Background: Selecting the appropriate sizes for laryngeal mask airways (LMAs) has become a concern for anesthesiologists. Traditionally, size selection has relied on factors like patient weight and gender. Nevertheless, emerging research indicates that incorporating anthropometric data could benefit the identification of the optimal LMA size for individual patients. Objectives: This randomized controlled trial aims to compare the effectiveness of LMA size selection based on weight against that determined by measuring the hyoid-cricoid distance (HCD). Methods: A total of 64 patients scheduled for eye surgery under general anesthesia were randomly assigned to two groups, each consisting of 32 participants. In the "W group", the size of the LMA was chosen based on the manufacturer's guidelines, which relied exclusively on the patient's weight. Conversely, in the "HCD group", the selection of LMA size was based on measuring the HCD. We compared postoperative complications and the ease of LMA insertion in these groups. Results: Data from 28 patients in the W group and 30 in the HCD group were analyzed. The incidence of postoperative complications was comparable between groups, with 16 patients in the W group and 12 in the HCD group experiencing complications (P = 0.1). Additionally, metrics such as the number of attempts, time to insertion, ease of insertion, peak airway pressure, and abnormal curve shape showed no statistically significant differences (P > 0.05). Conclusions: Based on the findings in this study, the method for selecting LMA size based on HCD did not statistically reduce airway complications nor did it facilitate the insertion process. We recommend conducting larger studies to further investigate this topic.

Dear Editor, Patients with mediastinal masses, particularly masses in the anterior or superior mediastinum present unique problems for the anesthesiologists which are during general anesthesia, which are usually the consequence of extrinsic compression of the airway, obstruction of the venous return or obstruction to the output of the heart (1-4).

Aims The study aimed to compare endotracheal intubation with i-gel and LMA (laryngeal mask airway) supreme supraglottic airway devices in orbital osteosynthesis surgery. Materials & Methods This comparative perspective single-center randomized study was conducted in Yekaterinburg Clinical Hospitals, Russia, in 2021. The number of 134 patients undergoing orbital plasty after fracture were enrolled in the study and were randomized into three groups: 43 in the endotracheal intubation group, 42 in the LMA-Supreme group, and 49 patients were included in the i-gel group. Hemodynamic parameters, respiratory mechanics, respiration, oropharyngeal leak pressure at different stages of surgical intervention, as well as the time of airway device insertion, the number of attempts, and the need for additional maneuvers to insert the airway device were assessed. For statistical processing, the EZR 1. 37 on R commander 3. 4. 1 was used with the Kruskal-Wallis h-criterion and Pearson’, s χ, ²,-test. Findings In the postoperative period, the assessment of complications associated with the insertion of airway devices was implemented. We did not receive clinically significant differences in mechanical ventilation parameters between groups at the study stages (p>0. 05). A reliable difference in oropharyngeal leak pressure at the beginning and the end of the surgical intervention was obtained (p<0. 05). The number of complications was minimal and did not differ between the groups (p>0. 05). Conclusion LMA-S and i-gel supraglottic airway devices allow to provide normal lung ventilation and gas exchange and can be an alternative to endotracheal intubation during orbital osteosynthesis surgery.

Background: Successful insertion of a laryngeal mask airway (LMA) requires deep anesthesia, the proper opening of the mouth, and adequate suppression of upper airway reflexes. Propofol injection can effectively reduce laryngeal reflexes. This study aimed to compare the effectiveness of propofol alone versus propofol plus a muscle relaxant on LMA insertion and hemodynamic parameters during the induction of anesthesia. Methods: This randomized, double-blind clinical study was performed on 70 patients in the age range of 18-65 years who were candidates for surgery in the operating room of Shahid Mohammadi Hospital in Bandar Abbas, Iran in 2020. The patients were randomly divided into two groups of 35. The first group received propofol and normal saline, and the second group received propofol plus cisatracurium. The parameters of ease of LMA insertion, jaw opening, cough and gag reflexes, head and limb movement, laryngospasm, and hemodynamic changes were recorded for investigation. Results: The patients were almost matched in terms of demographic variables. No significant difference was found regarding the ease of LMA insertion and hemodynamic parameters. However, the overall score of ease of LMA insertion was considerably higher in the propofol plus muscle relaxant group (P = 0. 029). The extubation time was significantly shorter (P < 0. 001) and the surgery duration was considerably longer (P = 0. 019) in the propofol plus muscle relaxant group. Conclusion: The findings demonstrated that both techniques were suitable for LMA insertion, and no significant hemodynamic changes were found between the two groups. However, the administration of propofol plus a muscle relaxant was more suitable due to ease of LMA insertion and shorter extubation time.

Background: The Laryngeal Mask Airway (LMA) has traditionally become an alternative device for airway management. This clinical trial compared two standard and lateral techniques in inserting laryngeal masks in pediatric airway management. Methods: This single-blind clinical trial study was conducted on pediatrics aged 2-6 years who were candidates for elective inguinal herniorrhaphy with ASA I and II under general anesthesia. The pediatrics were randomly assigned to either the standard or lateral methods according to the random number table. The time required to insert LMA and airway pressure as well as the number of attempts to insert in both groups were measured. Data analysis was performed using SPSS version 25,the significance level was less than 0. 05. Results: Chest movement and mean airway pressure had no significant difference in both groups (p>0. 05). The mean LMA insertion time in the lateral and standard methods was 22. 94±7. 89 and 65±15. 27 seconds, respectively (p=0. 001). There was no case of mucosal damage in the lateral method, but ten children had mucosal damage in the standard technique (p=0. 001). In the lateral method, LMA was inserted for the first time in 32 pediatrics (94. 1%) and two pediatrics (5. 9%) in the second time but in the standard group, LMA was inserted in the second time in 11 pediatrics (32. 4%) (p=0. 006). Conclusion: The lateral method for inserting LMA is practically easy, requires less effort, and has the least complications. Another advantage of the lateral method compared to the standard technique is that inserting a finger into the pharyngeal cavity is unnecessary.

Recently malignant fibrous hystiocytoma (MHF) is the common sarcoma of the soft tissue in adults. The most common sites of MHF are the extremities and retroperitoneum. This lesion is rare in the head and neck. MHF of the larynx often is seen in the old men and after radiotherapy of the head and neck cancers. We report a case of MHF of larynx, without history of previous cancer and radiotherapy, that underwent the total laryngectomy.

Background and Objectives: Providing and making airway is the first known measure that comes to mind at an emergency situation.Laryngeal mask airway (LMA) is an alternative for airway management, which its insertion training in beginners and professionals is easier than endotracheal intubation. This study was conducted to compare the speed of insertion and success rate in using two LMA and ETT methods in nursing students.Methods: In this quasi-experimental study, 49 last year nursing students were selected by simple random sampling method. After airway management training course, the students were tested on endotracheal intubation and LMA insertion in a manikin. Data were analyzed using t-test at the p<0.05 significance level.Results: The time for endotracheal intubation was obtained 28.73 s and for LMA was 5.05 s. Also, gender of the students had no significant relationship with airway management (p=0.45). Ninety-eight percent of the student succeeded to insert LMA with no error, but this rate for ETT was just 28%.Conclusion: Given that shorter time, lower error, and ease of insertion of LMA in comparison with the ETT method, use of this method is recommended as an appropriate alternative for endotracheal intubation, especially in emergency situation.

Background: This study was designed to compare the effects of using a laryngeal mask airway (LMA) and endotracheal intubation on airway resistance and compliance in patients undergoing orthopedic surgery under general anesthesia. Evaluating these two methods is crucial for improving respiratory quality and reducing complications related to airway management in patients. Methods: This analytical cross-sectional study was conducted on 50 patients undergoing orthopedic surgery under general anesthesia at Hospital in Bandar Abbas between May and September 2024. The patients were equally divided into two groups: the first group received a laryngeal mask airway (LMA), while the second group underwent endotracheal intubation under general anesthesia. The primary variables, including airway resistance and compliance, were measured at 0, 15, 30, and 60 minutes after anesthesia induction. Demographic characteristics such as age, gender, and ASA class were also recorded. Data analysis was performed using SPSS version 21, with descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (Mann-Whitney U test and Chi-square test), considering a significance level of P<0. 05. Results: The findings of the present study showed no statistically significant differences between the two groups regarding age distribution and ASA class. A comparison of airway resistance and compliance between genders revealed no significant differences at 0, 15, 30, and 60 minutes. There was no significant difference between the two anesthesia groups (laryngeal mask airway and endotracheal tube) in terms of age distribution. There was no statistically significant difference in ASA classification between the two anesthesia groups. At minute 0 of anesthesia, airway resistance was significantly higher in the endotracheal intubation group compared to the LMA group (P<0. 001). At 30 and 60 minutes of anesthesia, airway resistance remained significantly higher in the endotracheal intubation group (P<0. 001). Airway compliance was significantly higher in the LMA group at all measured time points (0, 15, 30, and 60 minutes) compared to the endotracheal intubation group (P<0. 001). Conclusion: The results of this study demonstrated that using a laryngeal mask airway (LMA) compared to endotracheal intubation leads to improved airway compliance and reduced airway resistance during anesthesia. These findings may influence the selection of anesthesia methods and enhance postoperative care quality.

Introduction: Healthcare workers are at risk of catching respiratory infections due to repeated contact with patients in the front row. The purpose of this paper was to compare surgical masks with N95 masks in the prevention of influenza in health care workers in the hospital. Methods: In this systematic review study, all articles published during the years (20052019) in both Persian and English on surgical masks and N95 masks were examined. These studies were conducted through the IranMedex, Magiran, IranDoc, SID, Elsevier, Pubmed, Medline, Cochrane databases. Keywords included surgical masks, N95 filter masks, treatment staff, Surgical masks, N95 respirators, health care workers and influenza. The result of this research was the achievement of 104 articles, which were obtained after deleting duplicate and unavailable articles (47) and review articles (10) and not having study conditions (34), 23 articles related to the subject. 13 articles were removed from the study due to lack of entry criteria, and finally 10 articles were included in the study. Results: Of the 10 studies, 7 were hospital-based, 2 were outpatient, and 1 were in the laboratory. Of these articles, 5 articles were about comparing the effectiveness of surgical masks with N95 masks and 1 article was about comparing the policies of choosing a surgical mask and N95 mask and 4 other articles were comparing surgical masks and N95 masks in preventing influenza. None of the articles found a link between the use of surgical masks and N95 masks and protection against influenza infection. Conclusions: No association was found between the use of surgical mask and N95 mask and protection against influenza infection. Therefore, it is recommended to use surgical masks and N95 along with hygienic issues.

Background: Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard. Methods: In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Preoxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared. Results: Totally, 105 EMTs participated in this study, of whom, 102 were male (97. 1%). The mean age of the subjects was 36. 4± 7. 3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1. 4% and 30. 6% were <1 min, respectively (p< 0. 001). However, no significant difference was observed in terms of the mean time (p= 0. 427). Conclusion: In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.