Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position
Bibliographic record
Abstract
PURPOSE: Unintentional extubation of the trachea while the anesthetized patient is in the prone position is a potentially life-threatening situation that is usually managed by turning the patient supine for emergent re-intubation. However, this approach may delay definitive airway management and lead to irreversible complications. This review evaluates the efficacy of insertion of a laryngeal mask airway device (LMAD) with the patient in the prone position as a rescue method in airway management for unintentional tracheal extubation. PRINCIPAL FINDINGS: We searched MEDLINE and EMBASE databases in the English language for the period 1980 to October 2009 in order to identify observational studies and case reports describing insertion of the LMAD with the patient in the prone position. We found 12 such articles (n = 526 patients) consisting of four retrospective studies, one prospective cohort with a control group, one non-controlled prospective study, and six case reports. On the first attempt, the LMAD was inserted successfully in 87.5-100% of the patients involved in the included reports. On the second attempt, the LMAD was inserted successfully in all patients, with or without laryngoscopy. Ventilation was maintained successfully in the lungs of 83.3-100% of the patients involved in the reported articles. Following insertion of the LMAD with patients in the prone position, the most common complications reported were sore throat, bleeding, bradycardia, and laryngospasm. CONCLUSIONS: Cumulative experience from published reports suggests the feasibility of placing the LMAD with the patient in the prone position in the elective setting; however, the evidence is lacking regarding the use of this method for emergency management of unintended tracheal extubation with the patient in the prone position.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".