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Home > Impact of Deep Versus Awake Laryngeal Mask Airway Removal on Airway Complications in Spontaneously Breathing Adult Patients Following Isoflurane General Anesthesia.

Impact of Deep Versus Awake Laryngeal Mask Airway Removal on Airway Complications in Spontaneously Breathing Adult Patients Following Isoflurane General Anesthesia.

Thesis Info

Author

Ombaka, Ronald

Department

Anaesthesiology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2017

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728053979

Similar


Background: The Laryngeal Mask Airway (LMA) is one of several supra-glottic airway management devices used in anaesthesia. The scope of use of the LMA is progressively expanding to areas previously contraindicated, for instance laparoscopy and prone position surgery. Certain aspects of LMA use remain unsettled. Whether to remove the LMA when a patient is “awake” vs “deep” following anaesthesia is one such area. The manufacturer Ambu® recommends that the AuraOnce™ LMA be removed once the patient is fully awake and protective airway reflexes are active. Despite this, several studies have shown benefit in removal of the LMA while a patient is “deep” (anaesthetized). Current evidence is inconclusive as to which approach is preferable and safer in adults. Primary Objective: To compare the impact of having LMA removal deep versus awake on the occurrence of airway complications following general anaesthesia in spontaneously breathing adult patients using Isoflurane as the sole volatile agent. Secondary Objective: To compare the impact of deep versus awake LMA removal on anaesthesia theatre turn-around time. Primary outcome measure(s): Airway complication(s), defined as; one or more of the following; Airway obstruction requiring airway manipulation; Laryngospasm; Desaturation to 90% or less on pulse oximetry. Secondary outcome measure(s): Time to theatre exit Study Setting: The Aga Khan University Hospital, Nairobi, Kenya. Study Design: A prospective randomized control trial (open). Sample size: A sample size of 116 participants, 58 in each arm. Study population: ASA I and II patients aged 18-65 years scheduled for theatre for low to moderate risk, non-emergent surgery. Procedure: 116 adult patients were randomly assigned to one of two groups. A standard anaesthesia protocol was used for induction and maintenance of anaesthesia. For the deep arm; The LMA was removed at the end of surgery after attaining an end tidal minimum alveolar concentration of Isoflurane of 1.15%. Occurrence of airway complication(s) (One or more of the following; Airway obstruction requiring airway manipulation; Laryngospasm; Desaturation to 90% or less on pulse oximetry) was noted until the subject was fully awake (appropriate response to command) in the post anaesthesia care unit. For the awake arm; The LMA was removed on attaining an end tidal minimum alveolar concentration of Isoflurane of <0.5% and an appropriate response to command or obtaining appropriate response to command irrespective of end tidal concentration. Occurrence of airway complication(s) (One or more of the following; Airway obstruction requiring airway manipulation; Laryngospasm; Desaturation to 90% or less
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نولکھی کوٹھی میں پسماندگی کے مظاہر

نو لکھی کوٹھی میں پس ماندگی کے مظاہر

                علی اکبر ناطق کا پہلا ناول’’نو لکھی کوٹھی‘‘جس نے اردو ادب میں ایک نئی تاریخ رقم کر دی ہے اور مصنف کی وجہ شہرت بنا۔یہ ناول 2014ء میں سانجھ پبلی کیشنز لاہورسے شائع ہوا ۔ ناول 448 صفحات پر مشتمل ہے ۔ناول کے اب تک سات ایڈیشن شائع ہو چکے ہیں اور انہوں نے ناول کا انتساب اپنے ابا جان’’محمد بشیر‘‘ کے نام کیا ہے۔

                مصنف  نے ناول کے ذریعے نہ صرف ادب کے معیار کو طے کیا ہے بلکہ ایک مختلف انداز میں یعنی روایتی اندازسے بالکل الگ ہو کر اسے پیش کیا ہے۔ناول نہایت دل فریب صورت میں اور دیدہ زیب انداز میں تحریر کیا گیا ہے،قاری ایک ہی نشست میں مکمل پڑھنا چاہتا ہے۔اس کا مختلف زبانوں میں ترجمہ بھی ہو چکا ہے۔

                فکشن میں ان کا یہ قدم حیرت زدہ کرنے والا ہے۔ نثر کو پڑھتے ہوئے ان کی مکالمہ اور بیانیہ پر مکمل گرفت کا احساس اجاگر ہوتا ہے۔ وہ لکھتے ہوئے ایسی منظر کشی کرتے ہیں کہ پڑھنے والا دنگ رہ جاتا ہے۔ایسا محسوس ہوتا ہے کہ جیسے کہانی بالکل ویسی ہے جس میں قاری اپنا ماضی گزار چکا ہے۔ وہ پڑھتے ہوئے خود کو اس کا ایک حصہ گردانتا ہے۔

                اردو ادب ان سے جتنی بھی امیدیں وابستہ کر لے وہ غلط نہ ہوں گی۔ہمارے دور کے ہو کر بھی انہوں نے نہایت ہی کمال طریقے سے ماضی کے ان واقعات سے پردہ اٹھایا ہے جنہیں ہم قصوں کہانیوں میں سنتے آئے ہیں۔

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