Comparative Evaluation of Placement of Auragain, ProSeal and Protector Laryngeal Mask Airways using Fiberoptic Bronchoscopy: A Randomised Clinical Study

Introduction: Supraglottic Airway Devices (SAD) can be used instead of endotracheal intubation in both regular and complicated airway situations. Auragain, ProSeal and Protector Laryngeal Mask Airways (LMA) are second generation LMAs. They have a separate provision for gastric drainage. Auragain LMA is a recent second-generation Supra Glottic Airway device (SGA) with a pre-formed curved shaft and a double lumen having wider airway path to aid endotracheal intubation. ProSeal LMA also has a double cuff for better sealing to prevent gastric insufflation and aspiration. Protector LMA has two large-volume gastric drainage channels and an integrated cuff pressure indicator called the cuff pilot which enables application of higher respiratory pressure. Aim: To compare the adequacy of placement of Auragain, ProSeal and protector LMAs by vocal cord visualisation using fiberoptic bronchoscopy. Materials and Methods: A randomised clinical study was conducted in the Department of Anaesthesiology, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from October 2021 to October 2022 among 120 patients. They were allocated by computer-generated random numbers into three groups namely Auragain, ProSeal and Protector LMA Group. The adequacy of placement of LMA through Fiberoptic Bronchoscopy (FOB) using Brimacombe and berry scoring, Oropharyngeal Leak Pressure (OLP), time of insertion of LMA, number of attempts for insertion, ease of insertion of LMA, Ryle’s tube insertion success rate and postoperative complications were recorded immediately, after an hour and 24 hour, respectively. Statistical analysis was performed using International Business Machines-Statistical Package for the Social Sciences (IBM-SPSS) software version 21.0. Results: The mean±Standard Deviation (SD) age in Auragain groups, ProSeal and Protector LMA groups was 41.35±12.96 years, 36.58±12.62 years and 36.65±12.50 years, respectively. The demographic data, procedures and duration of anaesthesia were comparable between the three groups. The mean insertion time (in seconds) was lower in the Auragain LMA group (16.80±3.66) when compared to protector LMA (20.20±6.93) and ProSeal LMA (21.68±4.44) with statistically significant difference (p-value<0.0001). The OLP (in cm H2O) was more with ProSeal LMA (34.43±5.26) than Protector LMA (32.60±3.45) and Auragain LMA (28.55±1.85) with statistically significant difference (p-value<0.0001). The fiberoptic view was better with ProSeal LMA and statistically significant with Grade 4 (p-value<0.0001) and Grade 3 (p-value=0.007). The three devices were comparable in terms of ease and success of insertion of LMA, ease of placement of gastric tube and postoperative symptoms. Conclusion: It can be concluded that the ProSeal LMA offers better airway access and safety despite being slightly difficult to insert compared to Ambu Auragain or Protector LMA

Synergistic Role of Electrolyte and Binder for Enhanced Electrochemical Storage for Sodium-Ion Battery

Sodium-ion batteries are promising futuristic large-scale energy-storage devices because of the abundance and low cost of sodium. However, the development and commercialization of the sodium-ion battery solely depends on the use of high-capacity electrode materials. Among the various metal oxides, SnO2 has a high theoretical specific capacity for sodium-ion battery. However, the enormous volume expansion and low electrical conductivity of SnO2 hinder its capability to reach the predicted theoretical value. Although different nanostructured designs of electrode materials like SnO2 nanocomposites have been studied, the effects of other cell components like electrolyte and binder on the specific capacity and cyclic stability are yet to be understood. In the present study, we have investigated the synergistic effect of electrolyte and binder on the performance enhancement of SnO2 supported on the intertwined network structure of reduced graphene oxide partially open multiwalled carbon nanotube hybrid as anode in sodium-ion battery. Our result shows that sodium carboxyl methyl cellulose and ethylene carbonate/diethyl carbonate as the electrolyte solvent offers a high specific capacity of 688 mAh g–1 and a satisfactory cyclic stability for 500 cycles. This is about 56% enhancement in specific capacity compared to the use of poly­(vinylidene fluoride) binder and propylene carbonate as the electrolyte solvent. The present study provides a better understanding of the synergistic role of electrolyte and binder for the development of metal-oxide-based electrode materials for the advancement of the commercialization of sodium-ion battery

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background: Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods: We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings: Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation: We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications. Funding: European Society of Anaesthesiology

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged &gt;= 18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARR(adj)). This study is registered with ClinicalTrials. gov, number NCT01865513.Findings Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7.6%] of 21 694); ORadj 1.86, 95% CI 1.53-2.26; ARR(adj) -4.4%, 95% CI -5.5 to -3.2). Only 2.3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1.31, 95% CI 1.15-1.49; ARR(adj) -2.6%, 95% CI -3.9 to -1.4) and the administration of reversal agents (1.23, 1.07-1.41; -1.9%, -3.2 to -0.7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1.03, 95% CI 0.85-1 center dot 25; ARR(adj) -0.3%, 95% CI -2.4 to 1.5) nor extubation at a train-of-four ratio of 0.9 or more (1.03, 0.82-1.31; -0.4%, -3.5 to 2.2) was associated with better pulmonary outcomes.Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications