Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : UC01 - UC05 Full Version

Baska Mask in Patients undergoing Elective Breast Surgeries under General Anaesthesia: An Observational Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53380.16986
ND Rachana, NS Shruthi, Vijay Mahantesh, CS Sumitha, VB Gowda, Namrata Ranganath

1. Associate Professor, Department of Anaesthesia and Pain Relief, Kidwai Cancer Institute, Bangalore, Karnataka, India. 2. Senior Resident, Department of Anaesthesia and Pain Relief, MS Ramaiah Medical College, Bangalore, Karnataka, India. 3. Senior Resident, Department of Critical Care, Manipal Hospital, Bangalore, Karnataka, India. 4. Associate Professor, Department of Anaesthesia and Pain Relief, Kidwai Cancer Institute, Bangalore, Karnataka, India. 5. Professor and Head, Department of Anaesthesia and Pain Relief, Kidwai Cancer Institute, Bangalore, Karnataka, India. 6. Professor and Ex Head, Department of Anaesthesia and Pain Relief, Kidwai Cancer Institute, Bangalore, Karnataka, India.

Correspondence Address :
Dr. CS Sumitha,
Kidwai Cancer Institute, Dr. M.H. Marigowda Road, Bangalore-560029, Karnataka, India.
E-mail: cssumitha@yahoo.com

Abstract

Introduction: Supraglottic airway devices are newer safer alternative devices to endotracheal intubation during General Anaesthesia. The Baska mask is a novel third generation Supraglottic Airway Devices (SADs) with an added advantage of silicon self-recoiling, non inflatable cuff. Postgraduate trainees will need hands on training in all available airway securing devices and have experience in using the Baska mask and also complications associated with it.

Aim: To assess the successful insertion of Baska mask by postgraduate trainees, and its placement in 50 low-risk female patients posted for breast surgeries, and also to determine the correct placement using fibreoptic bronchoscope.

Materials and Methods: The present study was an observational study conducted at Kidwai Cancer Institute, Bangalore, Karnataka, India from January 2019 to January 2020 in which a total of 50 study participants were selected, and Baska mask was inserted by postgraduate trainees in all patients. The placement of the mask was assessed by fibreoptic bronchoscope using Brimacombe scoring. Ease of insertion, time required for insertion and attempts required for the insertion of the mask was assessed along with postoperative complications. Student’s t-test and Chi-square test were used to study the parameters on continuous scale and categorical scale, respectively.

Results: The mean age of the study population was 46.9±7.8 years. The overall success rate for device insertion was 96%, while the success rate for the first insertion attempt was 60%. The device was ‘easy’ to insert among 48% of patients, and mean time required for insertion was 20.54±10.7 sec. The mean airway leak pressure was 39.17 cmH2O. Postoperative complications were notably less with sore throat seen in 20.8%, and the incidence of other side-effects like laryngospasm was nil.

Conclusion: Baska mask can be successfully and safely used by postgraduate trainees as a tool for securing the airway. As learning curve for Baska mask is short, it can be used safely for training postgraduate trainees and to improve their expertise in using the Baska mask.

Keywords

Brimacombe scoring, Fibreoptic bronchoscope, Trainees

Securing the airway during general anaesthesia is achieved with endotracheal intubation most of the times. Invention of SADs have brought revolutionary changes in airway management during general anaesthesia, both in spontaneously breathing patients and also in controlled ventilation. The ideal SADs should provide high airway seal pressure with low-risk for pulmonary aspiration (1). Commonly used SADs are Laryngeal Mask Airways (LMA), I-gel, and Baska mask. The Baska mask, a third generation SAD, is made of medical grade silicon self-recoiling, non inflatable cuff. The cuff is designed in such a way that during positive pressure ventilation, the seal opposes the glottic structure and augments the seal pressure incrementally without producing the tissue compression. The sump cavity of the cuff provide separate channel for aspiration of gastric contents continuously and intermittently (2),(3). These features of the mask render the patient to have a lesser risk of pulmonary aspiration of secretions or gastric contents. The integrated bite-block reduces the chances of patients biting and blocking the airway. The extended hand-tab attached to the cuff allows the operator to flex the device during the insertion. Insertion of the device is done in a head neutral position. Baska masks are available in four sizes and can be used based on the weight of the patients. Postgraduate trainees need to be trained to use the available airway securing devices and get expertise in the technique and usage of the devices. Using any new device will have an initial learning curve. Postgraduate trainees need to know-how easy or difficult it is to use the Baska mask, techniques required for successful placement of the mask and the complications associated with the usage of the mask.

Most Baska mask studies have been done with trained anaesthesiologists who had used Baska mask for more than 10 times (4). Manoeuvres like jaw thrust was required for correct placement in case of difficulty in insertion. In the clinical trial by Fotedar S et al., they have found it easy to insert Baska mask in first attempt, however additional manoeuvres applied and experience of proceduralist were not mentioned (5). In a study done by Al-Rawahi SAS et al., all proceduralist involved had experience of more than 15 insertions of the mask and they were of opinion that Baska mask had significantly shorter placement time (6). Most of the studies concluded that Baska mask placement required significantly shorter placement of time and with usage of additional manoeuvres most of the placements of mask was successful. This study was taken up to observe the usage of Baska mask by the anaesthesia postgraduate trainees with regard to the ease of insertion, success rate and its placement.

Material and Methods

An observational study of Baska mask was done in Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India, from January 2019 to January 2020. The Institutional Ethical Committee (IEC) clearance was obtained (KCI/MEC/001/04.December 2018).

Sample size calculation: Sample size was calculated based on the results of a previous study. With a mean sealing pressure of 35.7 cmH2O, standard deviation of 9, and alpha error of 5%, the sample size was calculated to be 50 (7).

Inclusion criteria: Fifty patients were included in the study, between 18-60 years of age with American Society of Anaesthesiologists (ASA) I and II status for breast surgeries requiring controlled ventilation.

Exclusion criteria: Patients with difficult airway, Body Mass Index (BMI) of >20 kg/m2, patient refusal, patients with abdominal distension were excluded.

Study Procedure

After a routine preanaesthetic examination a written informed consent was taken for all the patients enrolled in the study. All patients received tablet ranitidine 150 mg and tablet alprazolam 0.5 mg the night before, and were kept nil per oral for six hours prior to surgery. Patients were connected to the standard monitors and heart rate, non invasive blood pressure (systolic and diastolic blood pressure, mean arterial pressure), Electrocardiogram (ECG), oxygen saturation were recorded. The size of the device was decided by the trainee anaesthesiologist who was inserting the device based on patients body weight and manufacturers guidelines. The Baska mask of size 3 for patients weighing 30-50 kg and size 4 for patients weighing 50-70 kg and size 5 for patients weighing >90 kg were used. Integrity of Baska mask was checked by occluding the airway opening of the connector end of the device with one thumb, holding the mask head with the other hand and placing the thumb over the airway opening of the mask to seal. Pressure was applied for five seconds to confirm there is no leak in the device (8). Under aseptic precautions, the device was lubricated with lignocaine jelly.

Basal haemodynamic parameters were recorded. Patients were premedicated with inj. midazolam 0.02 mg/kg, inj. glycopyrrolate 0.2 mg. Patients were preoxygenated for three minutes with 100% oxygen via face mask before induction. Induction was done with inj. propofol 2 mg/kg and fentanyl 1.5-2 μg/kg, and once adequate ventilation was confirmed inj. rocuronium 0.9 mg/kg was given. After 90 seconds of mask ventilation Baska mask was inserted by the postgraduate trainees (they had no previous training). When the Baska mask was inserted the mouth was kept open, the proximal and firmer part of the mask was compressed between thumb and two fingers and the mask was pushed. Whenever required, the tab was used to help negotiate the palato-pharyngeal curve, while the mask was fully inside the mouth. When the tip of the mask passed around the curve the tab was released. The mask was advanced until a resistance was felt, when the tip of the mask was engaged into the upper end of the oesophagus (8). Once placement of the device was done, the adequate ventilation was confirmed with bilateral chest rise and on auscultation bilateral air entry was equal and appearance of square wave form in capnograph (1),(9),(10). If ventilation was found to be inadequate, manipulation like gentle pushing or pulling of the device, chin lift, jaw thrust, head extension or neck flexion were considered. Reinsertion of the device by senior anaesthesiologist was considered if adequate ventilation was not achieved even after gentle manipulations. If inadequate ventilation persists even after three attempts of device insertion, endotracheal intubation was considered.

Maintenance of anaesthesia was with 33% of oxygen, 66% of nitrous oxide, 1-1.5% of isoflurane, intermittent doses of inj. rocuronium 0.06 mg/kg and Intermittent Positive Pressure ventillation (IPPV). Placement of Baska mask was confirmed by adequate ventilation, good chest rise and ETCO2 curve. After five minutes the correct placement of Baska mask was noted and confirmed using fibreoptic bronchoscope with Brimacombe Scoring (10). At the end of the surgery, anaesthetic agents were discontinued and patients residual paralysis was reversed with inj. neostigmine 0.05 mg/kg body weight and inj Glycopyrrolate 0.01 mg/kg body weight. Once patient was awake and neuromuscular recovery was adequate, the device was removed. The device was inspected for the blood staining and patients oral cavity examined for any injury. Since the study aimed at observing the usage and efficacy of the mask inserted by postgraduate trainees, six 2nd year postgraduate trainees were selected (five males and one female). All the postgraduate trainees were made to observe Baska mask insertion and were thought prior by anaesthesia consultants on different set of patients. The ease of insertion (Table/Fig 1) time and number of attempts required for insertion, oropharyngeal sealing pressure, Brimacombe Scoring (Table/Fig 2) (10) and lastly injuries and postoperative complications were noted. Time for insertion was taken as time from picking the device, to the time of confirmation of effective ventilation by observing the chest rise, bilateral air entry on auscultation and appearance of square wave form capnograph (11). Number of attempts of insertion was taken as attempts required for insertion of the device till correct placement of device was confirmed by the consultant anaesthesiologist. Oropharyngeal sealing pressure was noted at five minute postinsertion of the device (1),(10),(12). Using closed circuit in DRAGER FABIUS machine keeping the flow rate at 5 L/min, the adjustable pressure limiting valve of the circle system are completely closed (70 cmH2O). The plateau pressure at which an audible noise was detected using a stethoscope placed just lateral to the thyroid cartilage was taken as the airway leak pressure. Maximum airway pressure limit allowed was 50 cmH2O. Haemodynamic parameters (HR, SBP, DBP, MAP, SpO2 and EtCO2) were recorded at basal, after induction of anaesthesia, after insertion of the device and every 5 minutes till 15 minutes after insertion of the device. The patients were inspected for any injury of the lips, teeth, or tongue, and device for any blood stain after its removal at the end of the surgery. Postoperative complications (sore throat, hoarseness of voice, and dysphagia) were looked for at two hours (Table/Fig 3) (13).

Statistical Analysis

The R statistical software was used for analysis of the data and Microsoft Word and Excel to generate graphs and tables. Descriptive statistical analysis was carried out in the present study. Results on categorical measurements presented in numbers (%) and results on continuous measurements are presented on Mean±Standard Deviation. Student’s t-test was used to find the significance of the study parameters on continuous scale and Chi-square test has been used to find the significance of study parameters on categorical scale. The p-value <0.05 was considered as significant.

Results

Demographic details of the patients are depicted in (Table/Fig 4). The minimum age was 24 years, and the maximum was 60 years, with mean age being 48.28±10.31 years. The mean body weight was 59.04±10.060 kg, and the mean BMI was 22.94±3.91 kg/m2.

(Table/Fig 5) shows the attempts of insertion. In 30 patients (60%) the mask was successfully inserted on the first attempt, while in two (4%) it was impossible. The overall success rate of the Baska mask insertion was 96%.

Time taken for insertion of Baska mask is depicted in (Table/Fig 5). The mean duration of successful insertion of Baska was 20.54 seconds, and first Baska mask insertion was of 35.5 seconds duration. Initial attempts in insertion of Baska mask took a little longer time but no more than 40 seconds. Oropharyngeal seal pressure is depicted in (Table/Fig 6). The mean oropharyngeal seal pressure was 39.17 cmH2O. Over period of time the seal pressure reached upto 50 cmH2O, where the testing was stopped as per protocol.

During positive pressure ventilation, audible leak from the mask was heard in 10 of 48 patients and among them five were in the first 10 recruited patients. Of these 10 patients, only three had persistent audible leak after five minutes of insertion which indicates that cuff seal pressure improved over time. Ease of insertion grading was as seen in (Table/Fig 7). In 24 (48%) patients it was found that the device was easy to insert, and in 17 (34%) it was easy to insert with slight difficulty, and in only 2 (4%) it was impossible to insert and had to be intubated to secure the airway.

Fibreoptic evaluation of Baska mask placement was evaluated using Brimacombe scoring. In 35 (72.9 %) patients 75-100% rima glottidis was seen and the mean score was found to be 70% through the Fibreoptic bronchoscope with the Baska mask in-situ (Table/Fig 8).

Haemodynamic parameters are depicted in the (Table/Fig 9), (Table/Fig 10). Mean heart rate and mean arterial pressures showed no statistical significance.

In 10 patients with Baska mask insertion airway injuries were noted (blood stain on the device). No other injuries were noted. Among 10 patients who had sore throat, six patients had Grade 1 degree of sore throat. Hoarseness of voice and Dysphagia were not seen in any patients (Table/Fig 11).

Discussion

This study was conducted to know the ease of Baska mask usage and placement by anaesthesia postgraduate trainees. The study was conducted with postgraduate trainees because trainees should know-how to use the available airway devices to secure the airway. Also, they should have sufficient hands-on training in insertion of the device and correct placement of the device. They should have a knowledge also on to deal with the complications that can arise in using these new devices and also to learn the techniques required in correct placement of the device. During placement of the device in the initial few patients, the time to insert the device was more, and it required manoeuvring techniques. Successful insertion of the Baska mask by trainees in first attempt was 60%, with an overall success rate being 96%. Among these, ease of insertion was ‘easy’ in 48% of patients and ‘slight difficult’ in 34% requiring manoeuvres in insertion. In a similar study done on Baska mask, in 50 adult patients requiring surgical intervention, overall ‘easy’ to ‘very easy’ insertion rate was 92%, and first attempt success rate was 88% (9).

Manoeuvres like compressing the proximal, firmer part of the mask between thumb and fingers and by pulling the hand tab attached to the cuff changed the degree of flexion of the device along with neck movements facilitating an easier insertion. The mean insertion time of 20.54 seconds indicates that Baska mask can be safely and easily used in patients to secure the airway by postgraduate trainees however more studies are required in obese patients. In another study, the mean insertion time was 23.9 seconds, which was almost similar to the present study (10). The time required to insert the mask depends on the expertise of the investigator and the ease of insertion is influenced by the patient factors. Mean airway sealing pressure was 39.17 cmH2O with maximum being 50 cmH2O. The shape of the Baska mask cuff, self-inflatable property, and its recoiling property provides a good sealing pressure and effective ventilation during positive pressure ventilation. Similar airway sealing pressure of 42.46 cmH2O was noted in a study of 100 patients posted for short duration surgeries including laparoscopic surgeries. This shows that Baska mask gives adequate sealing pressure and can be safely used (12). In a study done on 100 patients posted for laparoscopic surgeries, they found that mean airway seal pressure was 33.54 cmH2O which corelates well with present study value (14). Brimacombe scoring of fibreoptic visualisation of anatomic position of the mask in-situ showed grade 1 in 72.9% of patients. Better the Brimacombe grading, airway sealing pressures are better however, ventilation was not compromised in any grades. Grade 5 was seen during initial attempts of insertion and in one difficult insertion of the mask. Another study, on 100 patients posted for surgery, revealed that 78% patients had grade 1 Briacombe grading, and there was no compromise in ventilation among any grades (12).

Low incidence of postoperative complications were noted in other studies on Baska Mask (10),(12). In a similar study, airway injuries were noted in 5% of patients and mild sore throat was noted in 15% of patients in the immediate postoperative period (13). In this study, 20% of patients had airway injuries which was noted as blood stain in the device. This can be attributed to difficult insertion and the learning curve for postgraduate trainees. Postoperative complications like hoarseness of voice and dysphagia were not seen in any patients but sore throat was noted in 20.8% of the patients in immediate postoperative period. This is a major advantage over other supra glottic devices. Same postoperative complications like sore throat, dysphagia and dysphonia were evaluated in a similar study and the incidence was found to be low (15).

The advantages of this device are, firstly, placement of device could be improvised with repeated usage and it required a shorter learning curve. Secondly, leak around the mask gradually decreased over the period of time with positive pressure ventilation. This was mainly due to improvement of cuff seal with glottic opening with each positive pressure ventilation. Thirdly, presence of suction port helps in aspiration and drainage of secretions. With greater airway seal pressure because of the cuff, it provides good ventilation and also protects against aspiration of gastric contents and separate channel for drainage of secretions, which makes Baska mask better among the available SADs. Difficulties encountered with Baska mask was particularly with respect to the number of attempts required for the insertion of Baska mask initially and also with the correct depth of placement of Baska mask. Positioning of the cuff with good oropharyngeal seal pressure and also manoeuvres to minimise the leak. All these were mainly because of lack of expertise by the postgraduate trainees in usage of Baska mask. These difficulties can also be attributed to the patient related factors, like, large tongue, inadequate relaxation, improper positioning of the patient and dentition. In one of the study done on Baska mask insertion on 30 patients they found similar difficulties like difficult insertion in earlier attempts, repeated adjustment to get good seal and insufficient depth of insertion (7). In a study where Baska mask and I-gel was used for procedures requiring general anaesthesia it was found that they experienced difficulties in placing the device, but it became better with the use of muscle relaxants. (16). Repeated attempts were required for insertion of Baska mask in a study done on patients posted for laparoscopic surgeries (17). In yet another study on 150 patients, Baska mask was difficult to insert, requiring more insertion attempts and taking longer time to insert, however, expertise of the person inserting Baska mask was not mentioned (17). Based on the literature review it can be concluded that Baska mask is safe and can be easily used by postgraduate trainees. It also has a short learning curve.

Securing an airway as early as possible is the top priority for anaesthesiologists. The second major concern is to prevent aspiration and have good effective ventilation under general anaesthesia. Lastly, devices used for securing the airway should have minimal postoperative morbidity. Baska mask ensures good patient comfort, easy compliance and less learning curve by the user. All these properties make Baska mask a safe alternative to endotracheal intubation.

Limitation(s)

The haemodynamic parameters have not been assessed for the entire duration of surgery and at the time of removal of Baska mask. The future scope of this study includes the evaluation of the Baska mask in cases of emergency situation and its usage in patients with anticipated and unanticipated difficult airway. Further Baska mask usage in obese patients and in patients undergoing laparoscopic surgeries can be evaluated separately. The other major limitation was the cost factor of Baska mask and also that it cannot be reused. However, with introduction of reusable masks this limitation can be taken care of.

Conclusion

Baska mask is one of the supraglottic device which is easy to insert, provides effective ventilation and causes least complications intraoperatively and postoperatively. Baska mask also avoids injuries caused by laryngoscopy and intubation. Learning curve for the usage of Baska mask is short. Hence, Baska mask can be safely used for the training purpose of anaesthesia postgraduate trainees. Also, because of its advantages the device can be used as a safe alternative to endotracheal intubation even during training period of postgraduate trainees.

References

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DOI and Others

DOI: 10.7860/JCDR/2022/53380.16986

Date of Submission: Nov 23, 2021
Date of Peer Review: Dec 16, 2021
Date of Acceptance: Sep 19, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 24, 2021
• Manual Googling: Aug 01, 2022
• iThenticate Software: Sep 17, 2022 (23%)

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