Laryngeal Mask Airway Supreme Group Research Articles

Comparison of the Jcerity Endoscoper Airway with the LMA supreme for airway management in patients undergoing cerebral aneurysm embolization: a randomized controlled non-inferiority trial

BackgroundJcerity Endoscoper Airway is a new back-open endoscopic laryngeal mask airway device with a unique design. Our study sought to compare the implantation, ventilation quality and complications of JEA (Jcerity Endoscoper airway) versus LMA (Laryngeal Mask Airway) Supreme in the procedure of cerebral aneurysm embolization.MethodsIn this prospective, randomised clinical trial, 182 adult patients with American Society of Anesthesiologists class Ι-II scheduled for interventional embolization of cerebral aneurysms were randomly allocated into the Jcerity Endoscoper airway group and the LMA Supreme group. We compared success rate of LMA implantation, ventilation quality, airway sealing pressure, peak airway pressure, degree of blood staining, postoperative oral hemorrhage, sore throat and other complications between the groups.ResultsThere were no significant differences between the groups in terms of one-time success rate of LMA implantation, ventilation quality, airway sealing pressure or airway peak pressure. However, LMA Supreme group showed a higher degree of blood staining than the JEA group when the laryngeal mask airway was removed (P = 0.04), and there were also more oral hemorrhages and pharyngeal pain than JEA group (P = 0.03, P = 0.02). No differences were observed between groups in terms of other airway complications related to the LMA.ConclusionsThe JEA could not only achieve comparable one-time success rate of implantation and quality of ventilation as the LMA Supreme, but also have lower blood staining degree of mask and less sore throat in patients undergoing perioperative anticoagulation for cerebral aneurysm interventional embolization.Trial registrationChinese Clinical Trial Registry, ChiCTR2100044133; Registered 11/03/2021.Statement: This study adheres to CONSORT guidelines.

Comparison of the third-generation streamlined liner of the pharynx airway (SLIPA-3G) with the laryngeal mask airway supreme for laparoscopic cholecystectomy: a randomized prospective study

BackgroundThe third-generation streamlined liner of the pharynx airway (SLIPA-3G) is a new-generation supraglottic airway device (SAD) that is non-cuffed and disposable, with a sealing pressure that varies dynamically with the airway pressure. This study compared the SLIPA-3G with the laryngeal mask airway supreme (LMAS) in patients undergoing laparoscopic cholecystectomy.MethodsTwo hundred and twenty patients scheduled for laparoscopic cholecystectomy were randomly allocated to either the SLIPA-3G group or the LMAS group. Data were collected on the patients’ hemodynamic parameters at different time points, ease of insertion, fiberoptic view, oropharyngeal leak pressure (OLP) at different time points and SAD-related complications.ResultsThe mean OLP immediately after device placement in the LMAS group was significantly higher than that of the SLIPA-3G group (31.34 ± 6.99 cmH2O vs.28.94 ± 6.01 cmH2O, P = 0.008, 95% CI 0.62–4.17). The OLPs of the two groups were not significantly different after the induction of a pneumoperitoneum until the end of surgery. The OLP increased gradually through the course of the operation in the SLIPA-3G group (P value = 0.035) but not in the LMAS group (P value = 0.945). There was no significant difference between the two groups in hemodynamic parameters, insertion time and success rate, fiberoptic view and complication rate.ConclusionsThe SLIPA-3G and LMAS were associated with comparable OLPs, hemodynamic parameters, ease of insertion, fiberoptic views and complication rates when used during laparoscopic cholecystectomy. The SLIPA-3G can be used as an effective alternative to the LMAS in patients undergoing laparoscopic surgeries.

A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial

BackgroundThere are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events.MethodsThe present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia.ResultsIn the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups.ConclusionThe present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases.Trial registrationThis trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03903679 on April 5, 2019.

Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

BackgroundThe application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk. Applying positive pressure ventilation via supraglottic airway devices (SAD) can result in a degree of gastric insufflation. This study assessed and compared the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynecological surgery when managed with different SAD.MethodsOne hundred American Society of Anesthesiologists I or II female patients were assessed for inclusion in this study and divided into three groups of different ventilation devices. Patients were randomly allocated into three groups to receive LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). The primary outcome was the antral cross-sectional area and secondary outcomes included haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting.ResultsThe antral CSA was not significantly different among three groups before induction (P = 0.451), after induction (P = 0.456) and at the end of surgery (P = 0.195). The haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion (P < 0.0001) and after removal (P < 0.01). Sore throat was detected in none in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and fifteen patients (50%) in the tracheal tube group. Hoareness was detected in one (3.3%) in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and eleven patients (36.7%) in the tracheal tube group.ConclusionsThe SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynecological surgery.Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018212, data of registration, September 2018).

Results of the randomized comparative study of second-generation supraglottic airways in orbital osteosynthesis

The objective:to assess and compare supraglottic airways of LMA-Supreme and i-gel during orbital osteosynthesis.Subjects and methods.91 patients were included into the study. All of them underwent osteosynthesis of the orbit. The patients were randomly divided into two groups. LMA-Supreme group included 42 patients, while i-gel group included 49 patients.Results.The parameters of hemodynamics, gas exchange, and artificial pulmonary ventilation (APV) did not basically differ between the groups at different stages of the study. The oropharyngeal leak pressure differed between the groups at the end of surgery and made (Me – median, Q1and Q3– upper and lower quartiles): 28.0 (22.0; 30.0) and 21.0 (19.0; 27.0) mm WG the LMA-Supreme and i-gel groups, respectively;p= 0.021. A significant difference was observed in the insertion time of supraglottic airways (Me is the median, Q1and Q3are the upper and lower quartiles): 27.5 (19.3; 36.5) sec. for LMA-Supreme and 15.0 (13.8; 25.0) sec. – for i-gel;p= 0.001. When inserting the LMA-Supreme duct in 33 (78.6%) patients, jaw thrust maneuver, extension of the neck, etc. were required; while in the i-gel group, similar maneuvers were necessary in 18 (36.7%) patients;p&lt; 0.001. The number of postoperative complications was minimal in both groups.Conclusion.Both supraglottic airways can be used with equal efficacy in osteosynthesis of the orbit. At the same time, the i-gel duct has an advantage over the LMA-Supreme in speed and simplicity of insertion. The LMA-Supreme had greater leak pressure at the end of surgery, which might be an advantage in patients requiring greater peak inspiratory pressure to provide effective APV.

Efficacy of Baska mask and Laryngeal mask airway supreme during positive pressure ventilation - A comparative study.

Background and Aims:Supraglottic airway devices have several roles including maintenance of a clear upper airway during general anesthesia. We primarily compared the efficacy of Baska mask (BM) and laryngeal mask airway supreme (LMAS) for the rate of first time successful placement and the seal pressure. The secondary outcome measures included laryngopharyngeal morbidity and the correct positioning of the gastric port.Material and Methods:A sample size of 30 was calculated in each study group. A total of 70 study participants were included in the statistical analysis of which 36 patients were in the BM group and 34 patients were in the LMAS group.Results:The BM was successfully inserted in 28 patients (77.8%), whereas LMAS was successfully inserted in 33 patients (97.1%) in the first attempt (P = 0.028). The mean oropharyngeal seal pressure in the BM group was higher (33.28 ± 6.80 cm H2O) than compared to the LMAS group (27.47 ± 2.34 cm H2O) with a P value <0.001. There was no significant difference between the two groups in the incidence of postoperative laryngopharyngeal morbidity both in the immediate postoperative period (P = 0.479) and that seen 24 hours post operatively (P = 0.660). The nasogastric tube could easily be inserted in the entire study population.Conclusion:From the present study, it is concluded that the BM creates a higher oropharyngeal seal pressure than the LMAS. However, the BM is more difficult to insert. The incidence of postoperative laryngopharyngeal morbidity is similar in both groups.

A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®.

The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an 'insert-detect-correct-as-you-go' technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9cm H2O) compared to the LMA-Supreme (27.7 ± 3.5 cm H2O) group (mean difference 4.0 cm H2O, 95% confidence interval (CI) 2.7-5.3 cm H2O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided.

A clinical trial evaluating the laryngeal mask airway-Supreme in obese children during general anesthesia.

IntroductionThe laryngeal mask airway (LMA)-Supreme is a disposable double-lumen laryngeal mask airway that is widely used in clinical practice. However, its use in obese children has not been evaluated. The aim of this study was to determine whether the LMA-Supreme could perform equally as well as endotracheal intubation in obese children having a minor surgical procedure.Material and methodsAfter ethical board approval, 100 obese male children receiving non-emergent appendectomy for chronic appendicitis or surgery to correct concealed penis were randomly divided into an endotracheal intubation group and an LMA-Supreme group. Endotracheal intubation was performed under direct vision laryngoscopy. In the LMA group, a size-3 LMA-Supreme was placed and a stomach tube inserted via the drainage tube of the mask. Cardiovascular and respiratory parameters, time taken for placement, placement attempts, time to removal of the endotracheal tube/LMA, length of stay in the post-anesthesia care unit (PACU), and complications were recorded.ResultsInsertion time was significantly longer (p < 0.001) in the LMA-Supreme group than in the endotracheal intubation group. Peak airway pressure was significantly higher, and pulmonary compliance and PACU stay time lower in the LMA-Supreme group. No significant differences between endotracheal intubation and the LMA-Supreme were seen in other parameters, except for a higher incidence of coughing in the endotracheal intubation group.ConclusionsThe LMA-Supreme can be easily inserted and effectively used for airway management in obese children undergoing minor surgery.

Comparative Study of laryngeal mask airway Supreme and laryngeal mask airway Classic in paralyzed patients

Aim and Objectives: The present study was undertaken to compare the LMA Classic with LMA Supreme in assessing the ease of insertion, number of attempts, time for insertion, any unwanted responses, stability of device, peak airway pressure, leak volume and leak fraction and postoperative complications. Methods: A total of 274 patients of ASA grade 1 and 2 were included in the study and divided into two groups with 137 patients in each group: the LMA Classic group (group C) and LMA Supreme group (group S). All patients were induced with propofol 2.5 mg/kg and atracurium 0.5mg/kg after that appropriate sized supraglottic airway device was inserted. The ease of insertion, number of attempts, duration of insertion, stability of device, peak airway pressure, leak volume and leak fraction and postoperative complications were recorded. Results: The insertion of Supreme LMA was very easy in 134 patients and was easy in 3 patients, difficult in 0 patients while the insertion of Classic LMA was very easy in 122 patients, easy in 15 patients and difficult in 0 patients. The first attempt insertion rate was more with Supreme LMA as compared to Classic LMA. The mean duration of insertion was significantly lower with Supreme LMA than with Classic LMA. The mean airway pressure was similar in both groups. Both devices were stable. Leak volume and Leak fraction was significantly higher in Classic LMA than Supreme LMA. Peri-operative complications were not significantly different between Supreme LMA and Classic LMA. Conclusions: The LMA Supreme is superior to the LMA Classic because of its ease of insertion with lesser leak volume and leak fraction and better first attempt insertion rate.

Comparison of the Supreme and the ProSeal laryngeal mask airway in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

ObjectiveThe single-use LMA Supreme (Teleflex, Inc., Wayne, PA, USA) and the LMA ProSeal (Teleflex, Inc., Wayne, PA, USA) laryngeal mask airway (LMA) have similar characteristics. To date, studies have not achieved a consensus regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme and LMA ProSeal, and there is little information on their efficacy in laparoscopic cholecystectomy. This study compared the safety and efficacy of the LMA Supreme and LMA ProSeal devices in patients undergoing laparoscopic cholecystectomy. MethodEighty-four eligible consenting patients were randomly allocated to the LMA Supreme group or the LMA ProSeal group. Both groups received the standard anesthesia technique. The Supreme or ProSeal LMA was inserted, the cuff was inflated to 60 cmH2O, and the LMA position was confirmed. Anesthesia was maintained using propofol and 50% oxygen in air. A gastric tube was inserted through the drain tube of the LMA to deflate the stomach, and the first attempt success rate and insertion time were recorded. During surgery, the intra-abdominal pressure was maintained at 12 mmHg. The fiberoptic view of the larynx was determined by passing a flexible fiberoptic bronchoscope. The OLPs, success rate, insertion time, hemodynamic and respiratory parameters, and complications were recorded at different time points. ResultsThe mean OLP was significantly lower in the LMA Supreme group than in the LMA ProSeal group (24.9 ± 5.3 cmH2O vs. 28.4 ± 5.8 cmH2O; p < 0.01). The first attempt success rate and ease of insertion grading for LMA were higher in the Supreme group. The insertion time was lower in the Supreme group than in the ProSeal group (p < 0.01). The fiberoptic view was better with the ProSeal LMA. The hemodynamic and ventilatory parameters and postoperative sore throat were comparable in both groups. ConclusionThe LMA ProSeal has a higher OLP than the LMA Supreme. The success rate of first attempt insertion and ease of insertion were better for the LMA Supreme group and the insertion time was lower in the LMA Supreme group. The Supreme and ProSeal LMAs were both effective for positive pressure ventilation in laparoscopic cholecystectomy.

Efficacy of Ambu AuraOnce laryngeal mask airway in Chinese patients undergoing general anesthesia

Objective To evaluate the efficacy of Ambu AuraOnce laryngeal mask airway (LMA) in Chinese patients undergoing general anesthesia. Methods Fifty-six female patients, aged 20-64 yr, weighing 45-75 kg, of American Society of Anesthesiology physical statusⅠor Ⅱ (MallampatiⅠ-Ⅲ), scheduled for elective breast surgery under general anesthesia, were equally and randomly divided into either Ambu AuraOnce LMA group (group A) or LMA Supreme group (group S) using a random number table. After induction of anesthesia, Ambu AuraOnce LMA was inserted in group A, and LMA Supreme was placed in group S. After successful placement of LMA, correct position was confirmed by fiberoptic laryngoscopy. Intermittent positive pressure ventilation was performed during surgery to maintain pulse oxygen saturation > 95% and partial pressure of end-tidal CO2 at 30-45 mmHg. The success rate, insertion time, extubation time, airway sealing pressure, peak airway pressure and occurrence of air leakage of LMA were recorded. After removal of the LMA, the blood stains on the LMA were checked, and the occurrence of hypoxemia, regurgitation, nausea, vomiting and bucking was recorded. The occurrence of sore throat, hoarseness and dysphagia was also recorded within 24 h after surgery. Results There were no significant differences in terms of insertion time, overall success rate, success rate at first attempt, removal of LMA time, airway sealing pressure, and incidence of air leakage of LMA, hypoxemia, blood stains on the LMA, sore throat, hoarseness and dysphagia between the two groups. The rate for correct position of LMA confirmed by fiberoptic laryngoscopy was significantly higher in group A than in group S. Conclusion Ambu AuraOnce LMA can safely and effectively be applied for airway management in Chinese patients undergoing general anesthesia. Key words: Laryngeal masks; Respiration, artificial; Anesthesia, general

Comparison of laryngeal mask airway supreme and laryngeal mask airway proseal for laryngopharyngeal trauma and postoperative morbidity in children

Background and objectives: Laryngeal mask airway (LMA), which has been used frequently in airway management, can cause laryngopharyngeal injury and morbidity. In this trial, we compare the macroscopic changes on laryngopharyngeal structures and the postoperative laryngopharyngeal morbidity by using LMA supreme with LMA proseal in children. MethodsWe divided patients into two groups. We inserted size three LMA proseal into the first group and size three LMA supreme into the second group. Before LMA insertion and after LMA removal, we performed direct laryngoscopy on the patients. We compared hyperemia, mucosal injury and blood staining on LMA removal, as well as insertion time, rate of success in gastric tube insertion on the first attempt, nausea, vomiting, and sore throat between the two groups. ResultsWe recorded no significant differences between the two groups for mean operation time, sex, age, weight, rate of success in gastric tube insertion on first attempt, nausea, vomiting, sore throat and mucosal injury. Mean insertion time for the LMA proseal group was significantly longer than the LMA supreme group (p = 0.0001). The ratio of blood staining on LMA removal was significantly higher in the LMA proseal group than the LMA supreme group (p = 0.034). The patients with blood staining on LMA removal exhibited significantly more mucosal hyperemia and injury than the patients with clear LMA (p = 0.0001, p = 0.020). ConclusionLMA supreme insertion is faster and easier than LMA proseal and causes less laryngopharyngeal injury than LMA proseal in children.

Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy

A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. Prospective, single-blind, randomised, controlled study. The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ± 6.2 versus 26.8 ± 4.1 cmH2O;P < 0.01). This was consistent with a higher maximum tidal volume achieved with the LMAP compared to the LMAS (511 ± 68 versus 475 ± 55 ml; P = 0.04). The success rate of the first attempt insertion was higher for the LMAS group than the LMAP group (96.7 and 71.2%, respectively; P < 0.01). The time taken for insertion, ease of insertion of the drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.

A Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology

ABSTRACT Introduction This prospective study compares the efficacy of two disposable supraglottic airway devices with separate gastric access and integral bite block, the inflatable cuff of the LMA SupremeTM against the noninflatable i-gelTM cuff in providing an adequate seal for laparoscopic surgery. Materials and methods Ninety women of ASA grade I and II undergoing diagnostic laparoscopy with Trendelenburg position were randomly allocated to receive either size 3 LMA Supreme or i-gel. Induction and maintenance protocols were similar and patients were not paralyzed. We compared the airway leak pressure, ease and time to insert the device and a 10 FG nasogastric tube through it, and to note complications if any. Results There was no difference in airway leak pressure between the two devices (24.4 ± 4.0 vs 23.6 ± 3.8 cm H2O, p &gt; 0.05). Forty-one (91%) LMA Supremes and forty (88.8%) i-gels were successfully inserted on the first attempt, with similar ease, and comparable times (13.8 ± 4.9 sec for LMA Supreme vs 14.5 ± 6.7 sec for i-gel; p &gt; 0.05). Gastric tube insertion was easier and achieved more quickly with LMA Supreme compared to i-gel (9.0 ± 3.1 sec vs 14.3 ± 7.5 sec, respectively; p &lt; 0.01), but clinical significance of this finding is questionable. There was blood on removal of four LMA Supremes and three i-gel. Four patients in the LMA Supreme group and one patient in the i-gel group experience mild postoperative sore throat. Conclusion Both LMA Supreme and i-gel are equally effective ventilator devices for diagnostic gynecological laparoscopic procedures. How to cite this article Chattopadhyay S, Goswami S. A Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology. J South Asian Feder Obst Gynae 2013;5(3):124-128.

Efficacy of laryngeal mask airway i-gel in patients undergoing laparoscopic gynecological surgery

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery. Key words: Laryngeal mask; Respiration,artificial; Laparoscopy

Efficacy of laryngeal mask airway ProSeal and Supreme under low cuff pressure in patients undergoing laparoscopic surgery

Objective To assess the efficacy of laryngeal mask airway Proseal （LMA Proseal） and Supreme （LMA Supreme） used in patients undergoing laparoscopic surgery when the cuff-pressure was 35 cm H2O.Methods Sixty ASA Ⅰ or Ⅱ patients, aged 20-70 yr, weighing 50-80 kg, undergoing elective laparoscopic surgery, were randomized into2 groups （n = 30 each）： LMA ProSeal group （group P） and LMA Supreme group （group S）. After the LMA Proseal and LMA Supreme were inserted in group P and S respectively, the cuff pressure was monitored and maintained at 35 cm H2O by manipulate manometer. The airway sealing pressure, peak and mean airway pressure before and after pneumoperitoneum during mechanical ventilation and the complications were also recorded. Results The peak airway pressure was significantly higher after pneumoperitoneum than before pneumoperitoneum during mechanical ventilation （P 〈 0.05）, but there was no significant difference in the peak airway pressure before and after pneumoperitoneum between the two groups （ P 〉 0.05）. The air leakage had never happened before or after pneumoperitoneum during mechanical ventilation. There was no significant difference in the airway sealing pressure between the two groups （ P 〉 0.05）. There was no significant difference in the incidence of throat pain between the two groups（P〉0.05）.Conclusion When the cuff pressure is 35 cm H2O, the LMA ProSeal and Supreme can provide adequate ventilation during operation with fewer complications and can be used safely for laparoscopic surgery. Key words: Laryngeal masks; Respiration, artificial; Laparoscopy; Cuff pressure

Comparison of the LMA Supreme vs the i‐gel™ in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation*

We compared the efficacy of the inflatable cuff of the LMA Supreme against the non-inflatable i-gel cuff in providing an adequate seal for laparoscopic surgery in the Trendelenburg position in 100 female patients. There was no difference in our primary outcome, oropharyngeal leak pressure, between the LMA Supreme and the i-gel (mean (SD) 26.4 (5.1) vs 25.0 (5.7) cmH(2) O, respectively; p = 0.18). Forty-seven (94%) LMA Supremes and 48 (96%) i-gels were successfully inserted on the first attempt, with similar ease, and comparable times to the first capnograph trace (mean (SD) 14.3 (4.7) s for the LMA Supreme vs 15.4 (8.2) s for the i-gel; p = 0.4). Gastric tube insertion was easier and achieved more quickly with the LMA Supreme vs the i-gel (9.0 (2.5) s vs 15.1 (7.3) s, respectively; p < 0.001). After creation of the pneumoperitoneum, there was a smaller difference between expired and inspired tidal volumes with the LMA Supreme (21.5 (15.2) ml) than with the i-gel (31.2 (23.5) ml; p = 0.009). There was blood on removal of two LMA Supremes and one i-gel. Four patients in the LMA Supreme group and one patient in the i-gel group experienced mild postoperative sore throat.

Efficacy of laryngeal mask airway Supreme and Streamlined Liner of the Pharynx Airway in patients undergoing general anesthesia

Objective To compare the efficacy of laryngeal mask airway Supreme （LMAS） and Streamlined Liner of the pharynx Airway （SLIPA） in patients undergoing general anesthesia. Methods Eighty ASA I or II patients aged 18-70 yr weighing 45-80 kg undergoing general anesthesia were randomly divided into 2 groups （n = 40 each）： group LMAS and group SLIPA. Pharyngeal airway was inserted after induction of anesthesia with fentanyl 3 ug/kg and propofol 2.0-2.5 mg/kg. MAP, HR, number of insertion, rate of successful placement at first attempt, placement time, airway sealing pressure, peak and mean airway pressure and side effects were recorded. Results There were no significant differences in MAP, HR and rate of successful placement at first attempt between the two groups. The placement time was significantly longer, the airway sealing pressure lower and the incidence of side effects higher in SLIPA group than in LMAS group. There was no significant difference in the peak and mean airway pressure between the 2 groups. Conclusion Both LMAS and SLIPA can assure good airway sealing and adequate ventilation. The complication is rare. The efficacy of LMAS is better. Key words: Laryngeal mask ; Respiration, artificial

Efficacy of laryngeal mask airway Supreme in patients undergoing gynecological laparoscopic surgery

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing gynecological laparoscopic surgery. Methods Eighty ASA Ⅰ or Ⅱ patients, aged 40-64 yr,weighing 50-70 kg, undergoing elective gynecological laparoscopic surgery, were randomized into 2 groups ( n = 40 each): LMA Supreme group (group S) and LMA ProSeal group (group P). Mallampati test was performed before operation in both groups. The patients were classified as Ⅰ or Ⅱ . LMA Supreme and LMA ProSeal were inserted in group S and P respectively after induction of anesthesia with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA. The number of attempt, success rate, LMA placement time, success rate of gastric tube placement, cuff volume, peak airway pressure, and airway seal pressure, BP, HR, ECG, SpO2, PET CO2 and complications were recorded. The duration of surgery and pneumoperitoneum, and emergence time were also recorded. The fiberoptic bronchoscope scores were assessed after successful LMA placement. Results There were no significant differences in the duration of operation and pneumoperitoneum, emergence time between the two groups (P ＞ 0.05). The BP, HR,SpO2, PET CO2 and peak pressure were within the normal range during operation in both groups. The first attempt success rates of LMA placement and gastric tube placement were significantly higher, the LMA placement time was significantly shorter, and the fiberoptic bronchoscopic scores were significantly higher in group S than in group P ( P ＜ 0.05). Conclusion LMA Supreme is helpful for ventilation during operation with less complications and can be used effectively for gynecological laparoscopic surgery. Key words: Laryngeal mask; Respiration, artificial; Laparoscopy

Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults

The laryngeal mask airway (LMA) is an important airway device that was developed in 1983. From the first classic LMA models up to now, LMA models have been developed that are easily and quickly inserted, provide ventilation at higher airway pressures, have lower cuff pressure, a reduced risk of gastric aspiration and cause fewer stress responses. We aimed to compare the LMA Classic with the LMA Supreme in assessing the success rate and time for insertion, number of attempts and leak pressure. A total of 70 patients of ASA group I or II were included in our study. Regarding the airway device used during surgery, the patients were randomly assigned into two groups: the LMA Supreme group and the LMA Classic group. In order to provide common conditions for inserting the laryngeal mask, insertion was made while the bispectral index was between 50 and 60 and T1 was 0. The success rate of inserting the LMA, the duration of insertion, the number of attempts, the insertion complications, ventilation parameters, haemodynamic parameters and postoperative adverse effects were recorded for each group. In the LMA Classic group and the LMA Supreme group, the LMA was successfully inserted in 27 (88.5%) and 34 (97%) patients, respectively. The duration of insertion in the LMA Supreme group was shorter and the cuff pressure was lower than that in the LMA Classic group (P < 0.001). The LMA Supreme is superior to the LMA Classic because of its ease of insertion with low cuff pressure and high oropharyngeal leakage pressure.