LMA ProSealTM Research Articles

To Evaluate the Impact of Pneumoperitoneum on Oropharyngeal Seal Pressure of Proseal™ LMA and Baska™ mask in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract Background: Newer supraglottic airway devices (SGADs) are becoming more and more popular as a means of maintaining the airway during laparoscopic procedures. The present study’s aim was to compare the impact of pneumoperitoneum on the oropharyngeal seal pressure (OPSP) of Proseal™ laryngeal mask airway (PLMA) and Baska™ Mask (BM) in patients undergoing laparoscopic cholecystectomy. Methods: We enrolled 60 American Society of Anesthesiologists physical Status I and II patients and randomised to either the PLMA group or the BM group. After induction of anaesthesia using a standardised protocol, one of the SGADs was inserted. The primary outcome was the effect of pneumoperitoneum on the OPSP of the two devices. The secondary outcomes were the time required for insertion of the airway devices, OPSP, fibre-optic view of the vocal cord, ease of insertion and any laryngopharyngeal morbidity. Results: The demographic parameters were comparable between the study groups. The insertion time was 18.034 ± 7.73 and 18.7 ± 6.96 s for the PLMA group and BM group, respectively (P = 0.7255). The OPSP in each group was not significantly impacted by pneumoperitoneum, although it remained the same throughout the procedure. Compared to the PLMA group, OPSP was higher in the BM group at all three time intervals (5 min after the insertion of the device [T1], 10 min after pneumoperitoneum [T2] and 5 min after the revoking of pneumoperitoneum [T3]). Conclusion: Pneumoperitoneum had no effect on OPSP in either group. Significantly higher OPSP was noted in the BM group (both before and following pneumoperitoneum) compared to the PLMA group.

Comparison of weight-based and pinna size method for ProSeal laryngeal mask airway size selection in children receiving general anesthesia: A randomized clinical study.

Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size-based method is a promising new technique for accurate size selection. A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures. A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups (P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively (P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y (P = 0.180). The two groups were comparable as per the number of attempts needed for insertion (P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups. Pinna size-based estimation of LMA size is an effective alternative method to weight-based selection.

Comparison of Two Different Methods for ProSealTM Laryngeal Mask Fixation.

This prospective randomized study compared 2 different methods for ProsealTM Laryngeal Mask Airway (PLMA) fixation. Patients scheduled for ureterorenoscopic lithotripsy surgery in the lithotomy position were included in the study. General anaesthesia with PLMA was administered to the patients. To achieve PLMA fixation, patients were randomly assigned to either adjustable elastic band (Group I) or adhesive tape fixation (Group II). Fiberoptic bronchoscope (FOB) evaluation and glottic image grading (grade 1-4) and lip margin distances of PLMA (M1 and M2) were evaluated before and after the surgical procedure. We enrolled 116 patients. Surgery of 7 patients was postponed. PLMA dislocated in 2 patients in group II during positioning. For another patient who used adhesive tape in Group II, it was removed because it could not adhere to properly, and a new sticking plaster was used. The study was completed with 106 patients. In FOB evaluation, the number of patients with optimal FOB grade (FOB grade 1) after PLMA was inserted and fixed was more in Group I than in Group II (P = 0.01). FOB evaluation was repeated at the end of the operation, and the number of patients with the worst FOB grade (FOB grade 4) was 0 (0%) and 11 (10.5%) in Groups I and II, respectively. PLMA displaced more than 1 cm in 10 (18.9%) patients in Group I and in 30 patients (56.6%) in Group II. The adjustable elastic band method is simple, easy, and convenient and can be used in any surgical procedure for PLMA fixation.

Baska mask vs ProSeal Laryngeal mask on airway seal pressure in cases undergoing general anesthesia by mechanical ventilation: A randomized controlled trial

ABSTRACT Background Supraglottic Airway Devices (SGAs) are designed to counteract the drawbacks of endotracheal intubation. They have proven to be easy to use, robust, versatile, and usable in many difficult situations. This work aims to investigate the use of the Baska Mask (BM) airway and ProSeal™ Laryngeal Mask Airway (PLMA) as SGAs for ventilation. Methods This randomized controlled trial was carried out on 74 cases aged 21–65 years old for elective surgery of a planned duration of up to 2 h during general anaesthesia with intermittent positive pressure ventilation. Cases were divided into two equal groups. Ventilation was done either by BM® Airway (group BM) or PLMA (group PLMA). Results BM had a shorter insertion time and lower leak fraction versus PLMA, while seal pressure elevated significantly with BM versus PLMA (P < 0.001). PLMA had significantly more cases than the BM mask group complaining of a sore throat at 2 h (P = 0.042). Complication after gastric tube insertion was parallel between both groups. Conclusions BM can be used successfully during anesthesia as it displays a shorter insertion time, lower leak fraction, higher seal pressure, and lower incidence of sore throat and gastric tube insertion complications than PLMA.

Contrast of oropharyngeal leak pressure and clinical performance of I-gel™ and LMA ProSeal™ in patients: A meta-analysis.

Conflicting outcomes have been reported for the i-gel™ and laryngeal mask airway (LMA) ProSeal™ in children and adults during general anesthesia. Randomized controlled trials (RCTs) that yielded wide contrast outcomes between i-gel™ and LMA ProSeal™ were included in this meta-analysis. Two authors independently identified RCTs that compared i-gel™ with LMA ProSeal™ among patients receiving general anesthesia by performing searches in EMBASE, Cochrane, PubMed, and ScienceDirect. Discussion was adopted to resolve disagreements. Data were counted with Review Manger 5.3 and pooled by applying weighted mean difference (MD) and rlsk ratio (RR), and related 95% confidence intervals. A total of 33 RCTs with 2605 patients were included in the meta-analysis. I-gel™ provided a considerably lower oropharyngeal leak pressure [weighted average diversity (MD) = -1.53 (-2.89, -0.17), P = 0.03], incidence of blood staining on the supraglottic airway devices [RR = 0.44, (0.28, 0.69), P = 0.0003], sore throat [RR = 0.31 (0.18, 0.52), P<0.0001], and a short insertion time [MD = -5.61 (-7.71, -3.51), P<0.00001] than LMA ProSeal™. Compared with LMA ProSeal™, i-gel™ offered a significantly higher first-insertion success rate [RR = 1.03 (1.00, 1.06), P = 0.03] and ease of insertion [RR = 1.06 (1.01, 1.11), P = 0.03]. The gastric-tube-placement first insertion rate [RR = 1.04 (0.99, 1.10), P = 0.11], laryngospasm [RR = 0.76 (0.17, 3.31), P = 0.72], and cough [RR = 1.30 (0.49, 3.44), P = 0.60] between the two devices were similar. Both devices could achieve a good seal to provide adequate ventilation. Compared with the used LMA ProSeal™, the i-gel™ was found to have fewer complications (blood stainning, sore throat) and offers certain advantages (short insertion time, higher first-insertion success rate and ease of insertion) in patients under general anesthesia.

Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction.

Insertion of the laryngeal mask airway (LMA) without muscle relaxant requires adequate obtundation of airway reflexes, which may otherwise lead to incorrect or failed LMA placement. This study compared topical lignocaine spray vs. intravenous (IV) fentanyl, during propofol induction for insertion of the ProSeal™ LMA (PLMA). This was a prospective, randomized, double blind study, in ASA I or II patients, for elective or emergency surgery. Seventy patients (n = 70) who fulfilled the inclusion criteria were randomly assigned to receive IV fentanyl 2 mcg/kg or topical lignocaine spray 40 mg, prior to anesthesia induction with IV propofol (2–2.5 mg/kg). ProSeal™ LMA insertion condition was regarded optimal in the absence of adverse responses (gag, cough, laryngospasm and body movements), and successful LMA placement at the first attempt. Hemodynamic parameters were recorded and patients were assessed for sore throat and hoarseness post operatively. Seventy patients were analyzed. The number of patients with optimal PLMA insertion conditions were comparable between the groups (60% vs. 57%, P = 0.808). All hemodynamic parameters were comparable between groups with the exception of heart rate. Sympathetic obtundation of heart rate was greater with IV fentanyl than topical lignocaine (P < 0.05). The proportion of patients with postoperative sore throat significantly increased with the number of insertion attempts (P < 0.05). Topical lignocaine spray to the pharynx is as effective, and may be an alternative to IV fentanyl, during propofol induction for PLMA insertion. Success rate and optimal insertion condition at the first attempt, propofol requirement, blood pressure, adverse events and airway complications were comparable. Heart rate obtundation was less with topical lignocaine spray but remained within clinically acceptable values.

An Analysis of the Comparative Efficacy Between a Third-Generation and a Second-Generation Supraglottic Airway Device in Patients Undergoing Laparoscopic Cholecystectomy.

Background and objectiveSupraglottic airway devices are extensively used nowadays to secure the airway and minimize postoperative airway-related complications. This study aimed to evaluate whether the Baska® mask (BM) provides higher seal pressure and a better first-time insertion compared to the laryngeal mask airway (LMA) ProSeal™ (LMA-P) in adult laparoscopic cholecystectomy.MethodologyThis prospective, randomized, single-blinded interventional study was performed after obtaining ethical approval from the Institutional Ethics Committee at the Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Sixty adult patients of both genders scheduled for laparoscopic cholecystectomy under general anesthesia were divided into two groups, with 30 patients in each group. Our study observed the number of insertion attempts, time of insertion, oropharyngeal seal pressure (OSP), number of patients requiring manipulation for proper placement of supraglottic airway devices, and ease of insertion.ResultsThere were no significant differences in terms of insertion attempts, ease of insertion, and laryngopharyngeal morbidity between the groups. The mean OSP at five minutes was 31.55 ±2.23 cm H2O, and that at 30 minutes was 35.86 ±3.70 cm H20 in the BM group, while in the LMA-P group, it was 24.17 ±3.74 cm H20 and 25.97 ±3.79 cm H20 respectively (p<0.001). In our study, the trend of OSP continued to increase in the BM group more than in the LMA-P group during surgery.ConclusionThe BM provided better OSP than the LMA-P, which was observed throughout the surgery.

Safety and efficacy of LMA Supreme™ vs. LMA ProSeal™ for ambulatory surgeries in adult patients

Background &amp; objectives: The laryngeal mask airway Supreme™ (LMA-S) is a new, single-use, supraglottic device that combines the functionality of the ProSeal™ and Fastrach™ airways. Till now, there have been conflicting results regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme™ vs. the LMA ProSeal™, which is the major determinant of effective ventilation and airway protection during LMA use. We compared the safety and efficacy of the LMA ProSeal™ vs. the LMA Supreme™ in ambulatory surgeries.&#x0D; Methodology: In this prospective, comparative trial, eighty adult patients undergoing elective surgery, were randomly allocated to one of the two groups: Group LMA–P (LMA ProSeal™ group) and Group LMA–S (LMA Supreme™ group) of 40 patients each. OLP, insertion times, number of insertion attempts, ease of insertion and pharyngolaryngeal morbidity were assessed. Statistical analysis was performed using SPSS version 21.0 software using Student’s t-test and Chi-square test. P &lt; 0.05 was considered to be statistically significant.&#x0D; Results: Oropharyngeal leak pressure in Group LMA–P (26.65 ± 1.59 cmH2O) was comparable to Group LMA–S (26.08 ± 1.67 cmH2O) and both provided adequate seal and effective ventilation. The mean effective airway time was significantly less in Group LMA–S as compared to Group LMA–P (14.80 ± 1.24 sec and 17.80 ± 1.47 sec) respectively. Mean number of successful insertion attempts, hemodynamic response and pharyngolaryngeal morbidity were comparable in both the groups.&#x0D; Conclusion: Both LMA Supreme™ and LMA ProSeal™ are equally efficacious and safe for maintaining airway and ventilation in paralyzed patients. However, LMA Supreme™ is easier to insert with shorter effective airway time than LMA ProSeal™.&#x0D; Abbreviations: SAD - Supraglottic airway device; ETI - Endotracheal intubation; LMA - Laryngeal mask airways; PPV - Positive pressure ventilation; OLP - oropharyngeal leak pressure&#x0D; Key words: LMA ProSeal™, LMA Supreme™, Oropharyngeal leak pressure; Airway; Aieway management&#x0D; Citation: Singh A, Kaur J, Kaur S, Gupta KK. Safety and efficacy of LMA Supreme™ vs. LMA ProSeal™ for ambulatory surgeries in adult patients. Anaesth. pain intensive care 2021;26(1):63-68.&#x0D; DOI: 10.35975/apic.v26i1.1769&#x0D; Received: June 02, 2021, Reviewed: December 13, 2021, Accepted: December 15, 2021

A randomized comparative study of three supraglottic airway devices for controlled ventilation in anesthetized patients.

Background and Aims:The LMA® ProSeal™, LMA® Supreme™ and Ambu® AuraGain™ are second-generation supraglottic airway devices (SADs) with integrated gastric access. In this study, we compared the clinical performance of these three devices in adults for controlled ventilation in anesthetized paralysed patients.Material and Methods:Two hundred and seventy adults, American Society of Anesthesiologists (ASA) Physical Status I-III, undergoing elective surgical procedures, were randomized into three groups with 90 patients in each: Group 1: LMA® ProSeal™, Group 2: LMA® Supreme™ and Group 3: Ambu® AuraGain™. All the three devices were evaluated for oropharyngeal seal pressure (OSP) and other parameters: ease and the number of attempts at device placement, fibreoptic laryngeal view and intraoperative and postoperative complications.Results:In the present study, the mean OSP was 38.9 ± 3.050 cm H2O in the LMA ProSeal™ group, 37.41 ± 4.097 cm H2O in LMA® Supreme™ group and 37.32 ± 3.740 cm H2O in Ambu® AuraGain™ group. The difference was found to be statistically significant (P = 0.006). The three groups were comparable for the ease of device insertion, number of attempts at device placement, fibreoptic laryngeal view, intraoperative and postoperative complications.Conclusion:In this study, we found that the LMA® ProSeal™ provided the highest OSP in comparison to the other two devices, even though this difference is not clinically relevant. The use of Ambu® AuraGain™ was associated with difficult and lowest first-time insertion success rate (P < 0.001) along with an increased incidence of airway trauma as compared to the other two SADs.

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.

Optimum time of LMA ProSeal removal in adult patients undergoing isoflurane anesthesia: A randomized controlled trial.

Background and Aims:Optimum timing of laryngeal mask airway (LMA) removal after general anesthesia with isoflurane is debatable. The objective was to investigate the potential benefits of removing LMA ProSeal at ≤0.4 Minimum alveolar concentration (MAC) isoflurane over awake and “deep plane” extubation after short duration laparoscopic gynecological surgery.Material and Methods:In this prospective randomized trial 90 adult female patients undergoing elective laparoscopic surgery under general anesthesia using LMA ProSeal™ as airway device were included. At the end of surgery, LMA ProSeal™ was removed when the patient was awake, could open mouth following verbal command (Group A); at MAC ≤0.4 (Group B); or at MAC of 0.6 (Group C). Adverse airway events like nausea, vomiting, airway obstruction, coughing, bucking, laryngospasm were noted. Statistical analyses were done by SPSS statistical software (IBM SPSS Statistics for Mac OS X, Version 21.0. IBM Corp, Armonk, NY).Results:Baseline demographic characteristics were comparable in all three groups. Coughing or bucking at the time of LMA removal was higher in group A (P = 0.004). Snoring and airway obstruction after LMA removal was significantly higher in group C compared to group A and group B (P = 0.002 and P = 0.011, respectively). There was significant change in mean arterial pressure and heart rate between before and after LMA removal on group A (P = 0.008 and P < 0.001, respectively) but not in other groups.Conclusion:MAC ≤0.4 can be considered optimum depth of anesthesia for removal of LMA Proseal in adult patients undergoing isoflurane anesthesia.

Effect of neuromuscular block on surgical conditions during short-duration paediatric laparoscopic surgery involving a supraglottic airway

BackgroundUse of an LMA ProSeal™ laryngeal mask airway (P-LMA; Teleflex) with no neuromuscular block is considered a safe alternative to tracheal intubation in short-duration paediatric laparoscopic surgery. However, few studies have evaluated surgical conditions of short-duration paediatric laparoscopic surgery using this anaesthetic technique. We assessed surgical conditions for paediatric laparoscopic inguinal hernia repair using P-LMA with and without neuromuscular block. MethodsSixty-six patients undergoing laparoscopic inguinal hernia repair were randomised to receive a neuromuscular block (train-of-four 1–2 twitches) using rocuronium or no neuromuscular block with the P-LMA. All operations were performed by the same surgeon who determined the surgical conditions using the Leiden-surgical rating scale (L-SRS). Secondary outcomes included perioperative data, haemodynamics, and adverse events. ResultsNeuromuscular block improved surgical conditions compared with no neuromuscular block: mean (standard deviation) L-SRS 4.1 (0.5) vs 3.5 (0.6), respectively (P<0.0001). Mean rocuronium dose in the neuromuscular block group was 12.7 (4.4–29.7) mg or 0.7 (0.6–0.8) mg kg−1. The insufflation Ppeak was higher in the no neuromuscular block group than in the neuromuscular block group: mean (standard deviation) Ppeak 17.9 (1.8) cm H2O vs 16.2 (1.9) cm H2O, respectively (P=0.0004). Fifteen children (45.5%) in the no neuromuscular block group had adverse events during the surgery and anaesthesia vs four children (12.1%) in the neuromuscular block group (P=0.006). ConclusionsNeuromuscular block significantly improved surgical conditions and reduced the incidence of adverse events during surgery and anaesthesia when an LMA Proseal™ was used in short-duration paediatric laparoscopic surgery. Clinical trial registrationChiCTR2000038529.

Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique

Introduction: Endotracheal Intubation (ETI) is highest quality level for airway organization. LMA ProSeal™ (PLMA) insertion utilizing Gum Elastic Bougie (GEB) guidance, which has got 100% first attempt success rate, also requires laryngoscopy, hence nullifying its advantage of being a supraglottic airway device. We aimed to compare the hemodynamic responses associated with laryngoscopy assisted GEB guided PLMA placement with that of conventional endotracheal intubation. Method: Hundred normotensive ASA1 or 2 patients of either sex (age 18 to 40yrs) undergoing general anesthesia for elective surgery included and evaluated for pressor response. Following a uniform premedication and standard anesthesia technique (thiopentone + vecuronium), either of airway was placed and pulse rate, (beats/min); Mean blood pressure, MAP (mmHg) (at Tb = base line, T0 = just before laryngoscopy and PLMA/ETT placement, T1 = 1min, T3 = 3min, T5 = 5 min, T7 = 7 min after placement). Results: Patients demographics between the PLMA and ETT groups were similar. Following laryngoscopy and PLMA\ETT placement, both were associated with statistically significant increase in HR and MAP with respect to its basal value. Although it was less marked in case of PLMA Group, when comparison was made within individual Group. Duration of laryngoscopy and time of placement were longer in PLMA Group as compared to ETT Group (35.71 and 12.69 sec. vs 21.30 and 10.76 sec. respectively). ETT insertion was related with higher incidence of cough (p 0.05). Conclusion: Hence GEB guided PLMA method must be used as a reinforcement method in cases where standard insertion methods fall ineffective and in ineffectual tracheal intubation where the bougie is incidentally embedded into throat and quick control of the airway route is essential. Key words: Gum elastic bougie; Laryngeal Mask Airway; Hemodynamics; Pressor response Abbreviations: LMA – laryngeal mask airway; ETI – Endotracheal Intubation; GEB – Gum Elastic Bougie; ETT –Endotracheal tube; PLMA – Laryngeal Mask Airway ProSeal Citation: Upadhyay MK, Kumar G, Chaurasia A, Narang D. Evaluation of gum elastic bougie guided Proseal laryngeal mask airway insertion technique. Anaesth. pain intensive care 2021;25(3):338–344. DOI: doi.org/10.35975/apic.v25i3.1531 Received: March 20, 2021; Reviewed: April 11, 2021; Accepted: May 11, 2021

A Randomized Prospective Study to Compare Use of I-GELTM and LMA ProsealTM in Patients undergoing Laparoscopic Cholecystectomy

Introduction: With the availability of supraglottic devices in providing effective seal even in conditions of raised airway pressures, use of these devices in laparoscopic surgeries has become popular. Of the various supraglottic devices being used in laparoscopic surgery LMA ProSealTM and i-gelTM airway are commonly used with efficacy. The aim of this study was to compare the use of i-gelTM and LMA ProSealTM in patients undergoing Laparoscopic cholecystectomy. Methodology: This was a prospective randomized, hospital based study conducted at a tertiary care hospital. Adult inpatients of either gender posted for elective laparoscopic surgery were recruited in the study. A total of 100 patients were included out of which 50 each were randomly allocated to either i-gelTM group (Group I) or LMA ProSealTM group (Group P). After randomization, the chosen supraglottic airway device (i-gel/Proseal LMA) was inserted. Airway insertion attempts, time to successful ventilation, Gastric tube placement, Airway sealing quality, Numbers of attempts required for correct placement and complications were recorded and the data was assessed. Results: Demographic data were comparable in the two groups. The Ventilation time was found to be significantly faster with PLMA as compared to i-gel. I-gel and Proseal showed no significant differences in the airway and gastric tube insertion attempts, ventilation success rate, airway sealing pressures, SpO2, EtCO 2, airway sealing quality score and intra abdominal pressures. Conclusion: Both i-gel and Proseal both provide adequate ventilation in laparoscopic cholecystectomy surgeries. Complications such as airway injury and bleeding with Proseal LMA are significantly more as compared to i-gel.

A study of effect of lateral position on oropharyngeal seal pressure of i-gel® and ProSeal™ LMA in children.

Background and Aims:Supraglottic airways (SGAs) should have good oropharyngeal seal pressures (OSP) for adequate ventilation and prevention of aspiration. Our aim was to study the effect of lateral position on OSP and thereby on ventilatory parameters for i-gel® and ProSeal™ laryngeal mask airway (PLMA) in children.Methods:In this prospective observational study, 86 children of ASA I-II, aged 1 month to 12 years, scheduled for elective surgery under general anaesthesia using i-gel® or PLMA and requiring lateral position either for surgery or regional blocks were included. In both supine and lateral position OSP (constant flow method), expired tidal volume, fractional volume loss (%), and end-tidal carbon dioxide (ETCO2) were noted. Intragroup and intergroup difference in OSP from supine to lateral position was analyzed using paired and unpaired t-test respectively.Results:In lateral position, there was a significant decrease in the OSP (cm H2O) in both i-gel® (supine: 21.94 ± 5.82, lateral: 15.54 ± 5.37) and PLMA (supine: 17.53 ± 5.05, lateral: 12.76 ± 3.37) groups (P = 0.000). Percentage reduction in OSP from supine to lateral with i-gel® (28.14 ± 18.86) and PLMA (24.06 ± 19.75) were comparable (P = 0.339). With both i-gel® and PLMA significant increase in fractional volume loss and ETCO2 were noted in lateral position. I-gel® group had higher OSP compared to PLMA in supine (P = 0.001) and lateral position (P = 0.009).Conclusion:In lateral position there was significant reduction in OSP compared to supine position with both i-gel® and PLMA.

Assessment of Success and Ease of Insertion of ProSeal™ Laryngeal Mask Airway versus I-gel™ Insertion by Paramedics in Simulated Difficult Airway Using Cervical Collar in Different Positions in Manikins.

Background:Tracheal intubation, a critical intervention, performed by paramedics for airway management in trauma, has an unacceptably low success rate due to difficult airway, restricted access, and inexperience. Thus, the use of supraglottic devices to achieve ventilation has gained popularity.Aims:We aimed to compare the success rate, time to achieve ventilation, and ease of insertion of two popular supraglottic devices, ProSeal™ laryngeal mask airway (PLMA) and I-gel™, in simulated difficult airway with limited access in manikins in different positions which were supine, head against the wall, and sitting position like in car seat.Settings and Design:This was a prospective interventional study.Materials and Methods:After a brief training, 35 paramedics were asked to insert I-gel™ and PLMA in a manikin with cervical collar in 3 positions: head end free (Group A), head against the wall (Group B), and sitting position (Group C), to simulate difficult airway. Success rate and time to achieve ventilation in each position were noted. Each participant graded ease of insertion.Statistical Analysis:Statistical analysis was performed using SPSS 24.0. Categorical variables were analyzed using a Pearson's Chi-square test. Continuous variables were analyzed using the Kolmogorov–Smirnov test. If there was a normal distribution, a paired t-test was performed. Otherwise, a Wilcoxon signed-rank test was performed. P < 0.05 was considered statistically significant.Results:Success rate with I-gel™ was significantly higher than PLMA, 91% versus 77% in Group A, 100% versus 88% in Group B, and 100% versus 74% in Group C. Time to achieve ventilation was shorter with I-gel™ than PLMA, 8.9 versus 15 s in Group A (P < 0.001), 13.1 versus 21.3 s in Group B (P < 0.01), and 18.5 versus 30.3 s in Group C (P < 0.001).Conclusion:I-gel™ can be an effective device to achieve ventilation in difficult airway with limited access in trauma. More studies are required to validate its success and safety.

Efficacy of the LMA-ClassicTM and LMA ProsealTM in Children Undergoing Elective Surgery under General Anaesthesia

Efficacy of the LMA-ClassicTM and LMA ProsealTM in Children Undergoing Elective Surgery under General Anaesthesia

Comparison of the ProSeal laryngeal mask airway with the I-Gel™ in the different head-and-neck positions in anaesthetised paralysed children: A randomised controlled trial.

Background and Aims:Head and neck movements alter the shape of the pharynx, resulting in changes in the oropharyngeal leaking pressures and ventilation with supragottic airway devices. We compared the effect of the different head-and-neck positions on the oropharyngeal leak pressures and ventilation with the I-Gel™ and ProSeal™ laryngeal mask airway (PLMA) in anaesthetised paralysed children.Methods:A total of 70 children were randomly assigned to receive PLMA (n = 35) or I-Gel™ (n = 35) for airway management. Oropharyngeal leak pressure in maximum flexion, maximum extension and the neutral position was taken as the primary outcome. Peak inspiratory pressures (PIPs), expired tidal volume, ventilation score and fibreoptic grading were also assessed.Results:No significant difference was noted in oropharyngeal leak pressures of PLMA and I-Gel™ during neutral (P = 0.34), flexion (P = 0.46) or extension (P = 0.18). PIPs mean (standard deviation [SD]) were significantly higher (17.7 [4.03] vs. 14.6 [2.4] cm H2O, P = 0.002) and expired tidal volume mean [SD] was significantly lower (5.5 [1.6] vs. 6.9 [2] ml/kg, P = 0.0017) with I-Gel™ compared to PLMA. Fibreoptic grading and ventilation score were comparable in both the groups in all the three head-and-neck positions.Conclusion:PLMA and I-Gel™, both recorded similar oropharyngeal leaking pressures in all the three head-and-neck positions. However, higher peak pressures and lower expired tidal volume in maximum flexion of the neck while ventilating with I-Gel may warrant caution and future evaluation.

Airway challenges in laryngotracheoplasty with Montgomery T-tube for subglottic stenosis

Airway challenges in laryngotracheoplasty with Montgomery T-tube for subglottic stenosis

Comparison of I-GelTM and LMA ProSealTM as Airway Device for Laparoscopic Hernioplasty

Comparison of I-GelTM and LMA ProSealTM as Airway Device for Laparoscopic Hernioplasty