Classic Laryngeal Mask Airway Research Articles

Military Standard Testing of Commercially Available Supraglottic Airway Devices for Use in a Military Combat Setting.

Airway obstruction is the second leading cause of death on the battlefield. The harsh conditions of the military combat setting require that devices be able to withstand extreme circumstances. Military standards (MIL-STD) testing is necessary before devices are fielded. We sought to determine the ability of supraglottic airway (SGA) devices to withstand MIL-STD testing. We tested 10 SGA models according to nine MIL-STD-810H test methods. We selected these tests by polling five military and civilian emergency-medicine subject matter experts (SMEs), who weighed the relevance of each test. We performed tests on three devices for each model, with operational and visual examinations, to assign a score (1 to 10) for each device after each test. We calculated the final score of each SGA model by averaging the score of each device and multiplying that by the weight for each test, for a possible final score of 2.6 to 26.3. The scores for the SGA models were LMA Classic Airway, 25.9; AuraGain Disposable Laryngeal Mask, 25.5; i-gel Supraglottic Airway, 25.2; Solus Laryngeal Mask Airway, 24.4; LMA Fastrach Airway, 24.4; AuraStraight Disposable Laryngeal Mask, 24.1; King LTS-D Disposable Laryngeal Tube, 22.1; LMA Supreme Airway, 21.0; air-Q Disposable Intubating Laryngeal Airway, 20.1; and Baska Mask Supraglottic Airway, 18.1. The limited (one to three) samples available for testing provide adequate preliminary information but restrict the range of failures that could be discovered. Lower scoring SGA models may not be optimal for military field use. Models scoring sufficiently close to the top performers (LMA Classic, AuraGain, i-gel, Solus, LMA Fastrach, AuraStraight) may be viable for use in the military setting. The findings of our testing should help guide device procurement appropriate for different battlefield conditions.

Rare case of intraoperative LMA detachment.

Dear Editor, A 35-year-old female weighing 80 kgs was posted for abdominal liposuction. Patient was accepted under ASA (American Society of Anesthesiology) I and Mallampati score 1. After preoxygenation the patient was premedicated with intravenous midazolam 1 mg, ondansetron 4 mg, and fentanyl 100 mcg. Induction was done with intravenous propofol 120 mg and atracurium 30 mg. Bag mask ventilation was confirmed and classic LMA (Laryngeal Mask Airway) size 4 was placed in the prone position and patient was put on elective ventilation. Proper minute ventilation was achieved with peak airway pressure of 16 cm of water. After 45 min, posterior liposuction was completed and patient was placed in supine position for anterior abdominal liposuction but it was observed that the airway pressure started showing low volume of 4–5 mm of H2O and saturation was starting to fall. ETCO2 was not showing any reading and capnograph was not present. Monitors and ventilator settings were rechecked for any disconnection but everything was in place. There was no chest rise and saturation was starting to fall. LMA was pulled out immediately but only the shaft (airtube) came out and cuff remained inside. Laryngoscopy had to be performed and the cuff was removed with the help of Magill’s forceps. After ruling out any injuries to the airway, bag mask ventilation was done and a fresh LMA number 4 was placed again to complete the remaining procedure. Circuit was connected to the LMA and ventilation was started. All the parameters were normal thereafter. The procedure was completed properly without any difficulty. Patient was normal at the time of discharge. The LMA mask was carefully examined and detachment was confirmed as shown in Figures 1 and 2.Figure 1: Laryngeal mask airway detachmentFigure 2: Laryngeal mask airway detachmentThe cause of such a detachment could not be pinpointed but repetitive use and sterilization of the device may have been responsible for this malfunction. According to some researchers, the reusable LMA can be used for more than 40 times.[1] According to hospital records the LMA that we used during the procedure was sterilized by ethylene oxide and used for over 24 times before. Though this number lies within the recommended safety limit of 40 times, it raises a question on the accepted norm of reusability of LMA.[1] In spite of using correct techniques for cleaning and sterilizing the device, the probability of its deterioration over time with each use cannot be ruled out. It has been suggested that the cuff of the device should be deflated and dehydrated as much as possible before sterilization.[2] In conclusion, a thorough external examination of the LMA device preoperatively is obligatory along with following strict sterilization techniques including complete deflation and dehydration of the cuff before sterilization to avoid such incidences in future. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The Effect of Different Types of Laryngeal Mask Airways on Sound Quality: A Prospective Randomized Study

BackgroundAlthough the deterioration in sound quality is not as much as endotracheal intubation, it can also be seen after the use of laryngeal mask airway (LMA). The aim of this study is to investigate the effects of different LMA types on voice performance.MethodsThis study included 88 patients aged 18-80 years, whose surgical procedure was not planned to take longer than 120 minutes. In the acoustic voice analysis, F0, jitter%, and shimmer% were examined. In addition, the Voice Handicap Index (VHI)-30 questionnaire has completed an evaluation of voice quality. The patients were randomly divided into two groups (I-gel LMA [n=44]; Classic LMA [n=44]) according to the closed envelope method.ResultsA total of 88 patients were included in the study. Demographic data of the patients were statistically similar between the groups (p > 0.05). The changes in the preoperative and postoperative F0, jitter, and VHI-30 values in the I-gel group were statistically significant (p: 0.002, p: 0.001, p < 0.001). Shimmer values were not significantly different (p: 0.762). In the classical LMA group, preoperative and postoperative F0, jitter, shimmer, and VHI-30 values were statistically significantly different (p: 0.001, p: 0.012, p: 0.036, p < 0.001).ConclusionI-gel LMA and classic LMA negatively affect voice performance in the preoperative and postoperative periods. This situation was also observed in the VHI-30 index test. However, when this situation was evaluated in terms of shimmer analysis, the decrease in voice quality in the early postoperative period was more limited in the I-gel group.

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.

Unusual pericuff leak around proseal-laryngeal mask airway corrected by clamping gastric drain port: A case report

ProSealTM-Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on Thames, UK) is commonly used for securing the airway with an added advantage over classic LMA as its gastric drain tube allows the insertion of Ryle’s tube and suctioning of gastric contents. The ProSeal LMA is designed in such a way that it allows controlled mechanical ventilation. During controlled mechanical ventilation, air leaks can occur because of positive airway pressures. Air leaks from the gastric drain port are almost always due to the malposition of PLMA. Here, we report a case of air leak from gastric drain port despite correctly placed PLMA and its successful management without removing the device.

Comparison of the efficacy of supraglottic airway devices in low-risk adult patients: a network meta-analysis and systematic review

Numerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmH2O) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.

Success Rate of Insertion and Postoperative Sore Throat: I-Gel Versus Laryngeal Mask Airway Classic

Introduction: Supraglottic devices are a useful advent in airway management filling a gap between the facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Laryngeal mask airway classic (LMA-C) being first of its kind and I-gel is second generation non-inflatable supraglottic device. The objective of our study was to compare the two supraglottic devices, Laryngeal mask airway classic (LMA-C) and I-gel for a success rate of insertion and postoperative sore throat.&#x0D; Materials and Methods: A total of 80 patients scheduled for elective surgical procedures were studied in a prospective, randomly assigned, comparative and interventional manner. Patients were randomly allocated into two groups with forty patients in each group. I-gel and LMA-C were used in Groups 1 and 2 respectively. After achieving adequate depth of anesthesia the supraglottic device of appropriate size was inserted. The success rate of insertion of the device was represented by the number of insertion attempts. In the postoperative ward within 24 hours after surgery patient was asked whether a sore throat was present.&#x0D; Results: There was a statistically significant difference between the two supraglottic devices in terms of successful attempts of insertion (p-value 0.02).In group 1(I-gel)34 out of 40 patients had first attempt insertion success,6 patients in the second attempt, and no patient had third insertion attempt. In group 2 (LMA-C) first-time insertion success was in 14 patients, 23 patients in the second attempt, and 3 patients in the third attempt. The incidence of postoperative sore throat was higher in the LMA-C group than the I-gel group(17.5% vs 5% respectively) with a p-value of 0.154.&#x0D; Conclusion: Compared to the laryngeal mask airway classic, I-gel was inserted with less number of attempts and had a lower incidence of postoperative sore throat.

The Success Rate of Classic Laryngeal Mask Airway Insertion During General Anesthesia in Different Age Groups

Objectives: Uncertainty about the effect of age on the success rate of laryngeal mask airway (LMA) insertion led us to conduct the present study to evaluate the success rate of LMA in airway management in different age groups. Materials and Methods: A total of 183 patients, who were admitted to Shohada hospital (Tabriz, Iran) during 2018-2019, were enrolled in this descriptive, cross-sectional, prospective study. The patients were selected through the convenience sampling method and divided into 4 age groups. After anesthesia, patients were compared in terms of duration and number of LMA insertion attempts and LMA insertion complications. The data were analyzed using SPSS20 through one-way ANOVA and the Chi-square test at P&lt;0.05). Results: There were significant statistical differences between different age groups regarding resistance against LMA insertion (P=0.008) so that insertion was most comfortable and easy in the first attempt in the adult group compared to other groups. However, no significant statistical difference was observed between different groups in terms of the rate of air leakage (P=0.129), the duration of successful LMA insertion (P=0.119), and the number of LMA insertion attempts (P=0.091). Regarding LMA insertion complications, laryngospasm was significantly higher in the middle-age and aged group (P=0.009), and blood observation on LMA was significantly higher in the pre-school and child group (P=0.005). Conclusions: According to the results of this study, no difference was found between different groups in terms of successful LMA insertion and post LMA insertion complications.

Comparison of Clinical Performance of Ambu Aura40 Laryngeal Mask Airway with Classic Laryngeal Mask Airway for Spontaneous Ventilation during Elective Surgeries under General Anaesthesia

Background: Introduction of the laryngeal mask airway (LMA) has revolutionised the practice of anaesthesia. This study compares the clinical performance of Ambu Aura40 LMA with Classic LMA in anaesthetised spontaneously breathing patients in terms of its ease of use and side effects. Patients and Methods: In this prospective randomised controlled study, 176 patients were allocated to either the Classic LMA or Ambu Aura40 LMA group according to a pregenerated block randomisation number sequence with concealment method. The allocated LMA was placed under general anaesthesia without muscle relaxant. The time and ease of insertion were noted in addition to any adverse events. Results: It was observed that Ambu Aura40 LMA and the Classic LMA were positioned successfully in the first attempt in 94% and 81% of patients respectively. The Ambu Aura40 LMA was placed in &lt;12 s in 52% of patients, whereas only 2% of patients in the Classic LMA group could have the device placed within 12 s. Ninety-four percent of Classic LMA and 48% of Ambu Aura40 LMA were placed between 12 and 16 s, respectively. Statistically, a significant difference was noted with time and ease of insertion in between the groups. Conclusion: Ambu Aura40 LMA is better in terms of ease of insertion, with reduced time for insertion and lesser incidence of postoperative sore throat in comparison with Classic LMA.

Comparison between I-gel and Classic Laryngeal Mask Airway for Airway Management of Patients with Anticipated Difficult Airway: A Randomised Clinical Trial

Introduction: I-gel and classic Laryngeal Mask Airway (cLMA) are two Supraglottic Airway Devices (SAD) used for management of airway in various situations, including for management of difficult airway. Despite widespread use of these devices, there are very few trials studying I-gel and classic LMA for management of patients with difficult airway. The outcome of present study determines which SAD is better for managing difficult airway. Aim: To compare I-gel and cLMA in managing anticipated difficult airway. Materials and Methods: This randomised and single blinded clinical trial study was conducted in King George’s Medical University, Lucknow, Uttar Pradesh, India, between February 2019 to January 2020. Adult patients with Mallampati class 3 or 4, thyromental distance &lt;6 cm, sternomental distance &lt;12 cm, restricted neck movement, micrognathia/retrognathia or short/thick neck undergoing elective short duration surgery under general anaesthesia were included in this study. Total 50 patients divided into group C received cLMA while group I patients received I-gel for airway management. Fifty patients were recruited in each group. Nominal variables were analysed using chi-squared test. A two-sided p&lt;0.05 were considered significant for all the tests. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 25.0 for windows. Results: Mean age in group C was 40.38±12.96 (years) and in group I was 37.94±11.77 (years) with p-value 0.327. Overall (n=44 in group C, 50 in group I, p-value=0.012) and first attempt (n=10 in group C, 40 in group I, p-value &lt;0.001) success rate of device placement was higher for I-gel. Number of attempts, manipulations, time needed to insert and Leak Fraction was significantly lower for I-gel (p-value &lt;0.001). Compared to cLMA, Oropharyngeal Leak Pressure (OLP) was higher with I-gel. Fibreoptic view on a four-point scale was better with I-gel. Desaturation, tachycardia, bradycardia, and postoperative sore throat was more frequent with cLMA. Conclusion: Compared to cLMA, I-gel has higher success rate of insertion in patients with difficult airway and has added advantage of more rapid insertion, higher OLP and need for fewer insertion attempts and manipulations with lower rates of complications.

Intravenous Propofol and Inhalational Sevoflurane for Ease of Classic Laryngeal Mask Airway Insertion in Patients Undergoing Elective Surgery: A Randomised Clinical Trial

Introduction: The Laryngeal Mask Airway (LMA) has gained extensive popularity for airway management during surgery. Propofol, the most commonly used induction agent for LMA insertion, causes significant haemodynamic changes. Sevoflurane has the potential to be as good an induction agent as propofol. Aim: To compare ease of insertion of classic LMA in patients undergoing elective surgery using intravenous propofol and inhalational sevoflurane. Materials and Methods: The study was a randomised clinical trial conducted in the Operation Theatres of Midnapur Medical College and Hospital, Medinipur, West Bengal, India, from August 2019 to July 2020. Eighty patients of American Society of Anaesthesiologists (ASA) physical status grade I and II, of both sexes, and aged between 18 years to 65 years were equally divided into two groups: group P (Propofol group) and group S (Sevoflurane group). Group P was given injection Propofol 2.5 mg/kg body weight and group S was given vital capacity breath induction with 8% sevoflurane and oxygen at 8 litres/min. Loss of Consciousness (LOC) was confirmed and induction time was noted for each group. After confirmation of ease of mouth opening, by an independent observer, LMA insertion was attempted. Ease of LMA insertion was assessed by a predefined 18 points table along with time to LMA insertion and number of attempts. Haemodynamic changes and adverse effects were also recorded. Chi-square test or Student’s t-test were used and a p-value ≤0.05 was considered as statistically significant. Results: With respect to age, sex and weight there were no significant differences between the two groups. Induction time was significantly less in group P (51.85±6.66 seconds) compared to group S (68.38±13.93 seconds) (p-value=0.0001), but LMA insertion time, number of attempts and overall ease of LMA insertion conditions according to the 18 points score were comparable between the two groups. Mean arterial pressure at certain points after induction was significantly less in group P (at 3 minute p-value=0.009 and at 5 minute p-value=0.007). Apnea was significantly more in group P (p-value=0.023). Conclusion: Sevoflurane was comparable to propofol for LMA insertion in respect of ease of insertion and insertion time. Although induction time was significantly less for propofol, sevoflurane offered better haemodynamic stability and lesser incidence of apnea.

Use of laryngeal mask airway in the management of difficult airway during thyroidectomy

Patients with difficult airway may be encountered either predictably or not. The Laryngeal Mask Airway (LMA) has increasingly become an option for airway management including patients with airway difficulty. We report the case of a middleaged man who had thyroidectomy and whose anticipated difficult airway was managed with the classic LMA.

Choosing the best supraglottic airway for ophthalmic general anaesthesia: a manikin study.

General anaesthesia is sometimes favoured over regional anaesthesia in ophthalmic surgery. The use of supraglottic airway (SGA) or laryngeal mask airway (LMA) as the primary airway device is increasing due to numerous advantages over tracheal intubation. Compared with 1st generation SGAs, 2nd generation SGAs have an added benefit of isolating the airway from the alimentary tract. However, the vertical profile of SGAs may encroach into the surgical field and hence interfere with surgery. We investigated the vertical projections of 1st generation SGAs (LMA Classic, Ambu AuraFlex) and commonly used 2nd generation SGAs in our institution (LMA ProSeal, LMA Supreme, LMA Protector, Ambu AuraGain and I-gel) in a manikin model. Each device was connected to a corrugated catheter mount or angled connector following insertion as per usual clinical practice in our institutions. Vertical projections of all devices were measured from the chin using a centimetre ruler. Securing of airway device to the chin with an adhesive tape was possible for the LMA Classic and Ambu AuraFlex with straight corrugated connector, whereas the stiffer 2nd generations SGAs required the addition of an angled connector or straight corrugated tubing to direct the airway tube caudally, away from the surgical field. The LMA ProSeal had the lowest vertical projection amongst the 2nd generation SGAs and may be the suitable choice for ophthalmic surgery. We also describe a novel technique of utilising a 1st generation SGA with placement of an orogastric tube, although with some reservations. This study has several limitations and transferability of our findings into clinical practice is questionable as the use of a manikin may not fully imitate the real condition of the patient. Our study is the first study comparing vertical projected height of different SGAs in manikin, but future studies should investigate the use of SGA in the clinical setting during ophthalmic surgery.

EC50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial.

Background and Aims:Literature documents EC50 (End-tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2% and most of these studies suggest maintaining the required end-tidal sevoflurane concentration for 10-25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min.Material and Methods:In this randomized trial, children aged 2_8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8% sevoflurane and 100% oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end-tidal sevoflurane concentration at 2% for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was “movement” and successful if “no movement” occurred. End-tidal concentration was increased/decreased (step-size 0.2%) using Dixon and Massey up and down method in the next patient depending upon the previous patient's response.Results:EC50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100% oxygen was 1.1% (0.9-1.2) at 2.5 min and 1.6% (1.5-1.7) at 5.0 min. Derived EC95 (95% CI) at 2.5 min was 1.8% (1.5-9.2) and at 5.0 min was 1.8% (1.4-8.8) respectively.Conclusion:We suggest maintaining end-tidal sevoflurane of 1.6% for 2.5 min and 1.8% for 5 min for successful CLMA insertion.

Evaluation of I-Gel™ versus Classic LMA™ for Airway Management by Paramedics and Medical Students: A Manikin Study.

Background and Aim:Airway management is a lifesaving skill which all health-care workers should possess. Currently, most of the resuscitation councils recommend supraglottic airway devices as the technique of choice for airway management during cardiopulmonary resuscitation by health-care providers without expertise in tracheal intubation. This is because of its high first-pass success rate and easy to acquire and retain skill even by novices.Materials and Methods:The present study was planned to compare the efficacy of two commonly available supraglottic airway devices, classic LMA (cLMA) and I-gel in securing airway in adult manikin by inexperienced persons (58 paramedics and 46 medical students), after a brief training. Our primary aim was to determine the first attempt success rate, and other parameters studied were the time and ease of insertion, overall success rate, and preference for device.Results:The first-attempt success rate of I-gel was higher in both groups of participants (74% in students and 69% in paramedicals) compared to that of cLMA (70% in l students and 53% in paramedics) although the overall success was the same. Majority of participants could secure airway quickly and easily by I-gel than by cLMA. More than 90% of participants preferred I-gel over cLMA.Conclusion:This study shows that inexperienced persons could learn to place the I-Gel and cLMA successfully in the manikin after a brief training in manikin. The first-attempt success rate and insertion of I-gel was easier and faster than that of cLMA by both groups of participants and most participants preferred I-gel due to ease of handling.

A Comparative Study Between I –gel With Classical Lma in Short Surgical Procedure for Requirement of Propofol

Background and Aims: Supraglottic airway devices have been established in clinical anesthesia practice and have been shown to be safe and efficient. The objective of this, randomized trial was to compare I-Gel with LMA-Proseal in anesthetized spontaneously breathing patients. Material and Methods: 100 patients all asa 1 & 2 undergoing short surgical procedures were randomly assigned to I-gel (Group X) or LMA- Proseal (Group Y). Anesthesia was induced with standard doses of propofol and the supraglottic airway device was inserted. We compared the ease and time required for insertion, airway sealing pressure and adverse events. Results: There were no significant differences in demographic and hemodynamic data. I-gel was significantly easier to insert than LMA-Proseal (P < 0.05) (Chi-square test). The mean time for insertion was more with Group P (41 + 09.41 secs) than with Group I (29.53 + 08.23 secs) (P < 0.05). Although the airway sealing pressure was significantly higher with Group P (25.73 + 02.21 cm of H 2 O), the airway sealing pressure of Group I (20.07 + 02.94 cm of H 2 O) was very well within normal limit (Student's t test). The success rate of first attempt insertion was more with Group I (P < 0.05). There was no evidence of airway trauma, regurgitation and aspiration. Sore throat was significantly more evident in Group P. Conclusion: I-Gel is a innovative supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence I-Gel can be a good alternative to LMA-Proseal.

An Observational Study to Compare Supraglottic Airway Device I-Gel with Classic LMA for Short Surgical Procedures

An Observational Study to Compare Supraglottic Airway Device I-Gel with Classic LMA for Short Surgical Procedures

Comparative Evaluation of Haemodynamic Response to Conventional Tracheal Extubation and Removal of Classic Laryngeal Mask Airway (LMA-Classic) Following Bailey Manoeuvre: A Randomized Controlled Study

Comparative Evaluation of Haemodynamic Response to Conventional Tracheal Extubation and Removal of Classic Laryngeal Mask Airway (LMA-Classic) Following Bailey Manoeuvre: A Randomized Controlled Study

Comparison of Classic Laryngeal Mask Airway and I Gel Regarding Ease of Insertion and Efficacy of Ventilation in Lateral Position

Background: The laryngeal mask airway (LMA) is a supraglottic airway device designed to maintain a clear airway, which sits outside of and creates a seal around the larynx. Aim of our study is to compare the ease of insertion and adverse effects using the insertion of classic LMA ad I gel in lateral position and to note if there are any adverse effects between both. Subjects and Methods: Hundred patients of either gender aged between 15 and 70 years who belonged to ASA physical status I and II, who were posted for elective surgical procedures under general anaesthesia under supraglottic airway devices were recruited for study. They were randomly divided into four groups of 25 patients each by closed envelop method. First group is Group IRL: Patients in whom I gel was used in right lateral position Second group is Group ILL : Patients in whom I gel was used in left lateral position Third group is Group CRL : Patients in whom classic laryngeal mask airway was used in right lateral position Fourth group is Group CLL : Patients in whom classic laryngeal mask airway was used in left lateral position. Results: Group IRL had success rate of 88.5% in 1st attempt 11.5% in this group had 2nd attempt of LMA insertion. Group ILL had 1st attempt success rate of 76% with.&nbsp; 24% patients needed 2nd attempt for LMA placement Group, CRL had success rate of 86% at 1st attempt 14% patients had LMA insertion in 2nd attempt. Group CLL had 1st attempt success rate of 67% only. 33% of patients in this group needed 2nd attempt for successful LMA insertion. Conclusion: Supraglottic airway devices can be successfully used for securing airway in lateral position. Both classic LMA and I gel can be used to secure the airway. I gel is a supraglottic airway device with its own advantages which can be successfully used in patients who need lateral position for their surgery.

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.