The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients. In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period. In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge. The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients. Registered at Clinicaltrials.gov NCT02462915 , registered on 1 June 2015.

Background: Early detection of dysphagia is important for preventing aspiration pneumonia. Although videofluoroscopy is currently the primary diagnostic tool for dysphagia, access to this tool may be limited because of radiation exposure risk, high cost, and other factors. Purpose: In this study, a meta-analysis was used to determine the strength of the correlation between dysphagia detection outcomes obtained using subjective questionnaires and videofluoroscopy. Methods: The PubMed and Embase databases were searched for original articles up to December 2022. Studies published in English that used cross-sectional designs to assess the correlation between subjective questionnaires and videofluoroscopy were considered eligible for inclusion. The search terms used included “dysphagia,” “questionnaire,” and “videofluoroscopy.” Two reviewers critically appraised and extracted the correlation coefficient r values. In addition, a random-effects meta-analysis was conducted. The Q statistic was used to assess the heterogeneity among the included studies. Publication bias was checked using the funnel plot and Egger's tests. Multilevel analysis was used to determine sensitivity to consider within-study correlations. In addition, subgroup analyses were conducted based on type of questionnaire, head and neck cancer, and English-speaking regions. Results: The meta-analysis included five studies and 856 patients using the Eating Assessment Tool-10 and one study and 27 patients using the Sydney Swallow Questionnaire. The results of the random-effects meta-analysis showed a moderate relationship between the subjective questionnaires and videofluoroscopy (r = .35, 95% CI [0.20, 0.48]). Similar results were also obtained using multilevel analysis (r = .34, 95% CI [0.25, 0.42]). No publication bias was found for any of the studies (p = .88). In the subgroup analyses, a moderate relationship between Eating Assessment Tool-10 and videofluoroscopy (r = .31, 95% CI [0.19, 0.42]) and an ultrahigh relationship between Sydney Swallow Questionnaire and video-fluoroscopy (r = .74, 95% CI [0.50, 0.87]) were found. Furthermore, moderate associations were observed within each head and neck cancer and English-speaking regions subgroup. However, no significant differences were found between these two subgroups. Conclusions: These results indicate the subjective questionnaires considered in this study share a moderate relationship with videofluoroscopy. Subjective questionnaires may be used as an auxiliary tool by nurses and homecare givers for the early assessment of dysphagia risk in patients.

Increased abdominal pressure is common in obese patients and predisposes them to gastroesophageal regurgitation (GER). To drain GER and prevent aspiration, nasogastric (NG) tubes are frequently inserted in obese patients undergoing general anesthesia. However, whether gastric drainage actually decreases the occurrence of GER remains to be elucidated. In this study, increased abdominal pressure was simulated with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning, while the retained NG tube was replaced by a pre-inserted esophageal multichannel intraluminal and pH (MII-pH) monitoring. Fifteen patients undergoing elective gynecologic laparoscopy were enrolled in this study. Thirteen patients (86%) developed GER while in the LPT position. With the high occurrence of GER, pre-inserted NG tubes under general anesthesia are not likely to be protective in obese patients.

Background: The aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the effects on key swallowing muscles, including the upper esophageal sphincter (UES). Methods: We randomly assigned patients undergoing ACDF to either the corticosteroid group or the saline solution group. Patients received 10 mg of local triamcinolone or saline solution prevertebrally at the cervical spine level before wound closure. Swallowing function preoperatively and at 1 month postoperatively were compared between the groups with use of HRIM parameters (e.g., UES relaxation, UES opening extent, intrabolus pressure, and pharyngeal contraction) and EAT-10 scores. Patients were also followed for postoperative complications and mortality within 12 months after surgery. Results: Thirty patients completed the study. The median age was 55 years in the corticosteroid group and 57 years in the saline group, and each group had 8 female patients. All participants were Taiwanese. We found no significant difference in median preoperative UES relaxation pressure between the corticosteroid and saline solution groups (33.8 and 31.3 mm Hg, respectively; p = 0.54). Postoperatively, the corticosteroid group had significantly lower median UES relaxation pressure than the saline solution group (24.5 versus 33.6 mm Hg; p = 0.01). Before and after surgery, all other HRIM parameters and EAT-10 scores were similar between the groups, with the corticosteroid group demonstrating median pre- and postoperative EAT-10 scores of 0 and 4, respectively, and the saline solution group demonstrating scores of 2 and 3, respectively. There were no adverse events. Conclusions: The findings suggest that local corticosteroids may reduce UES relaxation pressure at 1 month after ACDF, potentially enhancing UES opening. Further research is required to verify our findings. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying.

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