Comparative Analysis of Supraglottic Airway Devices in Hospital and Pre-Hospital Settings: A Narrative Review
Ayah Badawy1, Megan Elizabeth DeKok2, Zachary Dickey3*, Nina E. Musgrove4, Aleksai Pankin5, Glenn Goodwin2
1University of Pikeville - Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
2Rocky Vista College of Osteopathic Medicine, Englewood, CO, USA
3Edward Via College of Osteopathic Medicine, Monroe, LA, USA
4Lincoln Memorial University DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
5Loyola University Medical Center, Maywood, IL, USA
Introduction: A supraglottic airway device (SAD) is an airway device that is inserted into the upper airway or pharynx to allow for oxygenation, ventilation, and administering anesthesia. Among the numerous SADs available, the Laryngeal Mask Airways (LMA), I-Gel, and Air-Q are among the most widely used in both hospital and pre-hospital settings. This narrative review compares the efficacy, safety, and usability of LMA, i-Gel, and Air-Q in hospital vs. pre-hospital environments by analyzing complication rates, insertion-success rates, and other operational characteristics.
Methods: This narrative review followed a structured search strategy using PubMed and Google Scholar with predefined keywords including “supraglottic airway devices,” “LMA,” “i-gel,” “Air-Q,” and “airway device efficacy.” Sources were limited to English-language articles indexed on PubMed. Articles reviewing the LMA, i-gel, and Air-Q were published between 2008 and 2024.
Results: The results demonstrate distinct advantages for each device corresponding to specific clinical scenarios. The LMA remains versatile and reliable for general use. The i-gel offers lower complication rates, including a postoperative sore throat (POST) rate of approximately 5–8%, compared to 10–15% for the LMA and 12–15% for the Air-Q. The Air-Q excels as an intubation conduit, making it ideal for difficult airways requiring endotracheal tube (ETT) passage. Postoperative sore throat was the most common adverse event across all three devices.
Conclusion: The LMA, i-gel, and Air-Q are all effective SADs with unique attributes. Device selection should be guided by clinical objectives, patient population, safety priorities, and practitioner experience. Further research, particularly in pediatric and high-risk populations, is warranted to refine their applications.
DOI: 10.29245/2768-5365/2026/2.1175 View / Download PdfThoracic Segmental Spinal Anesthesia: Advancing Sustainable Practices in Perioperative Care
Naresh Wamanrao Paliwal1, Imran Ahmed Khan2*
1Department of Anesthesiology, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra, India
2Department of Community Medicine, KMC Medical College and Hospital, Maharjganj, UP, India
The healthcare sector contributes substantially to global greenhouse gas emissions, with anesthetic practices representing a notable source due to the use of volatile anesthetic agents, high fresh gas flows, and disposable medical equipment. As healthcare systems increasingly strive to integrate sustainability into clinical practice, environmentally friendly anesthesia techniques have gained attention. Thoracic Segmental Spinal Anesthesia (TSSA) is an emerging regional anesthesia technique that provides targeted neuraxial blockade at thoracic levels and may serve as a sustainable alternative to general anesthesia (GA) in selected surgical procedures. By avoiding volatile anesthetics, agents with high global warming potential, TSSA has the potential to reduce direct greenhouse gas emissions associated with anesthesia delivery. Clinical literature has demonstrated the safety, feasibility, and effectiveness of TSSA in various surgical settings, with additional benefits including reduced drug requirements, faster recovery, and earlier patient mobilization. These factors suggest lower resource utilization and decreased environmental burden within operating theaters and post-anesthesia care units. However, TSSA is appropriate only for selected patients, requires advanced technical skill, and cannot broadly replace GA. TSSA therefore represents a promising strategy to advance both patient-centered care and environmentally sustainable perioperative practice pending further TSSA-specific environmental data and risk-mitigation validation.
DOI: 10.29245/2768-5365/2026/1.1174 View / Download PdfCommentary on: Dualism, Materialism, and the relationship between the brain and the mind in experiencing pain
DOI: 10.29245/2768-5365/2026/1.1173 View / Download PdfRichard Ambron
Emeritus Professor of Cell Biology, Anatomy, and Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
Ancillary Evaluation of Simultaneous Application of HIFEM and Synchronized Radiofrequency for Pain and Discomfort Reduction in the Upper and Lower Extremities
Jonathan Schoeff1*, Mohamed Abdulhamid2, Philip Saville3, Shawn Trokhan4, Pamela Levine5, Eugene Lou6
1The Longevity Lab, E Prentice Ave Suite, Greenwood Village, CO, USA
2Royal Spine Surgery, E Bell Rd, Scottsdale, AZ, USA
3Saville Spine Institute, Village Square Crossing, Palm Beach Gardens, FL, USA
4Trokhan Orthopaedics LLC, Closter Dock Road, Closter, NJ, USA
5New York Orthopedic Hand Surgery, Prospect Park West, Brooklyn, NY, USA
6Southeast Texas Orthopedic Group, Gessner Road, Houston, TX, USA
Background: Pain and discomfort in the extremities are common, yet current treatments often provide only temporary relief or are limited by adverse effects. Therapies utilizing electromagnetic field energy, with or without synchronized radiofrequency (RF), may offer a non-invasive alternative.
Methods: This ancillary, post hoc analysis combined data from two clinical studies originally designed to evaluate musculoskeletal outcomes. Fifty-seven participants (24 males, 33 females; age 23–78 years) underwent four weekly HIFEM or HIFEM+RF sessions targeting upper or lower extremities. Pain-related outcomes were assessed using the Subject Satisfaction Questionnaire (SSQ), WOMAC, and DASH at baseline, post-treatment, 1-month, and 3-month follow-ups.
Results: At 3 months post-treatment, 75% of participants reported reduced pain and 77% reduced discomfort on the SSQ. WOMAC pain scores decreased by 60% from baseline (d = 1.24 [95% CI: 0.43, 2.06], p = 0.001), and DASH pain scores by 45% (d = 1.66 [95% CI: 0.81, 2.51], p < 0.001), both representing large effect sizes. Notable improvements were observed in nocturnal pain and activity-related discomfort. Treatments were well tolerated, with 93% overall satisfaction and 91% reporting no procedural pain.
Conclusion: Clinically meaningful reductions in extremity pain and discomfort with large effect sizes, high patient satisfaction, and excellent tolerability were observed following the simultaneous HIFEM and synchronized RF treatment. These findings support further prospective evaluation of this combined non-invasive modality in musculoskeletal pain management.
DOI: 10.29245/2768-5365/2026/1.1167 View / Download PdfOptimising Postoperative Pain in Laparoscopic Incisional Hernia Repair: Analgesic Insights from the TACKoMesh Randomised Trial
J James Pilkington1, Aali J Sheen1,2*
1Department of Hernia Surgery, Manchester Foundation NHS Trust, Manchester, United Kingdom
2Department of Surgery, Fortius Clinic, London, United Kingdom
Postoperative pain remains a significant challenge following laparoscopic intraperitoneal onlay mesh with primary fascial closure (IPOM+) repair, with important implications for early mobilisation, functional recovery, and patient satisfaction. The TACKoMesh randomised controlled trial compared absorbable and non-absorbable tack fixation under a rigorously standardised multimodal analgesic protocol incorporating routine laparoscopic transversus abdominis plane (TAP) blocks. Although no difference was observed in pain on activity at 30 days between fixation methods, the trial provides valuable insight into early postoperative pain trajectories when anaesthetic variability is controlled. Procedure-specific evidence supports the role of TAP block in reducing early postoperative pain after laparoscopic ventral and incisional hernia repair, with effects that appear time-limited and converge as recovery progresses. This narrative review summarises the analgesic insights arising from TACKoMesh, examines the contribution of intra-operative regional analgesia to postoperative pain modulation in IPOM+ repair, and considers the implications for optimising perioperative pain management and the design of future pain-focused surgical trials.
DOI: 10.29245/2768-5365/2026/1.1171 View / Download PdfService evaluation of Advanced Clinical Prioritisation (ACP) tele triage pathway in pain medicine
Ankita Miglani1,2*, Alan Blake1, Camillus K Power1,3
1Department of Anaesthesia and Pain medicine, Tallaght university hospital, Dublin, Ireland
2Royal college of surgeons of Ireland, Dublin, Ireland
3Trinity college Dublin, Ireland
Background: Improving timely access to healthcare is one of the top priorities of the government of Ireland’s, Sláintecare healthcare reform programme. Telemedicine has been increasingly utilised in care delivery by pain management services in Ireland. Advanced clinical prioritisation (ACP) was one of the initiatives proposed by scheduled care transformation programme of the health service executive to validate and hence manage waiting lists. A pilot study on ACP pathway in pain management by our group showed potential for improving access.
Aim: The aim of this service evaluation was to describe referral outcomes and care pathway allocation following implementation of an ACP telemedicine clinic.
Methodology: The referral letters were pre-screened for review at the ACP clinic, and the appropriate care pathway was determined after a consultant delivered telephone consultation.
Results: Out of 307 ACP tele-consultations included in this study, only 21.4% patients needed to be scheduled for face-to-face appointment with the service and 45.4% patients were referred directly for diagnostic or therapeutic interventional pain management procedures.
Conclusions: The results document referral outcomes and care pathway allocations. This highlights the need for further studies to explore the potential of this ACP telemedicine model of care to improve service access. This would need a double arm design with measured access metrics.
DOI: 10.29245/2768-5365/2026/1.1168 View / Download Pdf