Airway Leak Pressure Research Articles

Video laryngoscopy improves ProSeal™ laryngeal mask airway position by anesthesia residents: A randomized controlled, double-blind study

BackgroundThe insertion of ProSeal laryngeal mask airway (LMA) using a blind digital technique is difficult for inexperienced performers and malpositioning of the device can impair ventilation and may lead to complications. AimThis study aimed to compare the proper ProSeal LMA position inserted by anesthesia residents between video laryngoscopy-assisted and blind digital insertion techniques. MethodsA total of 138 patients aged 18–80 years, ASA I and II undergoing elective surgery, were randomly allocated to the digital or video laryngoscopy-assisted group. Anesthesia residents performed ProSeal LMA insertion. The primary outcome was the proportion of a proper LMA position evaluated by a blinded assessor using the fiber-optic scores. Secondary outcomes included first attempt success rate, duration of insertion, incidence of desaturation during insertion, peak airway and oropharyngeal leak pressure, gastric tube placement difficulty, hemodynamic disturbance, and airway complications at 1 and 24 h after surgery. ResultsPatients in the video laryngoscopy group demonstrated a significantly higher proportion of proper LMA position than those in the digital group (53/68 [78 %] vs. 24/67 [36 %]; RR 2.18 [95%CI 1.54–3.07]; P < 0.001). Using the video laryngoscopy-guided insertion improved the fiber-optic scores by 7.11 folds (95%CI 3.53–14.32; P < 0.001) compared with the digital technique. Patients in the video laryngoscopy group showed higher sealing pressure, easier gastric tube placement, but longer insertion time. There was no significant difference in the peak airway pressure, first-attempt success rate, hemodynamic changes, and airway complications between groups. No desaturation occurred during the study. ConclusionUsing a Macintosh-shaped blade video laryngoscope facilitates novice anesthesiologists in achieving improved ProSeal LMA positioning without compromising airway or hemodynamic complications. The optimal ProSeal LMA position also provides a higher oropharyngeal sealing pressure and easier gastric tube placement.

Tissue displacement assessment by ultrasound predicts peri-laryngeal leak after supraglottic device insertion (I-gel)

Background and aims Supraglottic airway devices (SADs) have revolutionized airway management during general anesthesia, and they fill the niche between the face mask and endotracheal tube in terms of both airway anatomy and degree of invasion. The aim of this study was assessment of peri-laryngeal leak after insertion of I- gel using ultrasound (US) pulse Doppler mode. Methods Hundred patients scheduled for elective surgery after I-gel placement were recruited. Airway leak pressure was detected by using closed circuit in anesthesia workstation and increasing the pressure to 20 mm Hg. Parameters were noted include, leak as observed in the monitor, leak as assessed using the US machine, fiberoptic visualization of the SAD and grading and end tidal CO2 (ETCO2). Results In ultrasound we have detected peri-laryngeal tissue displacement in 18 patients (18%) out of which 10 patients have grade 3 or 4 on fiberoptic examination (Fig. 2). Among these ten patients, eight patients have inadequate ventilation required reinsertion of I-gel. Conclusion Tissue displacement assessment by ultrasound can be used as a noninvasive alternative to predict leak following supraglottic device insertion (I-gel) placement with the added advantage of no interruption of ventilation.

Evaluation of Ambu-Aura-i laryngeal mask as a conduit for endotracheal intubation. A comparison with Air-Q intubating laryngeal airway in adult surgical patients

ABSTRACT Background Supraglottic airway devices (SGA) are used as primary devices or conduits for endotracheal intubation with normal or difficult airway. The purpose of this study was to assess how the Ambu-Aura-i laryngeal mask would act as a conduit for endotracheal intubation compared to the Air-Q Intubating Laryngeal airway in adult patients in operating room. Methods Fifty-four adult patients scheduled for elective procedures under general anaesthesia were divided into air-Q and Aura-i groups. The ease and time of insertion, the number of insertion attempts, the airway leak pressure, the duration of fiberoptic endotracheal intubation, the grade of the fibre-optic laryngoscopic view, and the time to remove the device were noted. Results Comparing the Aura-i group to the Air-Q group, the Aura-i group had a considerably shorter insertion time and a longer time to remove the device (28.1 ± 3.5 vs 32.7 ± 6.9 sec P-value = 00.4 and 40.7 ± 5.1 vs 32.0 ± 5.4 sec, P-value = 0.001; respectively). Both devices were comparable regarding the number of insertion attempts and the time to insert an endotracheal tube. Compared to the Air-Q group, the Aura-i group’s airway leak pressure was considerably greater (25.9 ± 3.9 vs 23.4 ± 4 CmH2O, respectively, P-value = 0.03). Both groups had comparable fibre-optic laryngoscopic view grades. Conclusion The Ambu-Aura-i laryngeal mask and the Air-Q intubating laryngeal airway are efficient conduits for fibre-optic endotracheal intubation in adults with Ambu-Aura-i Laryngeal mask exhibiting advantages in terms of device insertion time and use during mechanical ventilation.

Comparison of Laryngeal tube suction II (LTS II) and Proseal laryngeal mask airway (PLMA) for controlled ventilation in anaesthetised and paralysed adult patients

Background: LTS II and PLMA are supraglottic devices that may be used for ventilation in patients with normal as well as difficult airways at risk of aspiration. Aim: Comparison of LTS II with PLMA during controlled ventilation in paralysed patients with respect to time to successful insertion, success rate of insertion, attempts at repositioning, airway leak pressure, ease of ventilation and Ryle’s tube insertion, fibreoptic laryngeal view and complications. Methods: Thirty patients were studied using a prospective, randomised cross-over design. Ethical committee clearance and informed consent were obtained from all patients. Anaesthesia was induced with propofol and fentanyl and neuromuscular blockade achieved with vecuronium. Patients were divided into two groups: Group LTS and Group PLMA. In each group, the first airway device was inserted, various parameters observed and then removed. The second airway device was then inserted and the same parameters noted. Anaesthesia was continued with the second device in position. Results: Success with insertion at first attempt and time to insertion were comparable with both devices [LTS II 27/30 (17.5 s) and PLMA 29/30 (15.5 s) respectively]. PLMA required repositioning in fewer patients and provided better fibreoptic view than LTS II. Ryle’s tube insertion failed in four patients with PLMA but in none with LTS II. No significant difference was found in the airway seal pressure [mean, PLMA (27 cm H2 O) and LTS II (26.4 cm H2 O)], ease of ventilation or overall complications. Conclusion: Insertion and ventilation are comparable with PLMA and LTS II. Ryle’s tube insertion is easier with LTS II but requires more repositioning attempts and does not provide a good view of the larynx

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

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 Chisquare 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 cmH2 O. 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.

A comparative study on the perfomance between I-gel® and Classic laryngeal mask airway in anaesthetized spontaneously breathing patients

The classic Laryngeal Mask Airway (c-LMA) is a first generation supraglottic airway device with an inflatable cuff forming a low pressure seal around the laryngeal inlet and permitting ventilation. I-gel is a supraglottic airway device made of thermoplastic elastomer which is soft gel-like and transparent. Unlike the classic LMA(c-LMA), I-gel does not have an inflatable cuff. In view of this, the present study was undertaken to compare the performance of the two supraglottic airway devices in spontaneously breathing adult patients posted for elective surgeries under general anesthesia.To compare the ease of insertion, number of insertion attempts, time for insertion, airway leak pressure, hemodynamic changes as well as perioperative complications such as cough sore throat between patients using the two devices.Sixty patients admitted in SRM medical college and research center scheduled for various elective surgical procedures under general anesthesia belonging to ASA class I and II were included in the study. They were randomly divided into two groups of 30 each using a random number generator. In group I, I-gel supraglottic airway device was used and in Group 2 classic laryngeal mask airway was used. Data was collected using a questionair containing socio-demographic details, details regarding performance of the device as well as hemodynamic changes and perioperative complications.The insertion was easy in 25 patients (83.3%) in group I, while in group II 15 patients (50%) had easy insertion. P=0.0 1781. The mean time of insertion for I-gel was (20. 17± 3 .91 seconds) which was significantly shorter compared to c-LMA (26.80 ±7.24 seconds) (P&amp;#60;0.001).There was no statistically significant difference between the devices with respect to number of attempts of insertion. Even though the airway leak pressure is not statically significant, the mean oropharyngeal leak pressure for I-gel was 20.40±5.68 (mm Hg), which was higher than c-LMA 18.73±5.06 (mm Hg), which is well within the normal limits to prevent aspiration. There were no statistically significant differences in hemodynamic changes. No Blood staining was seen after removal of device in I-gel group where it was observed in 2 (7%) patients in c- LMA group. Post removal cough was more in c -LMA (13 .3%) than l-gel (P= 0.04 SS*). Pharyngo-Laryngeal morbidity was more with classic LMA. Sore throat was more with the classic LMA (13 .3%) when compared to I-gel group (3%).We conclude that I-gel is a better airway when compared to c-LMA with respect to ease of insertion, shorter duration for insertion, adequate oropharyngeal seal with lesser pharyngo-laryngeal morbidity and less incidence of airway trauma.

Proseal Laryngeal Mask Gel vs I-gel- A Randomised Clinical Trial among Paediatric Patients

Introduction: A Supraglottic Airway Device (SAD) is placed above the larynx to form a seal around it. SADs like paediatric Proseal Laryngeal Mask Airway (P-LMA) and I-geltm are increasingly used in recent times. Aim: To compare the efficacy of paediatric P-LMA and I-gel in clinical practise. Materials and Methods: After obtaining ethical committee clearance and parent/guardian consent, 60 paediatric patients aged 2-12 years belonging to ASA grade I and II posted for elective surgeries under general anaesthesia, were included in the study. After induction of general anaesthesia, either of the SAD was inserted and study parameters namely ease and number of attempts of insertion of the device, ease of insertion of gastric tube, leak airway pressure, efficacy during positive pressure ventilation and postoperative complications were evaluated. Statistical comparison was performed by repeated measures of variance followed by Unpaired Student t-test and Chi-square test. A probability value p-value less 0.05 was regarded as statistically significant. Results: The device was easily inserted in 90% of the patients in both study groups (p-value 0.99). In P-LMA group, the device was inserted in first attempt in 83.33% against 90% in the I-gel group (p-value 0.70). In P-LMA group, gastric tube insertion was graded easy in 80% children while in I-gel group it was 90% children (p-value 0.47). The leak airway pressure measured at two different time intervals was statistically insignificant. Intra-operative dislodgement of the device was noted in one child in each group. Postoperative complications like sore throat and dysphagia were reported in four and two children, respectively in P-LMA group, while it was reported in two and one child in the I-gel group. Complications with P-LMA and I-gel were statistically insignificant. Conclusion: Paediatric P-LMA and I-gel are safe and non-invasive methods of securing the airway with regard to clinical safety parameters and hence can be used in paediatric population.

Efficiency of I-gel supraglottic airway device during mechanical ventilation in supine and lateral decubitus position in obese patient; prospective observational study

ABSTRACT Background I-gel supraglottic airway device has been widely used recently in anesthesia practice as an alternative to endotracheal intubation. However, its safety and feasibility in obese patients are still under investigations. The aim of this work was to evaluate the efficiency of I-gel in supine and lateral position in adult obese (BMI 30–40) mechanically ventilated patients undergoing short surgical procedures (60 − 120 min). Methods Prospective observational study was conducted at Kasr Alainy Hospital. A total of 40 obese patients with body mass index 30–40 aged between 20 and 60 years, American Society of Anesthesiologists class II & III scheduled for elective surgeries were enrolled in one group. We used the I-gel in supine position and lateral position in the same patient. The primary outcome was comparison between Oropharyngeal leak airway pressure during controlled ventilation in supine position after insertion of I-gel by 1 min and in lateral position. The secondary outcomes were fiberoptic view , insertion attempts and postoperative upper airway complications Results The leakage pressure required for I-gel did not show statistically significant difference between both supine and lateral positions (33.88 ± 7.34 cmH2O versus 33.10 ± 7.58 cmH2O) respectively. Fiberoptic view ranged between score 2 (8 patients) and score 3 (32 patients) in both supine and lateral position. I-gel was inserted in the first trial in 37 patients, the second trial in two patients and the third trial in one patient. None of the patients experienced postoperative swallowing difficulties, throat pain, hoarseness or postoperative nausea and vomiting. Only two patients (5%) showed blood on I-gel after removal. Conclusion The use of I-gel supraglottic airway device is safe and effective in both supine and lateral position in obese patients under mechanical ventilation with reliable ventilation and no postoperative airway complications. Clinical trial registration clinicaltrial.gov. ID: NCT04119245

A prospective, randomized comparison of the LMA-protector\u2122 and i-gel\u2122 in paralyzed, anesthetized patients

BackgroundIn the present study, we compare the LMA-Protector™ and the i-gel™ in terms of adequacy of the airway seal, insertion time, ease and accuracy of insertion, and the incidence of postoperative sore throat.MethodsIn 110 anesthetized and paralyzed adult patients, the i-gel™ (n = 55) or the LMA-Protector™ (n = 55) was inserted. The primary outcome was airway leak pressure. The secondary outcomes included the first-attempt success rate, insertion time, ease and accuracy of the device insertion, ease of gastric tube placement, blood staining on the device after removal, and incidence and severity of postoperative sore throat.ResultsThe airway leak pressure was higher with the LMA-Protector™ than with the i-gel™ (31 [7] cmH2O vs. 27 [6] cmH2O, respectively; P = 0.016). Insertion time was longer with the LMA-Protector™ than with the i-gel™ (27 [16] sec vs. 19 [16] sec, respectively, P < 0.001), but ease of insertion and the first-attempt success rate were not different between the two groups. The LMA-Protector™ provided a worse fiberoptic view of the vocal cords and more difficult gastric tube insertion than the i-gel™ (both P < 0.001). Blood staining on the device was more frequent with the LMA-Protector™ than with the i-gel™ (P = 0.033). The incidence and severity of postoperative sore throat were not different between the two groups.ConclusionThe LMA-Protector™ provided a better airway sealing effect than the i-gel™. However, it required a longer insertion time, provided a worse fiberoptic view of the vocal cords, and caused more mucosal injury compared to the i-gel™.Trial registrationClinicalTrials.gov (NCT03078517). Registered prior to patient enrollment, Date of registration: Mar 13, 2017.

A comparison of blind intubation with the intubating laryngeal mask FASTRACH\u2122 and the intubating laryngeal mask Ambu Aura-i\u2122 a prospective randomised clinical trial

BackgroundThe intubating laryngeal mask Fastrach™ is considered a gold standard for blind intubation as well as for fibreoptic guided intubation via a laryngeal mask. Recently, a single use version of the mask has been introduced. We compared the Fastrach single use with the new, low-priced single use intubating laryngeal mask Ambu Aura-i™.We hypothesised that the LMA Ambu Aura-i and the LMA Fastrach are comparable with respect to success rates for mask placement and blind tracheal intubation through the LMA device.MethodsA prospective, randomised clinical trial. University Hospital Schleswig-Holstein, Campus Kiel, from April 2011 to April 2012.Eighty patients undergoing general anaesthesia with planned tracheal intubation were randomised and enrolled in the study. Blind intubation was performed with either laryngeal mask using two different tracheal tubes (Rüsch Super Safety Silk™ and LMA ETT™). A crossover-design was performed after an unsuccessful procedure.Primary outcome measure was the overall success rate of blind intubation. Secondary outcome measures were the time to the first adequate ventilation, a subjective handling score, and a fibreoptic control of placement, as well as the success rate of mask placement, time for mask removal after successful intubation, differences in airway leak pressure, and the incidence of postoperative sore throat and hoarseness.ResultsThe success rate of tracheal intubation with the Fastrach for the first and second attempt was significantly better compared with the Ambu Aura-i. Tracheal intubation was also significantly faster (14.1 s. ±4.4 versus 21.3 s. ±9.0; p < 0.01), and the time interval for mask removal after successful intubation was significantly shorter using the Fastrach device (24.0 s. ±8.2 versus 29.4 s. ±7.5; p < 0.001). There were no significant differences between groups regarding the incidence of postoperative sore throat and hoarseness.ConclusionBoth laryngeal mask devices are suitable for ventilation and oxygenation. Blind intubation remains the domain of the LMA Fastrach, the Ambu Aura-i is not suitable for blind intubation.Trial registrationClinicaltrials.gov Identification Number NCT03109678, retrospectively registered on April 12, 2017.

Evaluation of a resorbable self-locking ligation device for performing peripheral lung biopsies in a caprine cadaveric model.

To compare airway leak pressures after sealing peripheral lung biopsy sites with a resorbable ligation device (LigaTie) or thoracoabdominal (TA) staples. Ex vivo study. Four normal caprine cadavers. Twelve lung lobes were harvested from 4 goats immediately after euthanasia. Each lobe was inflated to 20 cm H2 O to test for leaks prior to biopsy. Pressure was then maintained at 10 cm H2 O. Biopsy samples were obtained 3 cm from the periphery with a resorbable ligation device or a TA stapler (n = 6 per group). After biopsy, inflation pressure was slowly increased to 40 cm H2 O while lungs were submerged in water. The pressure at which bubbles were first seen was recorded as the airway leak pressure. The length, width, volume, and weight were recorded for each biopsy sample. Five of 6 LigaTie biopsy sites sustained the maximum pressure of 40 cm H2 O without leaking. One site leaked at 24 cm H2 O. The TA-stapled sites sustained airway pressure to median 25.5 cm H2 O (interquartile range, 23.5-26 cm H2 O), and none of them reached the maximum pressure (P = .015). There were no differences in biopsy length, volume, or weight between groups. Biopsy sites sealed with LigaTie withstood higher airway pressure without leaking compared with TA-stapled biopsy sites in normal cadaveric specimens. The LigaTie may be an alternative technique for sealing peripheral lung biopsy sites.

Analysing the efficacy of the I-gel supraglottic airway device in the supine and lateral decubitus positions.

The advantages of the I-gel supraglottic airway device include ease and speed of insertion, reduced trauma incidence, an integral bite block, gastric access, a non-inflatable cuff and superior seal pressure. The primary goal of this study was to compare airway leak pressures and the fibreoptic view in the supine and lateral positions. Our secondary aim was to analyse the effects of I-gel insertion on haemodynamic parameters. One hundred patients undergoing saturation biopsy due to prostatic hyperplasia were recruited to this prospective randomised study. An I-gel device was inserted in the supine position. Taking of measurements, patients were placed in the lateral decubitus position. Mean arterial pressure, heart rate, peripheral O₂ saturation and end-tidal CO₂ were recorded before and after insertion. We recorded the number of attempts and insertion time for the I-gel device. Oropharyngeal leak pressures and I-gel device positioning were scored in the lateral decubitus and supine positions. It was possible to insert the I-gel device in 88 patients on the first attempt. The median time for insertion was 7.97 ± 2.18 sec. The mean arterial pressure and heart rate decreased 1 and 2 min after insertion. Oropharyngeal leak pressure was similar in the supine (27.45 ± 5.37 mm Hg) and lateral decubitus positions (26.04 ± 4.92 mm Hg) (P > 0.05). On fibreoptic examination through the I-gel device, the scores of patients were comparable in different positions (P = 0.542). As there was no significant difference in oropharyngeal leak pressure and fibreoptic view, we concluded that the I-gel device may be used safely in both the supine and lateral positions.

Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube

BackgroundLubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study.MethodsWe placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmH2O and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmH2O and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen.ResultsFor both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15–35) cmH2O. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15–25) and 15 (15–35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15–35) cmH2O. Water application did not change these outcomes compared with the N group.ConclusionPre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.

Pediatric supraglottic airway devices in clinical practice: A prospective observational study

BackgroundSupraglottic airway devices (SGA) are commonly used in pediatric anesthesia and serve as primary or back-up devices for difficult airway management. Most SGA are marketed without proper clinical evaluation. The purpose of this study was to evaluate the performance of the pediatric LMA Supreme™, Air-Q® and Ambu® Aura-i™.MethodsThis prospective observational study was performed at Bern University Hospital, Switzerland. With ethics committee approval and a waiver for written informed consent 240 children undergoing elective surgery with an ASA class I-III and a weight of 5-30 kg were included. Three different pediatric supraglottic airway devices were assessed: The LMA Supreme™, Air-Q® and Ambu® Aura-i™. Primary outcome parameter was airway leak pressure. Secondary outcome parameters included first attempt and overall success rate, insertion time, fiberoptic view through the SGA, and adverse events. The primary hypothesis was that the mean airway leak pressure of each tested SGA was 20 cmH2O ± 10%.ResultsNone of the SGA showed a mean airway leak pressure of 20 cmH2O ± 10%, but mean airway leak pressures differed significantly between devices [LMA Supreme™ 18.0 (3.4) cmH2O, Air-Q® 15.9 (3.2) cmH2O, Ambu® Aura-i™ 17.3 (3.7) cmH2O, p < 0.001]. First attempt success rates (LMA Supreme™ 100%, Air-Q® 90%, Ambu® Aura-i™ 91%, p = 0.02) and overall success rates (LMA Supreme™ 100%, Air-Q® 91%, Ambu® Aura-i™ 95%, p = 0.02) also differed significantly. Insertion times ranged from 20 (7) seconds (Air-Q®) to 24 (6) seconds (LMA Supreme™, <p = 0.005). Insertion was rated easiest with the LMA Supreme™ (very easy in 97% vs. Air-Q® 70%, Ambu® Aura-i™ 72%, p < 0.001). Fiberoptic view was similar between the SGA. Adverse events were rare.ConclusionsAirway leak pressures ranged from 16 to 18 cmH2O, enabling positive pressure ventilation with all successful SGA. The highest success rates were achieved by the LMA Supreme™, which was also rated easiest to insert.Trials RegistrationClinicalTrials.gov, identifier NCT01625858. Registered 31 May 2012.

Sore throat following three adult supraglottic airway devices: A randomised controlled trial.

Sore throat is a common complaint after surgery. It affects patient satisfaction and can affect activity after discharge. The supraglottic airway device (SAD) offers an alternative to traditional tracheal intubation with potential benefit in preventing sore throat. The aim of this study was to compare the incidence of sore throat following three different SADs, the laryngeal mask airway Unique (LMA-U) and the more recent LMA Supreme (LMA-S) and the I-gel. A randomised single-blind controlled three parallel-group trial. University Hospital of Nîmes, Division of Anaesthesia Intensive Care Pain and Emergency, Nîmes, France, from April 2009 to September 2012. A total of 546 patients scheduled to undergo elective surgery of less than 2 h under general anaesthesia were randomly allocated to receive the LMA-U, the LMA-S or the I-gel. Anaesthesia was induced with propofol and sufentanil and maintained with propofol or with sevoflurane in air-oxygen. After airway device insertion, intra-cuff pressure was adjusted to less than 60 mmHg (LMA-U, LMA-S) and pressure-controlled ventilation initiated. The primary study endpoint was to compare incidence of sore throat 24 h postoperatively (H+24) following placement of the LMA-U, LMA-S and the I-gel. Secondary endpoints were clinical performance (airway leak pressure, dynamic airway compliance, complications during maintenance), ease of use (device insertion time, success on first attempt, ease of insertion and removal) and other adverse events (neck or jaw pain, dysphonia, dysphagia, nausea and vomiting). The authors analysed 177, 174 and 173 patients who received LMA-U, the LMA-S and the I-gel, respectively. The primary endpoint was assessed in 436 patients. In total, 104 patients (23.9%) patients reported a H+24 sore throat, with no difference between groups (P = 0.34). H+24 dysphagia with liquids was higher (P = 0.0065) with the LMA-S (12.1%) compared with LMA-U (5.3%) and I-gel (2.9%). Airway leak pressure (cmH2O) was lower (P < 0.0001) with LMA-U [21 (18 to 27)] compared with I-gel [26 (20 to 30)] and LMA-S [25 (21 to 30)]. Device insertion time (sec) was shorter (P < 0.0167) with the I-gel [30 (20 to 40)] compared with the LMA-U [34 (23 to 48)] and LMA-S [32 (22 to 50)]. The incidence of postoperative sore throat was not significantly different between the three SADs studied.

A preliminary assessment of the LMA protector\u2122 in non-paralysed patients

BackgroundThe LMA Protector™ is the latest CE marked single use supraglottic airway device. This airway device provides access and functional separation of the respiratory and digestive tracts. There are two ports (male, female ports) to provide suction in the laryngeal region and insertion of the gastric tube. The aim of our study is to assess the ease of use, airway quality, device positioning, airway leak and complications associated with initial clinical experience in LMA Protector™ usage.MethodsThis is an initial investigation of LMA Protector™ airway device. We conducted a preliminary assessment in the anaesthetised women who underwent minor gynaecological procedures with spontaneous ventilation in order to evaluate the performance of the airway device.ResultsInsertion was successful on first and second attempts in 23 (88.5%) and 3 (11.5%) respectively. Median [IQR (range)] insertion time was 19 [17-21(14-58)] seconds. Airway leak pressure was 25.5 [23-29(21-30] cmH2O. On fibreoptic examination via the device, vocal cords were visible in all 26 patients. There were no alternative airway use or airway manipulations required during maintenance of anaesthesia. Six patients had sore throat 24 h after procedures and there was no dysphagia or hoarseness.ConclusionThis pilot study of the LMA protector shows that the device is easily inserted with fast insertion time, providing a reliable and adequate airway seal.Trial registrationClinicaltrials.gov Registration NCT02531256. Retrospectively registered on August 21, 2015.

Comparison of I-Gel and classic Laryngeal Mask Airway in paediatric population: a parallel group study

Background: I-gel, the novel Supraglottic airway device, is easier to insert, has improved stability after insertion with reduced tissue compression.The study aims to compare the efficacy of I-gel with classic Laryngeal Mask Airway in the paediatric population.Methods: A randomised parallel group study was done in Department of Anesthesiology, Kanti Children Hospital, Kathmandu for a period of three months. I gel and classic LMA was compared based on leak airway pressure, time of insertion and ease of insertion.Results: Age and weight are comparable among groups. Compared to cLMA, I-gel provides a better leak pressure seal (16.40+-3.42 vs. 23.11+- 6.17 cm of H2O, p 0.027), faster time of insertion (19.42+-4.40 vs. 29.84+-7.70 seconds, p-0.02) and similar ease of insertion (p-0.571).Conclusions: I-gel compared to classic Laryngeal Mask Airway provides better resistance to leak airway pressure, faster time of insertion with comparable ease of insertion.

Blind intubation of anaesthetised children with supraglottic airway devices AmbuAura-i and Air-Q cannot be recommended: A randomised controlled trial.

Paediatric supraglottic airway devices AmbuAura-i and Air-Q were designed as conduits for tracheal intubation. Although fibreoptic-guided intubation has proved successful, blind intubation as a rescue technique has never been evaluated. Evaluation of blind intubation through AmbuAura-i and Air-Q. On the basis of fibreoptic view data, we hypothesised that the success rate with the AmbuAura-i would be higher than with the Air-Q. A randomised controlled trial. University Childrens' Hospital; September 2012 to July 2014. Eighty children, American Society of Anesthesiologists (ASA) class I to III, weight 5 to 50 kg. Tracheal intubation was performed through the randomised device with the tip of a fibrescope placed inside and proximal to the tip of the tracheal tube. This permitted sight of tube advancement, but without fibreoptic guidance (visualised blind intubation). Primary outcome was successfully visualised blind intubation; secondary outcomes included supraglottic airway device success, insertion times, airway leak pressure, fibreoptic view and adverse events. Personal data did not differ between groups. In contrast to our hypothesis, blind intubation was possible in 15% with the Air-Q and in 3% with the AmbuAura-i [95% confidence interval (95% CI) 6 to 31 vs. 0 to 13%; P = 0.057]. First attempt supraglottic airway device insertion success rates were 95% (Air-Q) and 100% (AmbuAura-i; 95% CI 83 to 99 vs. 91 to 100; P = 0.49). Median leak pressures were 18 cmH2O (Air-Q) and 17 cmH2O [AmbuAura-i; interquartile range (IQR) 14 to 18 vs. 14 to 19 cmH2O; P = 0.66]. Air-Q insertion was slower (27 vs. 19 s, P < 0.001). There was no difference in fibreoptic view, or adverse events (P > 0.05). In one child (Air-Q size 1.5, tube size 3.5), the tube dislocated during device removal. Ventilation with both devices is reliable, but success of blind intubation is unacceptably low and cannot be recommended for elective or rescue purposes. If intubation through a paediatric supraglottic airway device is desired, we suggest that fibreoptic guidance is used. Clinicaltrials.gov identifier: NCT01692522.

Performance of size 1 I-gel compared with size 1 ProSeal laryngeal mask in anesthetized infants and neonates.

Purpose. The size 1 I-gel, recommended for small infants and neonates weighing 2–5 kg, has recently been released. There are no prospective studies available that assess the insertion conditions, sealing pressures, or ventilation quality of it. This study was designed to compare the performance of recently released size 1 I-gel with size 1 ProSeal LMA. Methods. Fifty infants and neonates, ASA I-II were included in this prospective, randomized, and controlled study. Patients were divided into two groups for placing I-gel or ProSeal LMA. The primary outcome was airway leak pressure, and secondary outcomes included insertion time, insertion success and conditions, initial airway quality, fiberoptic view of the larynx, and complications. Results. There were no significant differences in terms of airway leak pressure between the I-gel (27.44 ± 5.67) and ProSeal LMA (23.52 ± 8.15) (P = 0.054). The insertion time for the I-gel was shorter (12.6 ± 2.19 s) than for the ProSeal LMA (24.2 ± 6.059 s) (P = 0.0001). Insertion success and conditions were similar in groups. We encountered few complications. Conclusion. Our study demonstrates that the size 1 I-gel provided an effective and satisfactory airway as the size 1 ProSeal LMA. It may be a good alternative supraglottic airway device for use in small infants and neonates. This trial is registered with: ClinicalTrials.gov NCT01704118.

Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™ and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial.

Background:A sustained and effective oropharyngeal sealing with supraglottic airway (SGA) is required to maintain the ventilation during laparoscopic gynecological surgery in the Trendelenburg position. This study was conducted with I-gel™ and ProSeal LMA™, two prototype SGA devices with a gastric access.Materials and Methods:We enrolled 60 American Society of Anesthesiologists physical status I and II patients and randomized to either I-gel or ProSeal LMA (PLMA) group. After induction of anesthesia using a standardized protocol, one of the SGA devices was inserted. The primary objective of this study was to compare the oropharyngeal leak (sealing) pressure of I-gel™ and ProSeal LMA™ after pneumoperitoneum and Trendelenberg position. The secondary objectives were to compare ease of insertion, cuff position as assessed by the fiberoptic view of the glottis, adequacy of ventilation and incidence of complication.Results:The baseline (before pneumoperitoneum) oropharyngeal leak pressure of I-gel was less than the PLMA (mean (standard deviation [SD]) 24 (4) vs. 29 (4) cmH2O, respectively; P < 0.001). After pneumoperitoneum, the leak airway pressure in I-gel group was significantly less than that of PLMA group (mean [SD] 27 (3) vs. 34.0 (4) cmH2O, respectively; P < 0.001). Peak airway pressure was increased after pneumoperitoneum compared to baseline in both the groups. However, end-tidal carbon dioxide was maintained within normal limits. The insertion parameters, fiberoptic view of the glottis, fiberoptic view of the drain tube, and complications were comparable between the groups.Conclusion:Both I-gel and PLMA are effective for ventilation in gynecological laparoscopic surgeries. However, PLMA provides better sealing as compared to I-gel.