposition test and make recommendations for improving the reliability of the test for malposition.
Kousuke Awara - One of the best experts on this subject based on the ideXlab platform.
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spinal endoscopy combined with selective ct myelography for dural closure of the spinal dural defect with superficial siderosis technical note
Journal of Neurosurgery, 2018Co-Authors: Hidetaka Arishima, Yoshifumi Higashino, Shinsuke Yamada, Ayumi Akazawa, Hiroshi Arai, Kenzo Tsunetoshi, Ken Matsuda, Toshiaki Kodera, Ryuhei Kitai, Kousuke AwaraAbstract:The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal Drainage Tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal Drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal Drainage Tube was inserted, and the tip of the Drainage Tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The u...
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spinal endoscopy combined with selective ct myelography for dural closure of the spinal dural defect with superficial siderosis technical note
Journal of Neurosurgery, 2018Co-Authors: Hidetaka Arishima, Yoshifumi Higashino, Shinsuke Yamada, Ayumi Akazawa, Hiroshi Arai, Kenzo Tsunetoshi, Ken Matsuda, Toshiaki Kodera, Ryuhei Kitai, Kousuke AwaraAbstract:The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal Drainage Tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal Drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal Drainage Tube was inserted, and the tip of the Drainage Tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.
Christian Keller - One of the best experts on this subject based on the ideXlab platform.
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gastric insufflation with the proseal laryngeal mask
Anesthesia & Analgesia, 2001Co-Authors: Joseph Brimacombe, Christian Keller, Alison BerryAbstract:T he ProSeal laryngeal mask airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, UK) is a new airway device with a large double cuff that forms a better seal than the standard laryngeal mask airway; it also has a Drainage Tube designed to protect against regurgitation, facilitate passage of a gastric Tube, reduce the risk of gastric insufflation, and facilitate the detection of malposition (1). The test for malposition involves placing a small volume of a water-based lubricating jelly in the proximal end of the Drainage Tube, applying positive pressure to the airway Tube, and observing the meniscus of the jelly to determine whether there is an air leak up the Drainage Tube. The presence of an air leak suggests that the distal end of the Drainage Tube and the airway Tube are not isolated and that the PLMA is malpositioned. We describe a patient undergoing laparoscopic cholecystectomy who developed gastric insufflation despite a negative malposition test and make recommendations for improving the reliability of the test for malposition.
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does the proseal laryngeal mask airway prevent aspiration of regurgitated fluid
Anesthesia & Analgesia, 2000Co-Authors: Christian Keller, Axel Kleinsasser, Joe Brimacombe, Alex LoeckingerAbstract:In this randomized, cross-over cadaver study, we determined whether a new airway device, the ProSeal laryngeal mask airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, UK), prevents aspiration of regurgitated fluid. We studied five male and five female cadavers (6 ‐24 h postmortem). The infusion set of a pressurecontrolled, continuous flow pump was inserted into the upper esophagus and ligated into place. Esophageal pressure (EP) was increased in 2-cm H2O increments. This was performed without an airway device (control) and over a range of cuff volumes (0 ‐ 40 mL) for the classic laryngeal mask airway (LMA), the PLMA with the Drainage Tube clamped (PLMA clamped) and unclamped (PLMA unclamped). The EP at which fluid was first seen with a fiberoptic scope in the hypopharynx (control), above or below the cuff, or in the Drainage Tube, was noted. Mean EP at which fluid was seen without any airway device was 9 (range 8 ‐10) cm H2O. EP at which fluid was seen was always higher for the PLMA clamped and LMA compared with the control (all, P , 0.0001). The mean EP at which fluid was seen for the PLMA unclamped was similar to the control at 10 (range 8 ‐13) cm H2O. For the PLMA unclamped, fluid appeared from the Drainage Tube in all cadavers at 10 ‐ 40 mL cuff volume and in 8 of 10 cadavers at zero cuff volume. Mean EP at which fluid was seen above the cuff was similar for the PLMA clamped and LMA at 0 ‐30 mL cuff volume, but was higher for PLMA clamped at 40-mL cuff volume (81 vs 48 cm H2O, P 5 0.006). Mean EP at which fluid was seen below the cuff was similar at 0 ‐10 mL cuff volume, but was higher for the PLMA clamped at 20, 30, and 40 mL cuff volume (62, 68, 73 vs 46, 46, 46 cm H2O, respectively, P , 0.04). For the PLMA clamped and the LMA, fluid appeared simultaneously above and below the cuff at all cuff volumes. We concluded that in the cadaver model, the correctly placed PLMA allows fluid in the esophagus to bypass the pharynx and mouth when the Drainage Tube is open. Both the LMA, and PLMA with a closed Drainage Tube, attenuate liquid flow between the esophagus and pharynx. This may have implications for airway protection in unconscious patients. (Anesth Analg 2000;91:1017‐20)
