cLMA Group Research Articles

Effect of classical laryngeal mask or I-gel use on otolaryngeal system in ambulatory inhalation general anesthesia: A prospective study

Objective: To investigate the effects of supraglottic airway tools such as classical laryngeal mask (cLMA) and I-gel, which can be used without the need for muscle relaxation in the airway management of general anesthesia patients, on the otolaryngeal system. Methods: This prospective randomised study was conducted at Karadeniz Technical University Hospital, Faculty of Medicine, Trabzon, Turkey, during November 2020 to December 2021. Eighty-nine patients in the American Society of Anesthesiologists (ASA) grade I-II group, who would undergo elective surgery under general anesthesia, were randomized into two groups, namely Group cLMA and Group I-gel. cLMA and I-gel were used for airway management of the patients. After anesthesia induction, tympanometric measurements were taken at regular intervals for middle ear pressures of both ears. Results: While air way pressures, SpO2 and EtCO2 values were within normal limits, there were no differences in terms of complications. In tympanometric measurements, middle ear pressure increase was statistically higher in the cLMA group than in the I-gel group (p <0.001). Conclusions: We think that I-gel may be a more advantageous supra glottic airway device in terms of otolaryngeal effecs and middle ear pressure in theair way management during short surgical procedures. doi: https://doi.org/10.12669/pjms.40.10.8416 How to cite this: Saylan S, Cobanoglu HBY. Effect of classical laryngeal mask or I-gel use on otolaryngeal system in ambulatory inhalation general anesthesia: A prospective study. Pak J Med Sci. 2024;40(10):2299-2304. doi: https://doi.org/10.12669/pjms.40.10.8416 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA in paediatric cases.

Aim: Analysis of ease of insertions, its attempts and time taken to insert for i-gel and cLMA inpaediatric cases. Methods: We did a prospective, randomised single-blind study on Eighty patientsof either sex belonging to American Society of Anaesthesiologists (ASA) physical status class I or II,between 6 months to 8 years of age, scheduled to undergo elective surgery for less than one andhalf hour duration under general anaesthesia. In this study we analysed the ease of insertion,attempts and time were taken to insert the supraglottic airway device. Results: The ease ofinsertion observed was easy in 39(97.5%) in the i-gel group and 35(87.5%) in cLMA group in ourstudy. The i-gel was placed successfully in 39 out of 40 (97.5%) patients in the first attempt, andachieved 100% insertion on the second attempt. Correct positioning of cLMA in the first attempt wasseen in 35 out of 40 (87.5%) patients. The remaining 5 patients (12.5%) required a secondattempt. The average insertion time of cLMA (12.88 ± 1.771 seconds) was longer than the averagetime of insertion of i-gel (9.48 ± 1.037 seconds), and these differences were highly significantstatistically (p= 0.000). Conclusion: To conclude, i-gel and cLMA is effective and safe devices foruse in children. Both are easy to insert and have insignificant morbidity, however, time taken andattempts of insertions for i-gel was lesser than cLMA. Also, the ease of insertion was relatively easyfor i-gel than cLMA in pediatric cases.

Comparison of laryngeal mask airway, cuffed and uncuffed tracheal tubes in pediatric patients during general anesthesia

American Heart Association and the International Liaison Committee on Resuscitation have now accepted cuffed tubes as an alternative to uncuffed ones for pediatric airway. Recently laryngeal mask airway (LMA) has become increasingly popular as an alternative device for airway management in children. The present study was undertaken to evaluate and compare LMA, cuffed and uncuffed Endo tracheal tube (ETT) as airway devices in small children during general anesthesia. The study included 150 patients of age 2-6 years undergoing elective surgery under general anesthesia and randomized to one of the three groups depending on airway device insertion i.e. Group C: Cuffed ETT; Group P: Uncuffed ETT; Group L: cLMA. Variables depicting ease of insertion, hemodynamic parameters and airway morbidity were recorded and assessed. The time taken for insertion of airway device as well as total duration of device in situ was statistically similar in the three groups. First attempt success rate was significantly higher in the cuffed ETT group. Change in size of device was required in 4%, 36.0% and 16.0% patients in groups C, P and L respectively. Number of failures in groups C, P and L respectively was 2%, 0% and 4% (p>0.05). Hypertensive tachycardiac response was minimum in cLMA group. All the three groups were comparable with respect to overall airway morbidity. We conclude that all the three devices including cuffed ETT can be used safely in the pediatric age group.

Comparison of ProSeal laryngeal mask airway, classical laryngeal mask airway with endotracheal tube in gynecological laparoscopy under controlled ventilation

Background: PLMA is a recent, complex, and ingenious development with some added feature of classic LMA like modified dual cuff, drain tube, positive pressure ventilation at higher peak inspiratory pressure. Study was to evaluate and compare the use of classical laryngeal mask airway, ProSeal laryngeal mask airway, and endotracheal tube with controlled ventilation in patients undergoing gynecological laparoscopic procedure.Methods: About 150 patients, ASA risk I and II, posted for elective gynecological laparoscopy were recruited in the study. All the patients between 18 to 45years of age were randomly divided in three groups, group PLMA, group CLMA, group ETT (50 patients each). Attempt of insertion of airway device, leaks pressure, pulmonary ventilation, hemodynamic; heart and MAP, gastric distention was recorded. All patients were of middle age group, comparable in weight. Mean duration of laparoscopy was comparable in all the groups.Results: Significant rise in heart rate and mean arterial pressure seen in group ETT after induction of anesthesia. Changes in the end tidal CO2 and peak airway pressure after induction of anesthesia, before and after pneumoperitonium were comparable in all three groups. After head low position peak airway pressure is slightly raised in group PLMA, group CLMA. Gastric distension was noted higher in group 10 % as compare to group PLMA (8%) and group (2%). Incidence of sore throat (22%), nausea vomiting (14%) and airway trauma (14%) was higher in group ETT.Conclusions: Hemodynamic stability was better in and CLMA group at time of induction and comparable in all three groups at time of pneumoperitoneum and trendelenburg position along with pulmonary ventilation. Post-operative sore throat, nausea vomiting was higher with endotracheal tube.

Comparative evaluation of air-Q and classic laryngeal mask airway for surgeries under anesthesia: A randomized open-label trial

Objective: Classic laryngeal mask airway (cLMA) is a prototype supraglottic airway device, and Air-Q is a newly introduced device for use as a primary airway and as an aid for intubation. Due to paucity of literature comparing Air-Q with cLMA, this prospective, randomized, single-blinded study was performed, to evaluate their clinical performance as a primary airway conduit. Methods: Sixty patients of either sex with the American society of anesthesiology Grade I or II, weighing between 50 and 70 kg, were randomly allocated to either the cLMA (n = 30) or Air-Q (n = 30) group. After induction of anesthesia, the assigned airway device was introduced. The ease of insertion, vital parameters, oropharyngeal seal pressure (OSP), airway morbidity, and fiberoptic grades of laryngeal view was recorded. Results: There was no significant difference in ease of insertion, the time taken for successful device placement, number of attempts, or postoperative morbidities. Air-Q was found better with respect to hemodynamic stability during placement of the device. There was a significant difference in the OSP between the Air-Q (22.12 ± 1.740 cm H2O) and cLMA (16.28 ± 2.052 cm H2O), P Conclusion: Air-Q was found to be superior to cLMA for controlled ventilation in view of better OSP and a superior fiberoptic laryngeal view.

Supreme and classic laryngeal mask airway in neonatal resuscitation

Objective To study the feasibility, efficacy and safety of laryngeal mask airway (LMA) Supreme (SLMA) in neonatal resuscitation. Methods Sixty neonates, who were born at South Medical University Affiliated Maternal & Child Health Hospital of Shenzhen from June 1, 2012 to June 1, 2013 and requiring positive pressure ventilation after 30 s primary resuscitation post born, with birth weight above 2 000 g or gestational age above 34 weeks, were randomly assigned into two groups: SLMA group (n=30) and LMA Classic (CLMA) group (n=30). The outcome indicators included the curative effect, insertion time and possible adverse reactions of the two kinds of LMA, and the serum bio-markers, heart rate and percutaneous pulse oxygen saturation (SpO2) of all neonates. Independent sample t test, non-parametric test and Chi-square test were applied for statistical analysis. Results The insertion time was shorter in SLMA group than in CLMA group [(4.9±1.0) vs (7.6±1.3) s, t=8.98, P<0.05]. And more displacement occurred in CLMA group than in SLMA group [13.3% (4/30) vs 0% (0/30), Fisher exact test, P<0.05]. The successful rate of resuscitation in SLMA group was higher [100.0% (30/30) vs 90.0% (27/30), Fisher's exact test, P<0.05], and both the onset time and the total ventilation time were shorter than those in CLMA group [(12.4±3.7) vs (15.6±3.8) s, t=3.31, P<0.05; (37.3±17.0) vs (48.2±20.1) s, t=2.29, P<0.05]. The heart rate at 1 min after delivery was higher in SLMA group than in CLMA group [(93.5±20.9) vs (74.2±17.8) bpm, t=-3.86, P<0.05], and the same results were shown for SpO2 at 1, 2 and 3 min after birth [(47.1±8.4)% vs (38.7±12.1)%, t=-3.13; (68.1±9.5)% vs (52.8±10.8)%, t=-5.82; (78.3±10.0)% vs (72.1±9.7)%, t=-2.46; all P<0.05]. In the CLMA group, vomit or regurgitation occurred in three neonates, abdominal distension in two cases, aerogastria in seven cases. However, none of the above was reported in the SLMA group. No laryngeal injury was found in any of the subjects. Conclusion SLMA is more potential than CLMA in neonatal resuscitation because of its simplicity, better airtight, less adverse effect, superior efficacy and less requirement for tracheal intubation. Key words: Resuscitation; Positive-pressure respiration; Laryngeal masks; Infant, newborn

A comparison of supraglottic airway i-gel™ vs. classic laryngeal mask airway in small children

Backgroundi-gel™ is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to compare the usefulness of i-gel™ versus a classic laryngeal mask airway (cLMA) in small children.MethodsSixty-three children (age range : 4-72 months) were randomly assigned to an i-gel™ or cLMA group. We evaluated hemodynamic data, airway sealing ability, the success rate of insertion, and adverse events including an inadvertent sliding out during ventilation.ResultsDemographic data and hemodynamic data obtained immediately after the insertion of these devices did not differ between the two groups. The success rates for insertion on the first attempt were 77 and 84% for i-gel™ and cLMA, respectively (P = 0.54), and the overall success rates were 87 and 100% respectively (P = 0.14). There were no significant differences in terms of airway leak pressure. The inserted i-gel™ inadvertently slid out in 8 of 31 patients but only one sliding out case occurred in the cLMA group (P = 0.02). There were no differences between the groups in terms of other side effects (e.g., coughing, bleeding) associated with the use of i-gel™ and cLMA (P = 0.75 and 0.49, respectively).ConclusionsOropharyngeal leak pressure and insertion success rate of i-gel™ are similar to those of cLMA. However, i-gel™ is prone to inadvertent sliding out of the mouth in small children. Therefore, it is recommended that the i-gel™ should be secured more tightly to avoid displacement of the device.

The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized, noncrossover study with the Classic™ laryngeal mask airway

In recent years, numerous scientific publications have endorsed the superiority of the ProSeal™ laryngeal mask airway (PLMA) over the Classic™ laryngeal mask airway (cLMA) in adults, children, and infants. The PLMA forms a better seal for both the respiratory and gastrointestinal tracts, provides easier access to the gastrointestinal tract, and exerts lower mucosal pressures for a given seal pressure. This study aims to determine whether this superiority can also be observed for the size 1 PLMA used in anesthetized neonates and infants with positive pressure ventilation. Sixty consecutive neonates and infants undergoing elective surgical procedures were randomized to airway management with the size 1 PLMA or cLMA. For all patients, we recorded ease of insertion, effective airway time, number of placement attempts, oropharyngeal leak pressure, fiberoptic position, audible leaks, mask displacement, number of reinsertions during maintenance, gastric insufflation, and frequency of blood stain. Ease of insertion, successful insertion in <3 attempts, fiberoptic position of the airway tube, and frequency of blood stain were similar in both groups. Effective airway time was lower for the PLMA group (30.5 vs 35.6 s). Oropharyngeal leak pressure was higher with the PLMA (32.9 vs 22.2 cm H(2)O, P < 0.001) and gastric insufflation less common (0% vs 6%, P = 0.492). There were fewer mask displacements during maintenance of anesthesia with the PLMA (0% vs 26.7%, P < 0.001). Mask reinsertion was not necessary during maintenance of anesthesia with the PLMA, although it was necessary in 14 cases in the cLMA group (0% vs 46%, P < 0.001). Audible leaks were less common with the PLMA (0% vs 46%, P < 0.001). We conclude that the size 1 PLMA is a stable, safe, and efficacious airway control device during neonatal and infant anesthesia, allowing higher peak airway pressure during positive pressure ventilation, with fewer mask displacements and gastric insufflations than the cLMA.

The effects of the Cobra perilaryngeal airway on intraocular pressure

Aim: To compare the effects of the Cobra perilaryngeal airway on intraocular pressure with the effects of the classic laryngeal mask and endotracheal intubation. Materials and methods: Forty-five ASA I or II patients were randomly allocated into 3 equal groups. Endotracheal intubation (EI group), the classic laryngeal mask airway (cLMA group), and the Cobra perilaryngeal airway (Cobra PLA group) were applied to the groups. Heart rate and systolic, diastolic, and mean arterial pressures were recorded. Intraocular pressure was measured with an applanation tonometer before and during the 15 min after application. Results: Heart rate and systolic, diastolic, and mean arterial pressures were lower in the cLMA group than in the other groups at 1 and 5 min after application (P < 0.05). In all of the groups, the mean intraocular pressure increased significantly compared to the baseline during the study. In the Cobra PLA and cLMA groups, these increases at 1 min (14.9 mmHg and 14.2 mmHg, respectively) were significantly lower than those in the EI group (mean: 18.8 mmHg) (P = 0.001). Conclusion: The Cobra PLA and cLMA should be chosen over EI in patients for whom increased intraocular pressure is not desirable.

Comparison of three supraglottic devices in anesthetised paralyzed children undergoing elective surgery.

Context:The newest variation of the i-gel supraglottic airway is a pediatric version.Aims:This study was designed to investigate the usefulness of the size 2 i-gel compared with the ProSeal laryngeal mask airway (PLMA) and classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children.Settings and design:A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital.Methods:Ninety ASA grade I–II patients undergoing lower abdominal, inguinal and orthopedic surgery were included in this prospective study. The patients were randomly assigned to the i-gel, PLMA and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure and postoperative complications.Results:There were no differences in the demographic and hemodynamic data among the three groups. The airway leak pressure of the i-gel group (27.1±2.6 cmH2O) was significantly higher than that of the PLMA group (22.73±1.2 cmH2O) and the cLMA group (23.63±2.3 cmH2O). The success rates for first attempt of insertion were similar among the three devices. There were no differences in the incidence of postoperative airway trauma, sore throat or hoarse cry in the three groups.Conclusions:Hemodynamic parameters, ease of insertion and postoperative complications were comparable among the i-gel, PLMA and cLMA groups, but airway sealing pressure was significantly higher in the i-gel group.

Comparison of i-gel™ supraglottic device with classic laryngeal mask airway in anesthetized paralyzed children undergoing elective surgery.

Context:The newest variation of the i-gel supraglottic airway is a pediatric version.Aims:This study was designed to investigate the usefulness of the size 2 i-gel compared with the classic laryngeal mask airway (cLMA) of the same size in anesthetized, paralyzed children.Settings and Design:A prospective, randomized, single-blinded study was conducted in tertiary care teaching hospital.Subject and Methods:Sixty ASA grade I–II patients undergoing lower abdominal, inguinal, and orthopedic surgery were included in this prospective study. The patients were randomly assigned to i-gel and cLMA groups (30 patients in each group). Size 2 supraglottic airway was inserted according to the assigned group. We assessed ease of insertion, hemodynamic data, oropharyngeal sealing pressure, and postoperative complications.Statistical Analysis Used:Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05.Results:There were no differences in the demographic and hemodynamic data among the two groups. The airway leak pressure of the i-gel group (26.1 ± 2.4 cm H2O) was significantly higher than that of the cLMA group (22.64 ± 2.2 cm H2O). The success rates for first attempt of insertion were similar among the two devices. There were no differences in the incidence of postoperative airway morbidity among the two groups.Conclusions:Hemodynamic parameters, ease of insertion, and postoperative complications were comparable between the i-gel and cLMA groups, but airway sealing pressure was significantly higher in i-gel group.

Efficacy of laryngeal mask airway Classic, Streamlined Liner of Pharyngeal Airway and laryngeal mask airway ProSeal in patients undergoing laparoscopic surgery

Objective To compare the efficacy of the laryngeal mask airway Classic (CLMA), Streamlined Liner of Pharyngeal Airway (SLIPA) and laryngeal mask airway ProSeal (PLMA) in patients undergoing laparoscopic surgery. Methods One hundred and twenty-three ASA Ⅰ or Ⅱ patients aged 20-64 yr undergoing elective laparoscopic surgery were randomly divided into 3 groups: CLMA group (group C, n =41 ), SLIPA group (group S, n =42) and PLMA group (group P, n =40). Laryngeal mask was inserted after induction of anesthesia with sufentanil 0.3 μg/kg, atracurium 0.5 mg/kg and propofol 2 mg/kg. Mll the patients were ventilated with intermittent positive-pressure ventilation. Anesthesia was maintained with contiunous infusion of propofol 6-8 mg· kg-1· h-1 and with supplementary administration of sufentsnil 0.1-0.2 μg/kg and atracurium 0.2 mg/kg as required. The degree of difficulty in inserting the laryngeal mask was evaluated. The rate of successful placement at first attempt, device placement time, recovery time and complications were recorded . Peak inspiratory pressure (PIP) and the number of patients with an airway sealing pressure less than PIP were recorded before pneumoperitoneum and when intra-abdominal pressure achieved 12 mm Hg. Results The placement was easier and the placement time and recovery time were significantly shorter in group S, and the placement time was significantly longer,the airway sealing pressure was significantly higher and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group C ( P ＜ 0.05). The placement time and recovery time were significantly longer, the placement was harder, the airway sealing pressure was significantly higher, and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group S ( P ＜ 0.05). PIP was significantiy higher when intra-abdominal pressure achieved 12 mm Hg than that before pneumoperitoneum in all the three groups ( P ＜ 0.05). There was no significant difference in the incidence of complications and rate of successful placement at first attempt among the three groups ( P ＞ 0.05). Conclusion All the three airway devices can provide adequate ventilation during operation, with fewer complications. SLIPA placement is easiest. PLMA can assure good airway sealing and is most suitable for patients undergoing laparoscopic surgery. Key words: Laryngeal masks; Respiration, artificial; Laparoscopy

The supraglottic airway I-gel in comparison with ProSeal laryngeal mask airway and classic laryngeal mask airway in anaesthetized patients

The I-gel is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to investigate the usefulness of the I-gel compared with the classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (pLMA) in anaesthetized, paralysed patients. The American Society of Anesthesiologists physical status I-II patients (n = 167) scheduled for orthopaedic surgery were included in this prospective study. General anaesthesia was achieved with intravenous infusion of propofol, remifentanil and rocuronium. The patients were randomly assigned to I-gel, pLMA and cLMA groups (64, 53 and 50 patients, respectively). Properly sized I-gel (No. 3-4) or LMA (No. 4-5) was inserted. We assessed haemodynamic data, airway leak pressure, leak volume, success rates and postoperative complications. There were no differences in the demographic data and haemodynamic data immediately after insertion of devices among the three groups. The airway leak pressures of the I-gel group (27.1 +/- 6.4 cmH2O) and pLMA group (29.8 +/- 5.7 cmH2O) were significantly higher than that of the cLMA group (24.7 +/- 6.2 cmH2O). The success rates for first attempt of insertion were similar among the three groups (P = 0.670). There were no differences in the incidence of adverse events except for the larger incidence of sore throat in the cLMA group. I-gel may have a similar airway sealing to that of pLMA, higher than that of cLMA, and is not associated with adverse events. The I-gel might be an effective alternative as a supraglottic airway device.

Comparison of fibreoptic‐guided orotracheal intubation through classic and single‐use laryngeal mask airways*

We compared times to intubate the trachea orally and success rates using two fibreoptically assisted techniques in 42 healthy patients with normal airways using (a) a 6.0-mm nasal RAE tracheal tube passed through a classic laryngeal mask airway (CLMA group) or (b) a 6.0-mm nasal RAE tracheal tube passed through a new disposable Portex Soft Seal laryngeal mask airway (PLMA group). The mean (SD) total intubation times were 82 (14) and 80 (17) s, respectively (p = 0.55). The success rates for intubation at the first attempt were similar (17/21 in the CLMA vs. 16/21 in the PLMA group; p = 0.50). We conclude that there is no clinically significant difference between the times to intubate the trachea or success rates using these two devices, but there may be other more subtle measures which might influence the choice of device in clinical practice. Finally, in the course of this study we developed a grading scale to describe the laryngeal views obtained when using a fibrescope passed through supraglottic airway devices.