Laryngeal Mask Airway ClassicTM Research Articles

Hemodynamic Changes After Intubation of Endotracheal Tube, LMA Classic™, and I-gel in Patients Candidates for Elective Eye Surgery

Background: One of the concerns of the anesthetists in performing surgical procedures is hemodynamic changes after laryngoscopy and tracheal tube intubation. In these cases, stress response with the release of catecholamines leads to increased blood pressure and heart rate in patients who are prone to cardiovascular disease and cerebral events, leading to the life-threatening risks. Objectives: Endotracheal Intubation (ETT) is one of the most stress response techniques for airway management. Here, we compare the effects of tree devices including ETT, laryngeal mask airway (LMA) classic, and I-gel with each other. Methods: The present study investigated the hemodynamic changes in patients undergoing elective cataract surgery after the intubation of an endotracheal tube. This clinical trial study was conducted on 75 patients with ASA class I or II in both genders and in the age group of 50 - 65 years old. The effects of LMA Classic™ and I-gel were also investigated. In this study, patients’ vital signs such as pulse rate, systolic blood pressure, and diastolic blood pressure were measured and recorded at times before insertion of the airway devices, one, two, and five minutes after the insertion. Results and Conclusions: Before the start of the operation, there was no significant difference between the groups in terms of hemodynamic parameters. Immediately before inserting ETT, LMA, or I-gel, the heart rate and systolic and diastolic blood pressure increased significantly in all groups. Our results generally showed that the hemodynamic changes due to the I-gel insertion compared to the tracheal tube and LMA Classic™ insertion followed minor adjustments. In a comparison between the insertion of the endotracheal tube and LMA Classic™, the use of the LMA Classic™ was associated with more stability.

Comparison of i-gel™ and laryngeal mask airway Classic™ in terms of ease of insertion and hemodynamic response: A randomized observational study.

Context:Laryngeal mask airway (LMA) Classic™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer.Aims:To compare ease of insertion, number, and duration of insertion attempts among the two device. Secondary objectives were to evaluate the hemodynamic response and SpO2 during device insertion and during maintenance of general anesthesia.Settings and Design:This study was conducted as randomized observational study in a teaching hospital.Subjects and Methods:One hundred American Society of Anesthesiologists I and II, patients posted for surgery under general anesthesia were divided in two groups of fifty each. LMA Classic™ and i-gel™. Ease of insertion, duration of insertion, hemodynamic data, and episodes of hypoxia during insertion, 1, 3 and 5 min for 30 min, during removal and 1 min after removal.Statistical Analysis Used:Descriptive analyses were expressed as a mean ± standard deviation. Independent t-test used for parametric data, Chi-square test for nonparametric data and hemodynamic data were analyzed using repeated measures ANOVA to find statistical difference within the groups.Results:Devices were easy to insert, the mean duration of insertion attempts was 15.92 ± 1.62 s in the i-gel™ group, while it was 26.06 ± 5.12 s in the LMA Classic™ group, was statistically significant (P = 0.0001).Conclusions:Successful and shorter duration of insertion, with less hemodynamic response makes i-gel™ a suitable alternative to LMA Classic™ during general anesthesia.

A two-stage approach to induction and intubation of two infants with Pierre Robin Sequence using a LMA Classic™ and Air-Q®: two cases report

The laryngeal mask airway (LMA) Classic™ and Air-Q® are supralaryngeal devices used for airway management in routine and difficult pediatric airways. We describe a novel two-stage technique of insertion of the LMA Classic™ awake prior to induction of anesthesia, to assure oxygenation and ventilation, and after induction removal and placement of the Air-Q® for intubation using the flexible fiberoptic bronchoscope. The LMA Classic's™ pliable design and relatively small size allow it to be easily placed in awake infants. In contrast, the Air-Q® is an excellent device for intubation because of its larger internal diameter and removable 9 mm adapter. Our goal was to reduce unpredictability and potentially increase the safety of induction of anesthesia and intubation in infants with Pierre Robin sequence. By using these devices in a two-stage approach we created a technique for consistent oxygenation, ventilation, and intubation in these infants.

Comparação da máscara laríngea i‐gel (i‐gel™) com a máscara laríngea clássica (LMA‐Classic™) em relação ao desempenho clínico

PurposeThe i‐gel™ is one of the second generation supraglottic airway devices. Our study was designed to compare the i‐gel and the Laryngeal Mask Airway Classic™ with respect to the clinical performance. MethodsWe compared the performance of the i‐gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation. ResultsThere was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p=0.951). The laryngeal mask insertion time for the i‐gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6±2.4s versus 13.1±1.8s [p=0.001]). The fiberoptic glottic view scores for the i‐gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p=0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24h after the procedure (p=0.752). ConclusionBoth devices had good performance with low postoperative complications and without occurrence of regurgitation. The i‐gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.

A randomised comparison of the i‐gel™ and the Laryngeal Mask Airway Classic™ in infants

We performed a randomised comparison of the i-gel™ and the Laryngeal Mask Airway (LMA) Classic™ in children aged less than a year who were undergoing general anaesthesia for elective surgery. Fifty-four infants were randomly allocated to either the i-gel or the LMA Classic. We measured performance characteristics, fibreoptic views through the device and complications. Success rate at first insertion attempt was 100% (27/27) in the i-gel group compared with 88% (23/26) in the LMA Classic group. Insertion of the device was considered easy in 26/27 (96%) patients in the i-gel group compared with 18/26 (69%) patients in the LMA Classic group (p = 0.009). There were no differences between the groups in insertion times, fibreoptic views through the device, airway leak pressures or complications. We conclude that the i-gel was considered easier to insert than the LMA Classic in infants.

Comparison of the i-gel™ and the Laryngeal Mask Airway Classic™ in terms of clinical performance

PurposeThe i-gel™ is one of the second generation supraglottic airway devices. Our study was designed to compare the i-gel and the Laryngeal Mask Airway Classic™ with respect to the clinical performance. MethodsWe compared the performance of the i-gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation. ResultsThere was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p=0.951). The laryngeal mask insertion time for the i-gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6±2.4s versus 13.1±1.8s [p=0.001]). The fiberoptic glottic view scores for the i-gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p=0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24h after the procedure (p=0.752). ConclusionBoth devices had good performance with low postoperative complications and without occurrence of regurgitation. The i-gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.

Laryngeal mask airway insertion by classic and thumb insertion technique: a comparison.

We evaluated the efficacy of an alternative technique, for insertion of the silicone laryngeal mask airway (LMA) Classic™ in 40 American Society of Anesthesiologists grade ASA I and II patients scheduled for elective surgery. In group I (Index Finger group), the LMA was inserted by the classic index finger technique and, in group T (Thumb Insertion group), the thumb insertion technique was used. Ease of insertion, fiberoptic laryngoscopic position, cuff pressures and laryngopharyngeal morbidity were assessed in both study groups. On statistical analysis, both groups were comparable in all respects. From our study it can be concluded that thumb insertion is an effective insertion technique for the LMA Classic™.

Comparison between the LMA Classic™ and New I-gel™ Supraglottic Airway Device: A Manikin Study

Objective It is nowadays well established that the laryngeal mask airway (LMA) is an alternative airway to endotracheal intubation for prehospital environment. However, problems have been reported and many other kinds of supraglottic airway devices (SGDs) were introduced. The I-gel™ is one of the latest SGD, and it has been designed for easy and fast insertion with non-inflatable cuff. We compared the efficacy between LMA Classic™ and I-gel™ by using both normal and difficult airway conditioned manikin. Methods One hundred and two non-experienced volunteers made out of students and nurses participated in the airway management educational program that was held in the emergency medical center of Gwangmyeong Sungae Hospital. After finishing the program, the participants were tested on their performance skills (insertion time) on using the two devices in both normal and difficult airway conditioned manikin. A structured questionnaire was used to measure the knowledge, attitude and preference about each device on a 5-point scale. Results In the LMA Classic™ and I-gel™ groups, it took 28.3±8.3 and 10.0±3.7 seconds with normal airway conditioned manikin (p&lt;0.001), and 29.1±8.2 and 10.3±3.0 seconds elapsed with difficult airway conditioned manikin to achieve adequate airway management (p&lt;0.001) in the corresponding order. The attitude and preference scale of the I-gel™ was higher than those of the LMA Classic™ (p&lt;0.001). Conclusions The insertion time of the I-gel™ was shorter than that of the LMA Classic™ in both normal and difficult airway conditioned manikin, and I-gel™ had a higher positive response for attitude and preference.

A randomised trial comparing the i-gelTM airway with the laryngeal mask airway classicTM in children

A randomised trial comparing the i-gelTM airway with the laryngeal mask airway classicTM in children

Brief review: The LMA Supreme™ supraglottic airway

This article is a review of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme™ as a stand-alone supraglottic airway during general anesthesia and as a conduit for tracheal intubation. Relevant articles were obtained using MEDLINE (1948-July 2011) and EMBASE (1980-July 2011). Only original studies with adult human patients and published in English were selected. The LMA Supreme was found to be comparable with the LMA Proseal™ with regard to success rate, insertion time, and complications. However, in three studies, oropharyngeal leak pressure was higher with the LMA Proseal than with the LMA Supreme. The LMA Supreme was superior to the LMA Classic™ with regard to insertion time and oropharyngeal seal pressure. The LMA Supreme was also used successfully in two difficult airway cases, and it has been used as a conduit for tracheal intubation by utilizing an intubation introducer (gum elastic bougie) and subsequently railroading an endotracheal tube over the bougie into the trachea. Techniques for achieving tracheal intubation include the use of the Aintree Intubation Catheter®, a guidewire-exchange catheter, a gum elastic bougie, and a small (<6.0mm internal diameter) endotracheal tube. The LMA Supreme has been shown to be a safe and efficacious device as a stand-alone supraglottic airway and may also be used as a conduit for tracheal intubation. Further trials are needed to determine the efficacy of the LMA Supreme compared with other supraglottic airways in both elective and emergent airway management situations.

Insertion of LMA Classic™ with and without digital intraoral manipulation in anesthetized unparalyzed patients

Background:The standard recommended insertion technique for LMA Classic™ requires the insertion of index finger into the oral cavity. Several anesthesiologists are reluctant to do this. We conducted this study to evaluate the modified technique of insertion of LMA Classic™ (not requiring insertion of fingers into the patient's mouth) against the standard index finger insertion technique.Materials and Methods:This prospective, randomized, comparative study was conducted on 200 consenting patients. Patients suitable for anesthetic with LMA Classic™ were randomized to standard technique group (standard insertion technique) and modified technique group (technique not requiring digital intraoral manipulation). Laryngeal mask airway (LMA) was inserted by five designated anesthesiologists. Anesthetic protocol was standardized. Time taken to achieve an effective airway, ease of insertion, glottic view obtained through LMA, and incidence of sore throat were assessed.Results:Patient characteristics and duration of surgery were comparable between the groups. Time to achieve an effective airway was comparable [18.5 (8) s with standard technique and 19.7 (10) s with modified technique; data are mean (standard deviation)]. Ease of insertion (92 easy with standard technique and 91 easy with modified technique), success rate (99% in both the groups), glottic view with fiberoptic bronchoscope, and sore throat incidence (six patients with standard technique and eight patients with modified technique) were comparable. The first attempt success rate was significantly higher with the standard technique (98 patients in the standard technique group and 91 patients in the modified technique group).Conclusions:LMA Classic™ can be inserted successfully without the need to insert index finger into patient's mouth, though the first attempt success rate is higher with the standard technique.

A Comparison of the Classic and a Modified Laryngeal Mask Airway (OPLAC™) in Adult Patients

A modified disposable laryngeal mask airway (LMA) (Oro-Pharyngo-Laryngeal Airway Cap, OPLAC™) was developed in our department. In this study, we compared the performance of the LMA Classic™ with that of the OPLAC. This was a randomized, single-blinded, crossover study involving 60 paralyzed, anesthetized adult patients. Both devices were inserted into each patient in different sequences after anesthesia had been induced. In 30 patients, the LMA was inserted first and in 30 patients, the OPLAC was inserted first. The success rate, insertion time, fiberoptic view, peak airway pressure, sealing pressure, incidence of gastric insufflations, trace of blood on the device, and incidence of postoperative sore throat were evaluated. The success rate of placement on the first attempt was high for both devices. The insertion time was significantly shorter and better engagement was noted on fiberoptic view with the OPLAC than with the LMA. The sealing pressure was significantly higher and the incidence of gastric insufflations was significantly lower with the OPLAC. The overall incidence of sore throat was 13.33%. Both devices have comparable airflow resistance and are easy to insert. The OPLAC requires less insertion time, has less variation on insertion time, fits better into the laryngopharynx, is less likely to cause gastric insufflations, and has a higher sealing pressure.

Successful Tracheal Intubation through an Intubating Laryngeal Airway in Pediatric Patients with Airway Hemorrhage

Background This case report describes the use of the air-Q intubating laryngeal airway (air-Q ILA; Cookgas LLC, St. Louis, MO) for airway rescue and a conduit for blind tracheal intubation in two pediatric patients with failed rapid sequence intubation and difficult airways secondary to airway bleeding in the emergency department (ED). Objectives To describe the use of a new supraglottic rescue device in the management of the pediatric patient’s difficult airway in the emergency setting. Case Report Case 1 was a 5-year-old boy who presented to the ED for bleeding one day after his tonsillectomy. After a rapid sequence intubation, direct laryngoscopy was difficult, with copious bleeding in the oropharynx and inability to visualize the glottis. After two failed direct laryngoscopic attempts to intubate, a size-2 air-Q ILA was inserted. A cuffed 5.0-mm inner diameter (ID) endotracheal tube (ETT) was blindly inserted through the lumen of the air-Q ILA into the trachea successfully. Case 2 was a 13-year-old boy who presented to the ED with a large nasopharyngeal laceration from a motor vehicle accident. After a rapid sequence intubation, direct laryngoscopy showed copious blood with no glottic visualization. A size 3 Laryngeal Mask Airway Classic™ (cLMA; LMA North America Inc., San Diego, CA) was inserted with a large airway leak, and blind ETT insertion via the cLMA was unsuccessful. Subsequently, a size-2.5 air-Q ILA was inserted and adequate ventilation was restored. A cuffed 6.0-mm ID ETT was blindly inserted through the air-Q ILA into the trachea successfully. Conclusion Two cases of failed laryngoscopy in pediatric patients with blood in the airway are described. In each case, insertion of an air-Q ILA was followed by successful blind tracheal intubation via the lumen of the air-Q ILA.

Brief review: The Cobra Perilaryngeal Airway (CobraPLA®) and the Streamlined Liner of Pharyngeal Airway (SLIPA™) supraglottic airways

To summarize the published literature related to two, new supraglottic airways (SGAs): the Cobra Perilaryngeal Airway (CobraPLA) and the Streamlined Liner of Pharyngeal Airway (SLIPA). We identified original articles, through searches on Medline and PubMed, using the keywords 'Cobra', 'CobraPLA', 'Cobra-PLA', 'PLA', and 'SLIPA'. Searches identified 28 publications evaluating the CobraPLA, six of which were randomized, controlled trials. Five publications evaluated the SLIPA, two of which were randomized, controlled trials. Studies compared the CobraPLA with a number of SGAs, in regards to both efficacy and safety. While the CobraPLA is comparable to the laryngeal mask airway (LMA) Classic, with respect to insertion times and the incidence and severity of sore throat, the CobraPLA is superior, with respect to airway sealing pressure, and has been used successfully in patients with limited mouth opening and limited head extension. Insertion times, first insertion success rates, recovery times, and hemodynamic responses, associated with insertion of the SLIPA, are similar to those of the LMA Proseal. Although the SLIPA has a unique reservoir chamber to contain regurgitated fluid, the extent of its protection against pulmonary aspiration has not been established in the clinical setting. Both the CobraPLA and the SLIPA are intended for use during short procedures under general anesthesia, and have comparable efficacy and complication rates in comparison to the LMA Classic. Both airways may be considered as primary SGA devices, and the CobraPLA may be also be used as a rescue airway device.

A Comparison of the Laryngeal Tube, Laryngeal Mask Airway ClassicTM and Laryngeal Mask Airway ProsealTM during General Anesthesia

Background: The laryngeal tube is a variant of the esophageal obturator airway. We compared laryngeal tube (LT), laryngeal mask airway (LMA) and laryngeal mask airway (PLMA) as a airway management device during general anesthesia. Methods: Forty-five fasted healthy adult patients were enrolled in this study into one of three groups in a randomized, single-blinded protocol. Group 1 was to receive LT for airway management, LMA for Group 2, and PLMA for Group 3. General anesthesia was induced identically in three groups with thiopental sodium 5 mg/kg followed rocuronium 0.6 mg/kg. 90 seconds later, LT, LMA or PLMA was placed for airway management. Blood pressure and heart rate were measured immediately pre-induction control value, post-insertion of device 0 min, 1 min, 3 min and 5 min. We also compared times of insertion, the amounts of secretion, blood stain, and postoperative sore throat. Results: There was no significant change of SBP, DBP and HR within three groups. All the groups showed stable hemodynamic results. The success rate on the first attempt was 93.6% (14/15, Group 1), 93.6% (14/15, Group 2) and 86.6% (13/15, Group 3). Minimum cuff volume to prevent gas leakage was 69.9 0.5 ml (Group 1), 11.1 4.3 ml (Group 2) and 11.9 3.2 ml (Group 3). The corresponding cuff pressure was 61.6 22.0 (Group 1), 4.8 0.9 (Group 2) and 4.6 1.5 (Group 3). Moderate, severe sore throat was 20% (3/15, Group 1), 6.6% (1/15, Group 2) and 6.6% (1/15, Group 3). Moderate, profuse secretion was 40% (6/15, Group 1), 20% (3/15, Group 2) and 13.3% (2/15, Group 3). There was a 20% (3/15, Group 1) and 13.3% (2/15, Group 3) blood stain. But there was no blood stain for the Group 2. There was a 20% (3/15) gas leakage in Group 1, so we had to insert gas intermittently, but there were no gastric distension, regurgitation, aspiration, hypoxia, airway obstruction and laryngospasm in all three groups. Conclusions: All the groups revealed stable hemodynamics, no serious complications such as regurgitation, aspiration, hypoxia and airway obstruction during general anesthesia. But we did not find any evidence that LMA and PLMA have the remarkable advantages than laryngeal tube. So we suggested that laryngeal tube could be an alternative airway management device, even though further study will be needed.