Oropharyngeal Leak Pressure Research Articles

Comparing the Functional Analysis of Baska® Mask with I-gel in Short Surgeries - A Prospective Randomized Trial.

We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel. The study design involves prospective randomized controlled trial. The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP). Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher's exact test. Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001). For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.

Comparison between the standard method and the 30° curved tongue depressor-aided technique for insertion of a laryngeal mask airway: a randomized controlled trial

BackgroundLaryngeal mask airway (LMA) has been increasingly used for airway management; however, LMA insertion can be difficult and cause adverse effects. Therefore, the rapid, safe, and effective insertion of LMA is necessary. This study aimed to compare the efficacy of the standard method with that of the 30° curved tongue depressor-aided technique for LMA insertion to determine the superior technique.MethodsThis study included 154 patients aged 18–70 years (American Society of Anesthesiologists class I or II) scheduled for general anesthesia. The patients were randomly assigned to the standard LMA insertion group (Group C, n = 77) or the 30° curved tongue depressor-aided LMA insertion group (Group T, n = 77). The primary outcome evaluated was the first-attempt success rate. The secondary outcomes were the second-attempt success rate, insertion time, fiberoptic position grade, oropharyngeal leak pressure (OPLP), and adverse events.ResultsThe first-attempt success rate was significantly higher in Group T than in Group C (97.40% vs. 88.31%, P = 0.029). The second-attempt success rate (P = 0.209), insertion time (P = 0.340), fiberoptic position grade (P = 0.872), and OPLP (P = 0.203) were slightly improved in Group T; however, there was no statistical significance. Bleeding events were reduced in Group T than in Group C (6.49% vs. 14.29%); however, there was no statistical significance. The incidence of sore throat symptoms was significantly reduced in Group T than in Group C (5.19% vs. 15.58%, P = 0.035).ConclusionsThe curved tongue depressor-aided technique significantly improved the first-attempt success rate of LMA insertion and reduced the incidence of sore throat symptoms.Trial registrationKCT0004964; Registered at https://cris.nih.go.kr on April 27, 2020.

Comparative analysis of LMA Blockbuster® clinical performance: Blind versus Miller laryngoscope-guided insertion in paediatric general anaesthesia - A double-blinded, randomised controlled trial.

The second-generation supraglottic airway device is conventionally inserted blindly, which might result in suboptimal placement. Limited literature exists on under-vision insertion techniques, particularly in paediatric patients. The primary objective of this study was to compare the oropharyngeal leak pressure (OPLP) between the blind insertion of the LMA Blockbuster® and the Miller laryngoscope-guided insertion in children. Secondary outcomes included the number of insertion attempts, haemodynamic disturbances, insertion time and airway complications. This randomised controlled trial study enroled 100 patients aged 1-4 years undergoing elective surgery. Patients were randomised into blind insertion (Group A) or Miller laryngoscope-guided insertion (Group B) of the LMA Blockbuster®. The primary outcome measure was OPLP. Insertion time, haemodynamic changes and postoperative complications were also assessed. The Chi-square, Fisher's exact and t-test were applied appropriately, with the significance level set at P < 0.05. Significantly higher mean OPLP was observed in Group B compared to Group A - 27.9 [standard deviation (SD): 1.58] cmH2O versus 25.94 (SD: 0.63) cmH2O [mean difference (MD): 1.96 (95% confidence interval {CI}: 1.48, 2.44; P < 0.001)]. Mean insertion time was longer in Group B, that is, 11.9 (SD: 1.91) s versus 8.7 (SD: 0.6) s [MD: 3.2 s; (95% CI: 2.63, 3.76; P < 0.001)]; however, the difference was not clinically relevant. First-attempt insertion, haemodynamic stability and postoperative complications were comparable (P > 0.05). Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion.

Ramped versus sniffing position for Ambu® AuraGainTM insertion in patients with obesity: a randomized controlled study.

The ramped position facilitates mask ventilation and endotracheal intubation in patients with obesity. This study aimed to determine whether the ramped position improves supraglottic airway (SGA) insertion in patients with obesity. In this prospective, randomized, single-center trial, 48 obese patients undergoing elective surgery were randomized into either ramped or sniffing position groups. The Ambu® AuraGainTM (Ambu A/S), a second-generation SGA, was used. The primary outcome was the time required for the AuraGain insertion. Secondary outcomes included ease and number of insertion attempts, oropharyngeal leak pressure (OLP), and complications. The number needed to treat (NNT) was calculated to ensure ease of insertion. The time required for the AuraGain insertion was significantly shorter in the ramped group than in the sniffing group (13.0 [11.0, 16.0] vs. 24.0 [21.0, 28.0], P < 0.001). The insertion was easier in the ramped group than in the sniffing group (23/24 vs. 13/24, NNT = 2.4 [95% CI, 1.6, 5.0], P = 0.003). The first-attempt success rate was higher in the ramped group than in the sniffing group, although the difference was not statistically significant (22/24 vs. 18/24, P = 0.319). The OLP and postoperative complication rates were not significantly different between the groups. The ramped position reduced the time required for the AuraGain insertion in obese patients while providing comparable airway sealing without increasing adverse events. Therefore, a ramped position may be a more suitable option for SGA insertion in this population.

Effect of Different Insertion Methods on LMA Protector-Related Complications: A Prospective Randomized Double-Blind Clinical Trail.

The authors compared the effect of 2 insertion methods, namely the conventional laryngeal mask airway (LMA) insertion and the index finger-assisted LMA insertion, on the incidence of complications associated with LMA Protector insertion. The authors enrolled 300 patients, who underwent painless bronchoscopy. The patients ranged in age between 18 and 75 and were classified as American Society of Anesthesiologists grade I to III. They were randomly divided into 2 groups: a control group of 150 patients and an assisted group comprising 150 patients. LMA was inserted using the conventional and index finger-assisted insertion methods in both groups, respectively. The primary outcome was postoperative complications, such as oral mucosal injury and pharyngeal pain. Secondary outcomes included the success rate of first-time insertion, the incidence rate of inverse folding of LMA tips, oropharyngeal leak pressure (OLP), and other postoperative complications. Compared with the conventional LMA insertion method, index finger-assisted LMA insertion can significantly reduce the incidence rate of oral mucosal injury and pharyngeal pain, with fewer insertion failures. There was a statistically significant difference between the 2 groups in the visual field grading before adjustment for LMA alignment (P<0.0001). The conventional insertion method increased the likelihood of inverse folding of LMA tips. When the conventional insertion method was utilized, there was a significant difference in airway pressure and tidal volume before and after alignment under a fiberoptic bronchoscope (P<0.0001), but no significant difference in visual field grading and respiratory mechanics-related indicators. Index finger-assisted insertion can significantly reduce the incidence rate of LMA Protector-related complications and inverse folding of LMA tips.

Clinical Performance Evaluation of Ambu AuraGain versus I-gel in Obese Female Patients Undergoing Short-duration Surgeries for Breast Cancer: A Randomised Controlled Trial

Background and Aims: Supraglottic airway devices (SADs) secure and maintain airways in patients undergoing breast cancer surgery. I-gel and Ambu AuraGain (AAG) are two common second-generation SADs used. However, data comparing their efficacy are limited in adult obese breast cancer patients. This study was planned with the primary objective of comparing the oropharyngeal leak pressure (OLP) of these two SADs at 1 min after insertion. Methods: A total of 80 patients scheduled for breast cancer surgery were recruited and randomised into two groups: Group A (AAG) and Group I (I-gel). The insertion time of the SADs, the number of insertion attempts, the OLP at 1 min after insertion, the ease of insertion, the fibre-optic bronchoscopy view (FOB), the ease of suction catheter placement, additional manipulation during insertion and maintenance, the OLP at 30 min after insertion and complications, etc., were assessed. Results: OLP was significantly higher (P &lt; 0.05) in Group I compared to Group A at 1 min and 30 min after the SAD placement. Ease of insertion and FOB view score were significantly better in Group I than in Group A (P &lt; 0.05). Moreover, patients in Group A reported a higher incidence of sore throat compared to Group I patients (P &lt; 0.05). Conclusion: The I-gel demonstrated superior sealing pressures and mitigated sore throat significantly compared to the AAG in obese female patients undergoing breast cancer surgery. Furthermore, as confirmed by FOB, its enhanced perilaryngeal positioning underscores its efficacy over the AAG in this patient demographic.

Intubating Laryngeal Mask Airway for Airway Management and Blind Tracheal Intubation Through It From 360° Around a Supine Patient: A Randomized Controlled Clinical Study in a Simulated Prehospital Emergency Scenario.

Introduction In emergency situations, airway management is often given priority over other treatment methods. The preferred technique for airway management of unconscious patients is endotracheal intubation, which has become the standard of care. Intubation of the trachea not only enables controlled ventilation even for extended periods and in any position but also allows for the removal of tracheal secretions. Supraglottic airways have several advantages over endotracheal intubation, including faster insertion,less need for neuromuscular blockade, and less hemodynamic instability. They can also be used as a bridge to intubation or as a rescue device when intubation fails or is contraindicated. The aim of this randomized controlled clinical study is to simulate a prehospital emergency/disaster scenario to evaluate and study the feasibility and effectiveness of the use of intubating laryngeal mask airway (ILMA) for onsite airway management from 360 degrees around the patient's head as in such situations, there may be limited or no access behind the head of the victim. Such a scenario can be extrapolated to disaster conditions where the victims may be trapped under the rubble following a building collapse /earthquake or are trapped in a vehicular road traffic/ train accident. It may take substantial time for extrication and evacuation of such patients to a hospital and hence it may be life-saving to provide prompt and early onsite airway management from wherever access is possible around the victim. We believe that the provision of a steel handle integrated with the airway tube may provide an opportunity for successful insertion of the device from 360 degrees around the patient merely by suitably changing the way the handle is gripped, so as to allow a single-handed smooth arc-like movement of the device for insertion, irrespective of the position of the rescuer relative to the patient's head. Objectives Our objective is to study the ease and time of insertion of ILMA, the number of attempts for successful ILMA insertion, and oropharyngeal leak pressure attained from unconventional positions in a supine patient. Materials and methods This prospective, randomized, observer-blinded controlled trial included 90 patients undergoing elective surgery under general anesthesia. Patients were randomized using a chit and box system for group allocation. Groups were as follows: Group 1 (n=30) - Investigator standing on the back of the head of the patient (0°); Group 2 (n=30) - Investigator standing on the left side facing the patient (120°); Group 3 (n=30) - Investigator standing on the right side facing the patient (240°). Then ease and time of insertion of ILMA, number of attempts for successful ILMA insertion and oropharyngeal leak pressure were noted, and intergroup comparison was done. Conclusion ILMA has proved to be an effective ventilatory device and a suitable conduit for intubation in patients lying in the supine position from a conventional standard position standing behind the head of the patient, as well as non-conventional position, facing the patient at 120° or 240° from the standard position.

A new video laryngoscope combined with flexible laryngeal mask insertion: A prospective randomized study

BackgroundThe video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method. MethodsOne hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity. ResultsThe first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH2O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups. ConclusionsThe new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events. Trial registrationChinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn).

Video laryngoscopy improves ProSeal™ laryngeal mask airway position by anesthesia residents: A randomized controlled, double-blind study

BackgroundThe insertion of ProSeal laryngeal mask airway (LMA) using a blind digital technique is difficult for inexperienced performers and malpositioning of the device can impair ventilation and may lead to complications. AimThis study aimed to compare the proper ProSeal LMA position inserted by anesthesia residents between video laryngoscopy-assisted and blind digital insertion techniques. MethodsA total of 138 patients aged 18–80 years, ASA I and II undergoing elective surgery, were randomly allocated to the digital or video laryngoscopy-assisted group. Anesthesia residents performed ProSeal LMA insertion. The primary outcome was the proportion of a proper LMA position evaluated by a blinded assessor using the fiber-optic scores. Secondary outcomes included first attempt success rate, duration of insertion, incidence of desaturation during insertion, peak airway and oropharyngeal leak pressure, gastric tube placement difficulty, hemodynamic disturbance, and airway complications at 1 and 24 h after surgery. ResultsPatients in the video laryngoscopy group demonstrated a significantly higher proportion of proper LMA position than those in the digital group (53/68 [78 %] vs. 24/67 [36 %]; RR 2.18 [95%CI 1.54–3.07]; P < 0.001). Using the video laryngoscopy-guided insertion improved the fiber-optic scores by 7.11 folds (95%CI 3.53–14.32; P < 0.001) compared with the digital technique. Patients in the video laryngoscopy group showed higher sealing pressure, easier gastric tube placement, but longer insertion time. There was no significant difference in the peak airway pressure, first-attempt success rate, hemodynamic changes, and airway complications between groups. No desaturation occurred during the study. ConclusionUsing a Macintosh-shaped blade video laryngoscope facilitates novice anesthesiologists in achieving improved ProSeal LMA positioning without compromising airway or hemodynamic complications. The optimal ProSeal LMA position also provides a higher oropharyngeal sealing pressure and easier gastric tube placement.

Ventilation quality and fiber optic glottic view of AuraGain laryngeal mask in neutral, moderate, and extreme lateral head and neck positions in anesthetized spontaneously breathing children

BackgroundWe investigated the effects of moderate (45°), and extreme (60°) right lateral rotation of the head and neck on the ventilatory performance of Ambu AuraGain Laryngeal mask airway in generally anesthetized spontaneously breathing children. MethodsFifty-two children (aged 2–9 years) were randomized in this open-label observational cohort, to receive Ambu® AuraGain either in moderate (45°) (Group I, n = 26) or extreme (60°) (Group II, n = 26) lateral rotation of the head and neck. The oropharyngeal leak pressure OLP (primary outcome), ventilation score, exhaled tidal volume, and fiberoptic glottic view score, were recorded with the head and neck in a neutral position, then in lateral position after insertion by 1,15,30 and 45 min., and at end of surgery. ResultsThe mean OLP in group I decreased from 23.81 ± 2.87 cmH2O in the neutral position to 23.77±3.78 cmH2O, (P = 0.941) 1 min. after lateral rotation. Whereas, In group II, it increased from 20.38 ± 4.18 cmH2O to 21.88±3.28 cmH2O, (P = 0.002). Afterward, the OLP was maintained decreased in group I and increased in group II (P < 0.05), with no intergroup differences. The ventilation score did not show significant intra or inter-group differences. After lateral rotation, the fiberoptic glottic score showed a trend towards better values in group II than in group I. ConclusionVentilation with AuraGain LMA can efficiently be implemented while the head and neck are in the neutral and laterally rotated positions in anesthetized spontaneously breathing children. Extreme lateral rotation (60°) was better tolerated than the moderate position (45°).

The Myth about the Laryngeal Mask

Peak pressures ≥20mbar are not a contraindication for laryngeal masks. The oropharyngeal leak pressure of a laryngeal mask does not correspond to the pressure at which oesophagogastric air leakage occurs. Setting a peak pressure limit of 20cm H2O on the respirator can lead to critical situations because the tidal volume may then remain too low. A good alternative is to use a pressure alarm limit. The use of laryngeal masks does not preclude the use of PEEP and/or relaxation.

Influence of Head and Neck Position on Ventilation Using Three Different Supraglottic Airway Devices (I-Gel, Ambu Auragain, BaskaMask) in Anaesthetized and Paralyzed Patients: A Prospective Randomized Clinical Study

Background: Supraglottic airway devices play a crucial role in managing the airway during various surgical procedures conducted under general anesthesia. In this study, we evaluated the impact of different head and neck positions (extension, flexion, neutral, and right rotation) on ventilation while using I-gel, Ambu AuraGain, and Baska masks in anesthetized paralyzed patients. Methodology: A total of 114 patients were randomly allocated into Group I (n=38) using I-Gel, Group II (n=38) using Ambu AuraGain, and Group III (n=38) using Baska Mask. Clinical performance in terms of OLP (Oropharyngeal Leak Pressure) and anatomical position of the device was evaluated after insertion under general anaesthesia. Ventilation parameters including peak airway pressure, EtCO2 (End-tidal Carbon Dioxide), expiratory tidal volume and ventilation score were assessed at different head and neck positions using three supraglottic airway devices. Results : Maximum OLP was observed in Group II and minimum OLP was observed in Group I. In all three devices, OLP was maximum in the flexion position and minimum in the extension position. The Median Brimacombe score was 3 in all three groups at all head and neck positions except at maximum extension in Group I. Although peak airway pressure in Group II is significantly higher than the other two groups, ventilation is not impacted as evidenced by comparable ventilation score, EtCO2 and expiratory tidal volume in all patients of three groups at different head and neck positions. Conclusion : To conclude, Ambu Auragain has better anatomical seal at all head and neck positions as compared to I-gel and Baska Mask. However, despite differences in OLP, the ventilatory performances of the three devices were not significantly affected. Keywords: Ambu Auragain, Baska Mask, I-Gel, Supraglottic Airway Device, Head And Neck Position, Oropharyngeal Leak Pressure

Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy

ABSTRACT Objectives A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques. Methods In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed. Results OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups. Conclusion The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion. Clinical trial registration www.ctri.nic.in identifier is CTRI/2022/10/046269

Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial.

Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.

Clinical Performance of I-gel® and BlockBuster™ Laryngeal Mask Airway in Adult Patients during General Anesthesia: A Randomized Comparison.

Supraglottic devices have revolutionized the current practice of airway management. We compared the clinical performance of a recently introduced BlockBuster™ Laryngeal mask airway with i-gel® in adult patients under general anesthesia. Following Institutional ethical clearance, the present study was conducted on 62 patients belonging to American Society of Anesthesiologists physical status 1 and 2 of either sex in the age group of 20-60 years under general anesthesia. Patients were randomly assigned to i-gel® (I) and BlockBuster™ (B) groups (31 per group). Time for successful insertion, insertion success rate, ease of insertion, oropharyngeal leak pressures (OLPs), and complications were assessed. Mean insertion time of device was less in Group I (13.52 ± 2.58 s) than that of Group B (14.10 ± 2.04 s), which was neither clinically nor statistically significant (P = 0.330). OLP in Group B (24.52 ± 2.77 cm of H2O) was found to be significantly higher compared to Group I (20.81 ± 2.56 cm of H2O) with P < 0.001. Overall insertion and first attempt success was similar (i-gel® 31/31 [100%] and 29/31 [93.5%] and BlockBuster™ 31/31 [100%] and 29/31 [93.5%], respectively). Ease of insertion (P = 0.684) and complications (P = 0.782) of both the devices were comparable. Both the devices are useful and effective for airway management in adult under general anesthesia. Having a high OLP and comparable insertion time, risk of aspiration may be further reduced with the use of BlockBuster™ in comparison to i-gel®.

Influence of different head and neck positions on performance characteristics of second generation supraglottic airway devices

BackgroundVarious head and neck positions alter the performance of supraglottic airway devices (SAD). We compared the influence of flexion, extension, neutral and rotation of the neck on performance characteristics of second generation airway devices namely Proseal (PLMA), i-gel and Auragain laryngeal mask. MethodsThis study was conducted in 90 ASA physical status I and II patients 18–65 years of age. Patients were randomised into three groups with 30 patients in each: PLMA, i-gel and Auragain. The primary objective was to compare oropharyngeal leak pressure (OPLP) among PLMA, i-gel and Auragain in neutral, flexion, extension and lateral rotation of the neck. The secondary objective was to compare Peak inspiratory pressure (PIP), ventilation score, expired tidal volume, fiberoptic grading of laryngeal view, end tidal carbon dioxide and OPLP-PIP difference. ResultsPLMA, i-gel and Auragain have the highest OPLP in flexion (34.4 ± 2.5, 31.6 ± 2.3, 32.8 ± 1.7) followed by neutral, left lateral rotation and lowest in extension (26.7 ± 1.6, 25.4 ± 3.19, 29.6 ± 1.0) respectively. PLMA and Auragain have significantly higher OPLP when compared to i-gel in all positions p < 0.05. In extension, OPLP with Auragain (29.6 + 1.0) was significantly higher than PLMA (26.7 + 1.6) and i-gel (25.4 + 3.1), p < 0.001. PIP was significantly higher in flexion position for all the three devices. No significant difference in fibre optic grading and ventilation score was seen for three devices in various neck positions. ConclusionsPLMA and Auragain have better sealing pressure than i-gel in all the positions. Flexion position during surgery is best for maintaining OPLP. Auragain should be preferred over PLMA and i-gel in surgeries involving extension of neck.

Effect of the new video laryngeal mask airway SaCoVLM on airway management in lateral laparoscopic urological surgery: A single center randomized controlled trial

There are few pertinent studies about the application of laryngeal mask airways (LMAs) in lateral decubitus surgery. Therefore, the aim of our study was to evaluate the effects of lateral position and pneumoperitoneum on oropharyngeal leak pressure (OLP) and ventilation efficiency for the LMA SaCoVLM. Patients undergoing elective retroperitoneal laparoscopic urological surgery were randomized 1:1 to the Supreme group or SaCoVLM group. The primary outcome was the OLP with LMA insertion. The secondary outcomes were the first-attempt success rate, insertion time, adjustment times, gastric tube success rate, LMA alignment accuracy, LMA removal time, regurgitation or aspiration, LMA blood staining, and incidence of adverse events 24 h after surgery. We recruited 70 patients to complete the study. Regardless of lateral position and pneumoperitoneum, the OLP was greater in the SaCoVLM group (n = 35) than in the Supreme group (n = 35), with a median difference of 4–7 cmH2O. The first-attempt success rate of the SaCoVLM group was higher than that of the Supreme group (91.4% vs. 77.1%, risk ratio (RR): 1.19; 95% CI 0.96 to 1.46, P = 0.188). Thus, in the lateral position with pneumoperitoneum, although the new video LMA SaCoVLM has a higher OLP than the LMA Supreme, both devices provide sufficient ventilation efficiency.

Influence of Different Head and Neck Positions on Oropharyngeal Leak Pressure with the LMA Protector Airway: A Cross-over Study

Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient’s head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in oropharyngeal leak pressure (OLP) with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H2O, SD 5.080 cm H2O vs. 34.49 cm H2O, SD 4.804 cm H2O, p&lt;0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position.

Comparison between Air-Q Self Pressurized Airway Device with Blocker and Proseal Laryngeal Mask Airway in anesthetized paralyzed adult female patients undergoing elective gynecological operations.

The Air-Q Self Pressurized Airway Device with Blocker (SP Blocker) was compared to the Proseal Laryngeal Mask Airway (PLMA) during positive pressure ventilation regarding the primary outcome (oropharyngeal leak pressure [OLP]), secondary outcomes (peak inspiratory pressure [PIP], inspired tidal volume [ITV], expired tidal volume [ETV], leak volume [LV] and leak fraction [LF]), insertion time, ventilation score, fiber-optic glottis view score, and postoperative laryngopharyngeal parameters (LPM). Adult healthy female patients scheduled for elective gynecological laparotomies under general anesthesia using controlled mechanical ventilation were recruited to a prospective randomized comparative clinical trial. Exclusion criteria were body mass index (BMI) ≥ 35 kg m -2 , El-Ganzouri score ≥ 5, upper airway problems, hiatus hernia or pregnancy. Patients were classified into an SP Blocker group ( n = 75) and a PLMA group ( n = 75). Primary and secondary outcomes were assessed initially and at fixed time points after successful insertion of devices. Initially after successful device insertion: the SP Blocker group showed statistically significant higher mean OLP (cmH 2 O) (29.46 ± 2.11 vs. 28.06 ± 1.83 respectively; 95% CI: -2.037 to -0.76, P < 0.0001), lower mean PIP (cmH 2 O) (15.49 ± 0.61 vs. 17.78 ± 1.04 respectively; 95% CI: 2.02 to 2.56, P < 0.0001), higher mean ITV (mL) (411 ± 30 vs. 403 ± 15 respectively; 95% CI: -15.65 to -0.347, P = 0.041), higher mean ETV (mL) (389 ± 12 vs. 354 ± 11 respectively; 95% CI: -38.72 to -31.29, P < 0.0001), lower mean LV (mL) (22 ± 18 vs. 49 ± 10 respectively; 95% CI: 22.3 to 31.7, P < 0.0001) and lower mean LF (%) (5 ± 2.04 vs. 12 ± 6.8 respectively; 95% CI: 5.38 to 8.62, P < 0.0001) than the PLMA group. Mean insertion time (seconds) was shorter in the SP Blocker group than the PLMA group (16.39 ± 2.81 vs. 18.63 ± 3.44 respectively; 95% CI: 1.23 to 3.25, P < 0.0001). The SP Blocker group offered a better fiber-optic glottis view score than the PLMA group without differences concerning ventilation score and LPM. SP Blocker provided as safe anesthesia during controlled mechanical ventilation as PLMA.

Clinical Efficacy of Ambu AuraGainTM and i-gel® in Patients Undergoing Elective Gynaecological Laparoscopic Surgeries Under General Anaesthesia: A Randomised Clinical Study

Introduction: Second-generation supraglottic airway devices that provide high seal pressures are found to be suitable for patients undergoing laparoscopic surgery, as they have a separate port for gastric tube insertion, effectively separating the airway and the oesophagus. The present study compares the usage of two such second-generation supraglottic devices-AuraGain™ and i-gel® in patients undergoing gynaecological laparoscopic surgeries. Aim: To compare the Oropharyngeal Leak Pressure (OLP) and airway pressures achieved by the i-gel® and Ambu AuraGain™ after insertion in the supine position and during laparoscopic carbon dioxide peritoneum in the Trendelenburg position. Materials and Methods: This randomised clinical, singleblinded study conducted at the Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra pradesh, India involved 100 female patients undergoing elective gynaecological laparoscopic surgeries under general anaesthesia with controlled ventilation. The primary objective was to compare the clinical performance of Ambu AuraGain™ (Group-A) and i-gel® (Group-I) concerning their oropharyngeal seal pressures and airway pressures in gynaecological laparoscopic surgeries. The secondary outcomes measured included the time taken for insertion, ease of insertion of the device, effects on postinsertion haemodynamic parameters like heart rate, blood pressure, oxygen saturation, ease of gastric tube insertion, and fibreoptic bronchoscopic grading of the visualised glottic structures after device placement, as well as postoperative side effects like blood staining upon removal of the device and sore throat. Data were analysed using Student’s t-test and chi-square test. Results: The mean age in Group-A was 39.62±4.085 years, and in Group-I, it was 39.48±2.468 years. The mean peak inspiratory pressures after device insertion were 14.34 mmHg in Group-A and 16.66 mmHg in Group-I. Haemodynamic parameters postinsertion were similar in both groups {Group-A: Mean Heart Rate (HR) 87.22 bpm, Mean Arterial Pressure (MAP) 89.72 mmHg, Oxygen Saturation (SpO2 ) 99.58%; Group-I: Mean HR 87.50 bpm, MAP 89.72 mmHg, SpO2 99.72%). Fibreoptic bronchoscopic grading in Group-A was 0/0/9/41, and in Group-I, it was 0/0/11/39. Blood staining upon removal was noted in four patients (8%) in Group-A and in 3 patients (6%) in Group-I. Sore throat in the postoperative period was noted in 14% of patients in Group-A and 8% in Group-I. Conclusion: Ambu AuraGain™ was found to provide a better seal and higher OLP compared to the i-gel® in gynaecological laparoscopic surgeries and therefore provide safer and more effective ventilation for patients undergoing such surgeries. I-gel® was found to be easier and quicker to insert than the AuraGain™.