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PubMed2007

Comparison of the GlideScope video laryngoscope vs. the intubating laryngeal mask for females with normal airways.

BACKGROUND AND OBJECTIVE: In this randomized clinical study, we compared the intubation success rates of the intubating laryngeal mask airway with the GlideScope in patients with normal airways. The primary hypothesis was that the intubating laryngeal mask airway was equally effective as the GlideScope in terms of successful intubation times. METHODS: Sixty ASA I and II adult patients undergoing elective gynaecological surgery were randomly allocated into either the intubating laryngeal mask airway group or the GlideScope group. After a standard anaesthetic intravenous induction, orotracheal intubation was performed. Time taken for successful tracheal intubation, ease of device insertion, difficulty of tracheal intubation, manoeuvres needed to aid tracheal intubation, number of intubation attempts, haemodynamic changes every 2.5 min interval for 5 min and complications during tracheal intubation were recorded. RESULTS: Time to successful intubation was longer (mean 68.4 s +/- 23.5 vs. 35.7 s +/- 10.7; P < 0.05), mean difficulty score was higher (mean 16.7 +/- 16.3 vs. 7.3 +/- 13.1; P < 0.05) and more intubation attempts were required in the intubating laryngeal mask airway group. CONCLUSION: The GlideScope improved intubation time and difficulty score for tracheal intubation when compared with the intubating laryngeal mask airway in our patients. Blind intubation through the intubating laryngeal mask airway offers no advantages over the GlideScope in patients with normal airways. Despite its limitations, the intubating laryngeal mask airway is a valuable adjunct, especially in cases of difficult airway management when it can provide ventilation in between intubation attempts.

Adult↗
PubMed2001

Tracheal intubation through the intubating laryngeal mask in patients with unstable necks.

BACKGROUND: In patients with unstable necks, the neck should be stabilized during induction of anaesthesia, but this may make tracheal intubation difficult. Awake intubation may produce straining, which could be detrimental to the unstable neck. METHODS: We studied 20 patients with unstable necks to examine the efficacy of insertion of the intubating laryngeal mask under conscious sedation (to minimize the possibility of losing a patent airway and to facilitate fibrescope-aided intubation) followed by tracheal intubation through the laryngeal mask after induction of anaesthesia (to reduce stress response to intubation). After the patient had been sedated with midazolam (up to 5 mg) and fentanyl (up to 100 microg), the intubating laryngeal mask was inserted. General anaesthesia was then induced with sevoflurane and tracheal intubation attempted. RESULTS: In all patients, tracheal intubation through the laryngeal mask succeeded without airway obstruction. Neither insertion of the mask under conscious sedation nor tracheal intubation after induction of anaesthesia caused straining, and only two patients moved upper extremities at intubation. Insertion of the laryngeal mask did not significantly alter blood pressure or heart rate. Tracheal intubation significantly increased blood pressure and heart rate, but the increase was considered to be small. CONCLUSIONS: In the patient with an unstable neck with a low risk of pulmonary aspiration, insertion of the intubating laryngeal mask while the patient is sedated may minimize difficulty in obtaining a patent airway before tracheal intubation and may facilitate a fibrescope-aided tracheal intubation; subsequent induction of anaesthesia before tracheal intubation may minimize stress response to intubation.

Adult↗
PubMed1976

Visual masking during pursuit eye movements.

In three experiments, targets and masking stimuli were briefly flashce while observers visually tracked a moving dot. Masking stimuli were more effective when they appeared to be in the same place as the target but stimulated different parts of the retina than when they stimulated the same parts of the retina but appeared displaced because of of an intervening pursuit eye movement. Visual masking during pursuit eye movements thus depended on the apparent position of the stimuli, not their retinal positions as such, which is in disagreement with previous studies of visual masking during saccadic eye movements. The apparent conflict can be explained in terms of the functional significance of visual masking in tracking and saccardic movements: Retinal position masking after saccadic eye movements may erase previous images, and apparent position masking during pursuit eye movements may make moving targets more visible.

Eye Movements↗
PubMed1998

Beyond the attentional blink: visual masking by object substitution.

If 2 targets are to be identified among distractors displayed in rapid sequence, correct identification of the 1st target hinders identification of the 2nd. To obtain this attentional blink (AB), the 1st target must be masked with a simultaneous (integration) or a delayed (interruption) mask indifferently. In 3 experiments, it was shown that the 2nd target must also be masked, but that the precise form of masking is important: An AB occurs with interruption but not with integration masking. This nonequivalence of masking paradigms parallels that found in studies of masked priming, a phenomenon arguably related to the AB. The results are explained by a revised 2-stage model (M. M. Chun & M. C. Potter, 1995).

Adult↗
PubMed1978

Perception and masking of wholes and parts.

These exerpiments show that the effects of masking on reports of target lines depend on the context in which the target lines appear. Subjects viewed brief presentations of target lines either alone or in drawings of three-dimensional objects, and each target display was preceded and followed by one of several different mask stimuli. There were two main findings: (a) A mask containing a haphazard array of lines interfered more with single lines than it did with lines in objects. (b) A mask containing drawings of the object displays interfered more with lines in objects than did either of two control masks containing relatively flat, less coherent patterns. In a control condition, the object mask interfered slightly less with reports of single lines than either of the control masks did. The discussion considers how the effects obtained here bear on models of the processing of wholistic stimuli and their component parts.

Discrimination, Psychological↗
PubMed1982

Recognition masking-level differences for 10 CID W-1 spondaic words.

Psychometric functions for the S omicron N omicron and S pi N omicron conditions and masking level differences were obtained for a subgroup of 10 words having the largest masking-level differences of 36 CID W-1 spondaic words. The mean masking-level difference obtained from 36 young normal adults was 9.4 dB with a standard deviation of 1.2 dB. The smallest masking-level difference of 7.4 dB was suggested as the low cut-off for normalcy. A shorter version of the masking-level difference procedure was suggested for clinical implementation. The subgroup of 10 words may permit a wider separation between normal and abnormal performance, and thus may enhance the clinical utility of the masking-level difference task for speech recognition. Because the magnitude of the masking-level difference will vary with the materials and procedures used, each clinic must establish its own norms.

Adult↗
PubMed1997

Modulation masking in listeners with sensorineural hearing loss.

This study compares amplitude-modulation (AM) masking in listeners with normal hearing and in listeners with a hearing loss. To address this issue, we measured the detection of sinusoidal AM applied to a white noise carrier, as a function of the frequency of a masking sinusoidal AM applied to the same noise carrier. These input filter patterns were measured for four listeners with normal hearing and three listeners with moderate or mild-to-severe sensorineural hearing losses. Stimuli were presented at 50 dB SL for all listeners with normal hearing and for two of the three listeners with hearing loss. The third listener with hearing loss was tested at 25 dB SL. For the listeners with normal hearing, the input filter patterns obtained for 100-Hz signal modulation had a broad bandpass characteristic. All input filter patterns showed a primary masking peak at 100 Hz. A secondary masking peak was apparent also at 50 Hz. For the listeners with impaired hearing, the unmasked modulation thresholds were similar to those measured in the listeners with normal hearing. One listener with a moderate hearing loss exhibited a broadly tuned input filter pattern with a masking peak at 100 Hz, but no secondary peak. The two other listeners with moderate or mild-to-severe sensorineural hearing loss showed no main masking peak and increased thresholds at low masker modulation frequencies. These results suggest that cochlear damage may affect performance in a modulation masking task.

Adult↗
PubMed2002

Efficacy of the ProSeal laryngeal mask airway during manual in-line stabilisation of the neck.

The laryngeal mask airway has a potential role during cardiopulmonary resuscitation, but its placement becomes more difficult during manual in-line stabilisation of the neck, and the device cannot reliably prevent pulmonary aspiration. The ProSeal laryngeal mask airway has a theoretical advantage of reducing aspiration because of its drainage tube, but its ease of placement during stabilisation of the neck is unknown. We studied 20 patients to compare ease of placement and the sealing effect between the standard and ProSeal laryngeal mask airways. In a randomised cross-over fashion, after induction of anaesthesia and neuromuscular blockade, the standard and ProSeal laryngeal mask airways were placed in turn. Placement was significantly easier for the ProSeal laryngeal mask airway (successful at the first attempt in 16 patients and at the second attempt in the remaining four patients) than for the laryngeal mask airway (successful at the first attempt in 12 of 20 patients and at the second attempt in three patients, and failed (> two attempts) in the remaining five patients; p = 0.04). The airway pressure at which gas leaked around the device was greater for the ProSeal than the laryngeal mask airway (mean difference 5.8 cmH2O; 95% CI 2.9-8.7 cmH2O; p = 0.0008).

Adolescent↗
PubMed1999

Light-guided tracheal intubation using a prototype illuminated flexible catheter through the intubating laryngeal mask.

We evaluated the efficacy of a newly developed prototype illuminated flexible catheter to facilitate tracheal intubation through the intubating laryngeal mask and compared this light-guided technique with the conventional blind tracheal intubation through the intubating laryngeal mask. The illuminated flexible catheter consists of a completely flexible thin plastic catheter, a bulb attached to its distal end, a 15-mm concentric adapter at its proximal end connected with a battery and a power switch. The device is placed into a silicone tracheal tube in such a way that the bulb protrudes from the distal end of the tracheal tube. One hundred adult patients, ASA I-III, scheduled to undergo propofol/fentanyl/atracurium anaesthesia for elective surgery were studied. All participants underwent a randomized double comparative cross over trial with respect to the tracheal intubation technique through the intubating laryngeal mask. The light guided tracheal intubation was performed as follows; the tracheal tube preloaded with the illuminated flexible catheter was inserted through the intubating laryngeal mask and by observing the glow in the neck was advanced into the trachea. Whenever resistance was felt during insertion, appropriate adjusting manoeuvres were performed. The intubating laryngeal mask was inserted successfully in all patients. The success rate for the blind and light-guided technique was 91% and 100%, respectively (P = 0.003). The mean (+/- SD) duration including appropriate intubating laryngeal mask placement and tracheal intubation, was significantly lower in the light-guided tracheal intubation technique, than with the blind tracheal intubation (31 +/- 8 s vs. 43 +/- 18 s; P < 0.0001). We conclude that the use of an illuminated flexible catheter carries advantages either in optimizing the intubating laryngeal mask position in the laryngopharynx or in achieving a quick and safe light-guided advancement from laryngopharynx into the trachea.

Adult↗
PubMed2001

Minimal-flow anaesthesia with controlled ventilation: comparison between laryngeal mask airway and endotracheal tube.

BACKGROUND AND OBJECTIVE: Minimal- and low-flow anaesthesia (fresh gas flow below 1 L min(-1)) provide many advantages, including reduced cost, conservation of body heat and airway humidity. An airtight seal is essential between the airway device and the airway of the patient. Therefore, we investigated whether the airtight seal created by a laryngeal mask airway allows controlled ventilation of the lungs when the fresh gas flow is reduced to 0.5 L min(-1) and compared this with an endotracheal tube. METHODS: In a prospective clinical study, 207 patients were managed using a laryngeal mask or an endotracheal tube. After intravenous induction of anaesthesia and 15 min of high fresh gas flow, the flow was reduced to 0.5 L min(-1). The breathing system was monitored for airway leaks, and the patients were assessed for complications after airway removal and postoperative discomfort. RESULTS: Both the laryngeal mask and endotracheal tube allowed fresh gas flow reduction to 0.5 L min(-1) in 84.7% and 98.3% of cases respectively (small leaks: 12% laryngeal mask, 1.7% endotracheal tube). Three patients with the laryngeal mask (3.3%) had airway leaks that were too large to permit any reduction in the fresh gas flow. CONCLUSIONS: The use of the laryngeal mask airway was more likely to be associated with a gas leak than use of an endotracheal tube; however, if modern anaesthesia machines and monitors are used, in 96.7% of the patients managed with a laryngeal mask a reduction in the fresh gas flow to 0.5 L min(-1) was possible. The incidence of coughing and postoperative complaints (sore throat, swallowing problems) was higher after use of an endotracheal tube.

Adolescent↗
PubMed1982

A note on the masking of pictures.

An experiment is described in which photographs of everyday objects were masked by frequency-filtered random visual noise. The masking functions obtained were of the same type as those obtained by masking letters and words with random noise or a pattern mask. That is, the high-frequency mask produced a type A function while the low-frequency mask produced a type B function. This result is discussed in terms of the general applicability of models of visual information processing constructed on the basis of experiments with letter or word stimuli. It is suggested that spatial-frequency concepts may usefully be employed to describe the relevant features of different types of mask.

Female↗
PubMed1989

Anatomy of a flash. 1. Two-peak masking and a temporal filling-in.

A modified paradigm of Crawford masking was used to link masking to brightness fluctuation, as distinct from flash brightness. Thresholds were measured for a 10 ms incremental pulse (the 'probe') presented before, during, or after a 500 ms pulse (the 'flash'). Both pulses were spatially coextensive with the background field, thus the criterion for probe detection was purely temporal. The flash occurred either in the tested eye, the opposite eye, or in both eyes. In all conditions, masking was strongly bimodal: thresholds peaked near flash onset and flash offset. The flash was perceived as a unitary event. Bimodal masking is attributed to cortical on-and off-effects, as (i) dichoptic masking was strong and (ii) the same incremental probe was masked by either incremental or decremental flashes. Strikingly, monocular probe thresholds were about equally elevated by binocular as by monocular flashes, although the binocular flashes were brighter. Therefore, some monocular features can be preserved in the larger net binocular response. A general conclusion is that masking depends on the same transient neural responses that bring about a brightness fluctuation, whereas the appearance of the flash as a single event, a unitary change of brightness, depends on a different mechanism, perhaps a sustained response that performs a temporal filling-in.

Attention↗
PubMed1993

Masking, information integration, and tactile pattern perception: a comparison of the isolation and integration hypotheses.

Two competing models of the effects of pattern element proximity, masking, and perceptual integration on the discriminability of spatiotemporal vibrotactile patterns are compared. Kirman's 'integration hypothesis' predicts that pattern perception is facilitated by a process of perceptual integration which requires that pattern elements be presented in close spatial and temporal proximity. Conversely, the 'isolation hypothesis' predicts that the strong masking effects which occur when pattern elements are presented in close proximity impede the perception of patterns. Traditional masking studies do not provide a fair test of these two hypothesis because they rely on methods that measure the subject's ability to identify the target when the target is presented in conjunction with the mask, rather than the discriminability of the complex percept resulting from the integration of the target and mask. To account for this, a new procedure was devised where the amount of interelement masking and the discriminability of the pattern as a whole were measured independently as the spatial and temporal separation of the pattern elements were varied. As expected under both hypotheses, masking between pattern elements increased as either the spatial or the temporal separation between them was decreased. The pattern discrimination data also support the isolation hypothesis in that the patterns were discriminated less well with increasing temporal element separation with a similar but nonsignificant trend in the case of spatial separation. It is concluded that this new methodology should be applied to a wider range of tactile pattern processing situations in order to assess the generality of the results obtained.

Adult↗
PubMed1995

Cortical correlate of pattern backward masking.

The perception of a briefly presented shape is strongly impaired when it is followed by another pattern, a phenomenon called backward masking. We found that the vast majority of a sample of shape-selective neurons in the macaque inferior temporal cortex respond selectively to backward-masked shapes, although these shapes could not be discriminated by human and monkey subjects. However, this selective response was brief, since it was either interrupted by the mask or overridden by a response to the mask itself. We show that reliable discrimination of briefly presented shapes by single neurons depends on the temporal integration of the response. Presentation of the mask, however, reduces the number of spikes available for integration, explaining backward masking. These results also provide direct neurophysiological evidence for the "interruption theory" of backward masking.

Action Potentials↗
PubMed1995

Cricoid pressure impedes placement of the laryngeal mask airway.

We have studied 22 patients to examine whether or not cricoid pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without cricoid pressure applied with a standardized force of 30 N using a cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient's occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no cricoid pressure was applied, but in only three of 22 patients when cricoid pressure was applied (P << 0.001; 95% confidence interval (CI) 0.72-1.0). The mask was positioned correctly in 18 patients when no pressure was applied, and in none after application of cricoid pressure (P << 0.001; 95% CI 0.66-0.98). We had planned to study, in an additional 20 patients, the effect of cricoid pressure without a pillow under the occiput; placement of the mask, however, was difficult even when cricoid pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when cricoid pressure was applied. We conclude that when sufficient force was applied, cricoid pressure, regardless of the method of application, did impede placement of the laryngeal mask.

Adult↗
PubMed1996

Detection of tastes in mixture with other tastes: issues of masking and aging.

When one taste (masker) is strong enough, it can completely mask another task (target) of different quality. How strong the masker must be to do this depends on how strong the target is. As the target concentration is increased, the masking concentration must be increased, too, but in ever-increasing proportion. To quantify the conditions for such complete masking, the target's detection threshold was measured as a function of the masker's concentration, from zero to strong. This was done for 12 binary combinations of sucrose, sodium chloride, citric acid and quinine hydrochloride. The 12 functions generated show that some tastants mask each other much more efficiently than others. Masking gives new insight into the role of aging in taste: older (66-90 years) subjects' thresholds, regardless of masking concentration, always measured a constant factor higher than younger (18-29 years) subjects' thresholds (about two to seven times higher, depending on target tastant). Thus, with increasing level of the masker, the thresholds of young and elderly go up in parallel. Thresholds of tastants in water alone are false predictors of elderly persons' ability to perceive ingredients like salt and sugar condiments in foods, where, because of masking, their thresholds can be several times higher than in water. Age manifested itself relatively mildly in sucrose and citric acid, moderately in sodium chloride, and strongly in quinine hydrochloride.

Adolescent↗
PubMed1997

The laryngeal mask airway: a comparison between two insertion techniques.

UNLABELLED: The purpose of the study was to compare the ease of insertion of the laryngeal mask airway using the standard uninflated approach or with a fully inflated cuff. Two hundred consecutive patients undergoing anesthesia using a laryngeal mask airway were randomized to have the laryngeal mask inserted using either method. Successful insertion was judged primarily by the clinical function of the airway. The number of insertion attempts to achieve a satisfactory airway and whether an alternative technique was required for success were recorded. On removal of the laryngeal mask, a blind observer noted the presence or absence of blood. Just before leaving the recovery room, each patient was asked whether they had a sore throat. Insertion technique made no difference with regard to first attempt success. However, the presence of blood on the removed masks (P < 0.01) and sore throat (P < 0.01) were less frequent in the inflated cuff group. We conclude that the inflated cuff insertion technique is an acceptable alternative to the standard approach and has the advantage of reducing the incidence of minor pharyngeal mucosal trauma, as evidenced by mucosal bleeding and sore throat. IMPLICATIONS: Insertion of the laryngeal mask airway with the cuff fully inflated is equally successful to the standard uninflated approach in experienced hands. The inflated technique was associated with less minor pharyngeal mucosal trauma and, consequently, a lower incidence of postoperative sore throat. This implies that the inflated technique would be acceptable to the general population of laryngeal mask users.

Anesthesia↗
PubMed1994

The laryngeal mask airway and positive-pressure ventilation.

BACKGROUND: The utility of the laryngeal mask airway during positive-pressure ventilation has yet to be determined. Our study was designed to assess whether significant leaks occurred with positive-pressure ventilation and if leaks were associated with gastroesophageal insufflation. METHODS: Forty-eight patients undergoing elective surgery were studied. After induction of anesthesia and paralysis, controlled ventilation was used with four different peak pressure settings in each patient (15, 20, 25, and 30 cmH2O). The order of ventilator pressure settings was assigned from a randomized block schedule. Data collected included inspiratory and expiratory volumes, qualitative assessments of gastroesophageal insufflation, and leak at the neck. After data collection during laryngeal mask use, the anesthesiologist intubated the trachea and measurements were repeated for tracheal tube ventilation. Leak was calculated by subtracting the expiratory from the inspiratory volume and expressed as a fraction of the inspiratory volume. RESULTS: Ventilation with the laryngeal mask airway was adequate at all ventilation pressures and comparable with tracheal tube ventilation. Leak fraction (mean +/- SD) at 15, 20, 25, and 30 cmH2O for laryngeal mask ventilation were 0.13 +/- 0.15, 0.21 +/- 0.18, 0.25 +/- 0.16 and 0.27 +/- 0.17, respectively, and 0.03 +/- 0.03, 0.05 +/- 0.03, 0.05 +/- 0.03 and 0.04 +/- 0.03, respectively, for tracheal tube ventilation. Leak fractions for ventilation with the laryngeal mask were consistently greater than those measured for tracheal tube ventilation at similar ventilation pressures. Leak fraction with laryngeal mask ventilation increased with increasing airway pressures, whereas leak with tracheal tube ventilation remained unchanged. The frequency of gastroesophageal insufflation ranged from 2.1% at a ventilation pressure of 15 cmH2O to 35.4% at 30 cmH2O. CONCLUSIONS: Ventilation using the laryngeal mask appears to be adequate if airway resistance and pulmonary compliance are normal. Gastroesophageal insufflation of air will become a problem in the presence increased ventilation pressure.

Adolescent↗