I-gel Insertion Research Articles

Valuation of Propofol with Propofol -Midazolam for I-gel Insertion in Impulsively Breathing Patients for Elective Day Care Procedures

valuation of Propofol with Propofol -Midazolam for I-gel Insertion in Impulsively Breathing Patients for Elective Day Care Procedures

Optimal propofol dosage for i-gel® insertion in healthy paralyzed patients.

BackgroundPropofol is used for supraglottic airway device insertion, often with the i-gel. However, the propofol requirement for i-gel insertion has not been explored in paralyzed patients. This study was performed to explore hemodynamic changes and sedation level with different propofol doses in healthy paralyzed patients when the i-gel was inserted.MethodsA total of 141 patients undergoing a urologic operation were randomly allocated to three groups depending on the propofol dose (1.5, 2, and 2.5 mg/kg; Groups P1.5, P2, and P2.5, respectively). After patients had been administered each propofol dose and rocuronium, the i-gel was inserted and changes in hemodynamic parameters and bispectral index were evaluated.ResultsGroup P2 showed a lower incidence of complications (17%) such as hemodynamic instability and inadequate sedation than Group P1.5 (55.3%, P < 0.001) or Group P2.5 (40.4%, P = 0.012). The incidence and dose of additional propofol increased in Group P1.5 (51%, median [range]; 20 [0–50]) compared with those in the other groups (0%, 0 [0–0] in Group P2 and 8.5%, 0 [0–50] in Group P2.5, all P < 0.001), and the incidence and dose of additional ephedrine were significantly higher in Group P2.5 (31.9%; 0 [0–20]) than in Group P1.5 (10.6%, P = 0.012; 0 [0–5], P = 0.007, respectively).ConclusionsFor the stable maintenance of hemodynamic parameters and proper sedation level during i-gel insertion, 2 mg/kg propofol has an advantage over 1.5 mg/kg or 2.5 mg/kg propofol in healthy paralyzed patients.

Laryngeal mask airway versus i-gel for airway maintenance during general anesthesia with controlled ventilation in pediatrics

Background Supraglottic airway devices have become prevalent in children because they are typically more user-friendly than a face mask and avoid many of the problems associated with endotracheal intubation. i-gel is a new single-use supraglottic airway device without an inflatable cuff. Pediatric i-gel is now available in four different sizes, 1, 1.5, 2, and 2.5, on the basis of body weight. Patients and methods This study was carried out in Alexandria University Hospitals on 70 patients of American Society of Anesthesiologists grade I and II, aged 3–6 years. They were classified randomly into two equal groups of 35 patients each and admitted to undergo elective surgery under general anesthesia with controlled ventilation in the supine position without head and neck manipulation. In group I, a classic laryngeal mask was used and in group II, i-gel was used to maintain a patent airway during anesthesia. The devices were compared in terms of insertion success, hemodynamic responses, oropharyngeal sealing pressure, airway interventional requirements during maintenance, and postoperative complications. Results The time of insertion of i-gel was significantly shorter than that of the classic laryngeal mask airway (cLMA) (P Conclusion Both the i-gel and the cLMA are suitable devices for controlled ventilation for pediatric patients undergoing short surgical procedures who are not at risk of aspiration. The insertion time of i-gel was less than that of cLMA and airway sealing pressure of i-gel was higher than that of cLMA.

Dose of propofol for successful insertion of I-gel and laryngeal mask airway.

Dose of propofol for successful insertion of I-gel and laryngeal mask airway.

Fiberoptic-guided intubation after insertion of the i-gel airway device in spontaneously breathing patients with difficult airway predicted: a prospective observational study

Study objectiveTo assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway. DesignProspective observational study. SettingOperating room in a tertiary care hospital. PatientsEighty-five adult patients with at least 3 difficult airway predictors or difficult airway management history were included. InterventionsThe i-gel device was inserted in spontaneous ventilation under oropharyngeal local anesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anesthesia was induced to introduce the endotracheal tube guided by fiberoptic bronchoscope. MeasurementsWe recorded the i-gel insertion time (tgel), intubation time (tint), and O2 saturation in pulse oximetry in different moments: basal (t0), after 3 minutes of preoxygenation with a face mask at 100% fraction of inspired O2 (t1), after i-gel mask insertion (t2), and after intubation (t3). Adverse events during the procedure were also recorded, and patient discomfort was questioned. Main resultsAll patients were successfully intubated. O2 saturation in pulse oximetry values were (mean±SD): 96.9±1.22 (t0), 99.0±0.85 (t1), 96.2±2.37 (t2), and 96.0±2.54 (t3). tgel and tint were 38.0±7.76 seconds and 36.5±5.55 seconds (mean±SD), respectively. No serious adverse events were recorded, and no patient suffered airway damage. Visual analogue scale for patient discomfort was 2 (interquartile range, 1-3). Conclusionsi-gel insertion in spontaneously breathing patients avoids the “cannot ventilate” scenario. The subsequent fiberoptic-guided intubation through the i-gel is a safe and effective technique. More studies might be necessary to confirm the results presented, but we consider that the technique described is an adequate alternative to classic orotracheal intubation with fiberoptic bronchoscope in spontaneous ventilation for certain patients with predicted difficult airway.

Comparison of Ease of I-Gel Insertion with Standard and Rotational Techniques in Adults

Comparison of Ease of I-Gel Insertion with Standard and Rotational Techniques in Adults

Muscle relaxant facilitates i-gel insertion by novice doctors: A prospective randomized controlled trial

Study objectiveThis study aimed to determine whether muscle relaxants facilitates insertion efficacy of the i-gel supraglottic device (i-gel) by novice doctors in anesthetized patients. DesignRandomized clinical trial. SettingOperating room. PatientsSeventy adult patients scheduled for elective surgery under general anesthesia. InterventionsSeventy adult patients were assigned to the rocuronium (MR group; 35 patients) or control group (C group; 35 patients). Anesthesia was induced with propofol and remifentanil, and 0.9mgkg−1 rocuronium was administered in the MR group. MeasurementsThe number of attempts to successful insertion, sealing pressure, and subjective difficulty of insertion were compared between the groups. Main resultsThe total number of insertion attempts were as follows: one (MR group, 17 cases; C group, 4 cases), two (MR group, 13 cases; C group, 14 cases), three (MR group, 4 cases; C group, 14 cases), and failure (MR group, 1 case; C group, 3 cases), which was significantly different (P<.001). Sealing pressure was significantly higher in the MR group than in the C group (MR group, 22.1±5.4 cmH2O; C group, 18.7±3.2 cmH2O, P<.001). Subjective difficulty of insertion was significantly lower in the MR group than in the C group (C group, 72.4±19.0mm; MR group, 29.4±18.3mm; P<.001). ConclusionsOur randomized clinical trial suggests that muscle relaxation facilitates i-gel insertion efficacy in anesthetized patients, as assessed by successful insertion rate, sealing pressure, and subjective difficulty of insertion.

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

Clinical performance comparison of I-gel insertion by anesthesiology residents versus novice clinicians

Optimum sevoflurane concentration for I-gel insertion in unpremedicated children

Study objectiveEnd-tidal concentration of sevoflurane for I-gel insertion in children has not been studied. This study was designed to determine the sevoflurane EC50 and EC95 for I-gel placement in children as compared with classic laryngeal mask airway (CLMA) placement. DesignThe design was a prospective, randomized controlled study. SettingsThe setting was single tertiary care center. PatientsPediatric subjects of either sex aged 1.5-8 years, weighing 10-20 kg having American Society of Anesthesiologists physical status I/II of undergoing elective cataract surgery were included in the study. InterventionInduction and maintenance of anesthesia were achieved with sevoflurane and oxygen with preservation of spontaneous breathing. Children were randomly subjected to either I-gel size 2 (group I) or CLMA size 2 (group II) insertion. The target end-tidal sevoflurane concentration (ET SEVO) was maintained for 8-10 minutes before supraglottic airway device was inserted in both the groups. In the first child, the ET SEVO was kept at 2% and was increased or decreased by 0.2% in the next child depending on the previous child's response according to Dixon method. After each supraglottic airway device insertion, child was observed for 1 minute for any “movement” or “no movement.” MeasurementsThe measurements were EC50 and EC95 for I-gel and CLMA placement in children. Main resultsEC50 and EC95 for group I were 0.94% (0.83%-1.06%) and 1.26% (1.12%-1.66%) and for group II were 1.9% (1.70%-2.1%) and 2.54% (2.24%-3.41%), respectively. ConclusionI-gel insertion in children can be accomplished at nearly half ET SEVO (0.94%) of that required for CLMA insertion (1.9%).

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial

This study investigated the hypothesis that the efficacy of insertion of the supraglottic device i-gel(®) (i-gel) can be improved by laryngoscopy and can provide better sealing pressure in anesthetized patients by novice doctors. Eighty-four adult patients were assigned to the laryngoscopy group (L group, 42 patients) or control group (i.e., conventional blind insertion; C group, 42 patients). Anesthesia was induced with propofol and remifentanil, and rocuronium 0.6-0.9 mg/kg was administered. The number of attempts until successful insertion, sealing pressure, vital sign changes upon insertion, and subjective difficulty of insertion by novice doctors were compared between the groups. The total number of insertion attempts was one (L group 36 cases, C group 23 cases), two (L group 6 cases, C group 18 cases), and three (L group 0 case, C group 1 case), with significant differences between groups (P = 0.007). The sealing pressure was significantly higher in the L group than in the C group (L group 22.3 ± 2.6 cmH2O, C group 19.5 ± 2.7 cmH2O, P < 0.001). Vital sign changes (heart rate and blood pressure) did not differ between the two groups. The subjective difficulty of insertion was significantly lower in the L group than in the C group (L group 26.8 ± 11.8 mm, C group 47.0 ± 15.1 mm, P < 0.001). The incidence of postoperative pharyngeal pain was significantly lower in the L group than in the C group (P < 0.001), while the incidence of hoarseness did not differ between the two groups (P = 1.00). Our results suggest that laryngoscopy facilitates i-gel insertion by novice doctors, as reflected in the rate of successful insertions, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.

I-gel insertion with modified jaw thrust technique.

Sir, Since the introduction of i-gel in modern anaesthesia practice, it is widely used by the anaesthesiologists, accident and emergency department personnel and in pre-hospital care setting. The reported first attempt success rate is 86%[1] with primary (manufacturer's recommended) insertion technique. The manufacturers have also advised alternative manoeuvres to overcome the i-gel insertion difficulties by use of reverse i-gel insertion technique and jaw thrust. Rotational i-gel insertion[2] technique and tongue stabilization manoeuvre[3] are other useful methods. However, manufacturer's recommended jaw thrust manoeuvre technique is not widely supported.[3] Manufacturer's jaw thrust i-gel insertion technique is to seek the help of other's hand (requesting assistant help) to thrust the jaw while inserting the i-gel. The operator harmonisation is the key for successful placement with this technique. Lack of synchronisation may lead to insertion failure, trauma and prolong insertion time. This is mainly due to incoordination between the operator and the ‘helping’ hand. We have devised a modified jaw thrust i-gel insertion technique. Once the pre-insertion preparation is ensured and patient is in sniffing morning air position, the i-gel is grasped firmly along with the integral bite block with cuff facing the patient's chin. Chin needs to be gently pressed down before inserting i-gel into patient's mouth. Then it is slid towards hard palate with a gentle push until it reaches the soft palate or oropharynx. Then modified jaw thrust technique is applied by lifting the angle of mandible with little fingers and other fingers to stabilise the jaw [Figure 1a], and then gently pushing the i-gel with thumbs [Figure 1b] till the final placement position by checking for the integral bite block mark at incisor teeth. Figure 1 (a) Index finger lifting angle of mandible and other fingers stabilizing the jaw (b) i-gel pushed to final position using thumbs This technique creates room at hypopharynx by displacing tongue and other oral cavity structures. The force of thumb allows the i-gel to stay in centre and to the correct final position. This smooth insertion technique is favourable in terms of minimal possibility of oral cavity abrasions, trauma and displacement. After encountering repeated difficulties with i-gel insertion by standard insertion technique, we now use the modified jaw thrust technique routinely; it is easier, takes shorter insertion time and is less traumatic then the standard insertion technique. This technique can be considered as an alternative to standard insertion techniques and true efficacy can be ascertained by randomised controlled trials.

Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study.

Background:Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD) have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature.Aims:The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation.Materials and Methods:In the study, Airway Trainer (Laerdal) manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA) and LMA Classic™ (CLMA) in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups.Results:The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds) as compared to CLMA (17.07 ± 3.5 seconds) and PLMA (25 + 4.78 seconds). Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%). The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA.Conclusion:All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA.

Comparison of the Disposable Streamlined Liner of the Pharynx Airway and the Disposable I-gel in Anaesthetized, Paralyzed Adults: A Randomized Prospective Study.

Introduction. This study compared streamlined liner of the pharynx airway (SLIPA) and I-gel noninflatable, single-use, supraglottic airway device (SAD) performance in anesthetized, paralyzed adults. Methods. Eighty adults (ASA physical statuses I–III) who were undergoing elective procedures under general anesthesia with an SAD were enrolled in this prospective, randomized, single-blind study. Subjects were randomly and evenly assigned to the SLIPA or I-gel group for intraoperative airway management. Ease and number of insertions, insertion time, oropharyngeal sealing pressure, hemodynamic response, oxygen saturation (SpO2), end-tidal CO2 (EtCO2), and peri- and postoperative complications were examined. Results. The SLIPA and I-gel devices were successfully inserted in 100% and 95% of subjects, respectively. In two I-gel subjects (5%), ventilation was not possible after two attempts, but a size 55 SLIPA was successfully inserted in both cases. Forty-two and 38 patients were ultimately included in the SLIPA and I-gel groups, respectively. Insertion time was significantly shorter with the SLIPA (11.19 ± 3.03 s) than with the I-gel (15.05 ± 6.37 s, P = 0.003). Oropharyngeal sealing pressure was significantly higher in SLIPA (28.76 ± 3.11 cmH2O) than in I-gel (25.9 ± 3.65 cmH2O) subjects (P = 0.001). Blood staining occurred more frequently in SLIPA (n = 8, 19.0%) than in I-gel (n = 5, 13.2%) patients (P < 0.01). Heart rate, mean arterial blood pressure, SpO2, and EtCO2 were not significantly different between groups. Conclusion. Although blood staining incidence was higher, SLIPA insertion was easier and faster than I-gel insertion. The SLIPA provided better airway sealing pressure. Both devices had similar mechanical ventilation and oxygenation characteristics and comparable hemodynamic stability. Both noninflatable SADs are useful, but SLIPA rapid insertion and good airway sealing make it an effective alternative to the I-gel.

Propofol requirement for insertion of I-gel versus laryngeal mask airway: A comparative dose finding study using Dixon′s up-and-down method

Background and Aims:Propofol is the drug of choice when used as sole anesthetic agent for placement of supraglottic airway devices. We aimed to find and compare the propofol dose required for smooth first attempt insertion of I-gel versus the classic laryngeal mask airway (cLMA) using Dixon's up-and-down method.Material and Methods:Prospective randomized controlled trial (n-60) was planned. I-gel or cLMA was inserted 60 s after propofol injection whose dose was calculated based on previous patients response as per Dixon's up-and-down method. Propofol requirements for successful placement of devices was noted and compared. Difference between the groups was measured by ANOVA. A P < 0.05 was considered as statistically significant.Results:Significantly lower (P < 0.001) propofol dose was required for I-gel (2.02 ± 0.26 mg/kg) insertion than cLMA (2.70 ± 0.28 mg/kg).Conclusions:I-gel requires significantly lower dose of propofol for insertion when compared to cLMA.

A comparison of I-gel with the LMA-classic in spontaneously breathing patients

Introduction Laryngeal mask airway (LMA) is a supraglottic airway device (SAD), which was primarily designed to facilitate airway maintenance. Thereafter, many modifications have been made in the SADs, and I-gel is a recent one, which has a unique characteristic of a self-inflatable cuff. It is claimed to be better in terms of ease and success of insertion, risk of complications, etc. Aims and objectives The aim of this study was to investigate and compare the insertion characteristics and complication rate of classic LMA with I-gel. Materials and methods Eighty patients of American Society of Anaesthesiologists I/II, between 16 and 60 years of age, of either sex were randomly divided into two groups of 40 patients each. In respective groups, classic LMA or I-gel were introduced under spontaneous ventilation. Insertion characteristics such as number of attempts at insertion, ease of insertion, better seal, etc. were studied. Proper positioning was confirmed as per fiberoptic view of the glottis. Patients were continuously monitored and hemodynamic variables were studied at frequent intervals. We also recorded the complications at the time of extubation, if any. Data were statistically analyzed using t -test and the χ 2 -test. A P value less than 0.05 was considered statistically significant. Results I-gel required less time to insertion (29.32 ± 6.88) compared with cLMA (36.72 ± 7.33 s) ( P 2 O) compared with the LMA group (20.77 ± 8.20 cm H 2 O) ( P = 0.003). Statistically significant difference was found between the two groups as regards the assessment of patients after removal of the SAD. Fiberoptic view of vocal cords was better in the I-gel group. Conclusion Insertion of I-gel was easier and quicker and proper positioning was achieved in more number of patients as compared with classic LMA. Moreover, there were fewer complications noted at the time of removal of the device.

I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study.

BACKGROUND:The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries.MATERIALS AND METHODS:A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded.RESULTS:There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups.CONCLUSION:We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries.

A randomized controlled trial of the effect of preoperative dexmedetomidine on the half maximal effective concentration of propofol for successful i-gel insertion without muscle relaxants.

Dexmedetomidine is a useful anesthetic adjuvant for general anesthesia. We determined whether preoperative dexmedetomidine administration could reduce the half maximal effective concentration (EC50) of propofol for successful i-gel insertion without muscle relaxants. Thirty-seven patients were randomly allocated to one of two groups. In the dexmedetomidine group (n = 19), dexmedetomidine (1 µg/kg) was loaded for 10 min preoperatively. In the control group (n = 20), the same volume of 0.9% normal saline was administered in the same manner. The EC50 of propofol for successful i-gel insertion was determined using Dixon's up-and-down method. The EC50 of propofol was calculated as the midpoint concentration after at least six crossover points had been obtained. For successful i-gel insertion, all of the following four factors were required—(1) no major movement of the body within 1 min of insertion, (2) no significant resistance to mouth opening, (3) cough ≤2, and (4) visible square wave capnogram without air leakage at a peak airway pressure of <10 cmH2O. Mean blood pressure (MBP) and heart rate (HR) were monitored during the peri-insertion period of i-gel. The EC50 of propofol for successful i-gel insertion was 3.18 μg/mL in the dexmedetomidine group and 6.75 μg/mL in the control group (p < 0.001). The incidence of hypotension (MBP <80% of the baseline) during the peri-insertion period of i-gel was higher in the control group (p = 0.001), whereas the incidence of bradycardia (HR <80% of the baseline) was higher in the dexmedetomidine group (p = 0.001). Preoperative dexmedetomidine reduced the EC50 of propofol for successful i-gel insertion without muscle relaxants.

A New Twist on i-gel Insertion

The i-gel is a supraglottic device with a soft, noninflatable cuff. Although insertion is usually successful, it sometimes fails because of tongue

A prospective randomised comparison of two insertion methods for i-gel™placement in anaesthetised paralysed patients: standard vs rotational technique

In this prospective randomised study, we compared two techniques for i-gel(™) insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. In the rotation group (n = 90), the i-gel was rotated 90° anticlockwise in the mouth and re-rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs. 87 (97%; p = 0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs. 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cm H2O vs. 27.1 (9.4) cm H2O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs. 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.

Comparison of I-gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study.

Background:We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment.Materials and Methods:In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident.Results:The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H2O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable.Conclusion:Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H2O were more in PLMA group which indicates its better suitability for controlled ventilation.