ProSeal Laryngeal Mask Airway Research Articles

To compare clinical versus ultrasound assessment of correct placement of ProSeal Laryngeal mask airway (PLMA): a prospective randomized study

Extraglottic airway devices (EAD) have revolutionized the perioperative airway management. The accuracy of clinical tests to identify malposition has been questioned by recent studies where fibreoptic evaluation identified various malpositions that were undiagnosed by a clinical test. Ultrasound (USG) has evolved to guide various airway interventions. However, USG is under-evaluated in the assessment of the EADs position. Our study aimed to compare clinical versus USG assessment of optimal placement of ProSeal laryngeal mask airway (PLMA). This randomized control trial was done in 212 consenting patients undergoing onco-surgery with PLMA as an airway device. Patients were randomized in Group CL (n-107) and US (n-105). Following primary assessment-using clinical tests and USG evaluation using a scoring system, fibreoptic evaluation of the placement of PLMA was done and then assessed for optimal position. The accuracy of each technique for optimal placement was compared statistically. We found that the sensitivity and specificity of the clinical evaluation were 98.77% and 34.62% with a diagnostic accuracy of 83.18% when compared with fibreoptic evaluation. While USG evaluation using the scoring system has sensitivity and specificity of 95.45% and 29.41% with a diagnostic accuracy of 84.76%. It was noted that USG assessment has a higher positive predictive value (87.5%) as compared to clinical assessment (82.47%). The incidence of rotation was higher in the clinical group. There was no difference in airway related morbidity. USG is comparable to clinical tests for evaluation of the optimal placement of PLMA. However, USG has various advantages over clinical assessment as it is quick and identifies the unacceptable placement of PLMA where the tip of PLMA may not lie over the tip of the esophagus, thereby, avoiding unnecessary mucosal injury during forceful or repeated attempts for gastric drainage tube insertion.Trial registration: Clinical Trials Registry (CTRI/2017/11/010359) dated 3rd November 2017.

Comparative evaluation of Air-Q blocker and Proseal laryngeal mask airway in patients undergoing elective surgery under general anaesthesia: A randomised controlled trial.

Background and Aims:The Air-Q blocker (Cook gas LLC, Mercury Medical, Clearwater, FL, USA) is a relatively new supraglottic airway device (SAD) with capability to serve as a conduit for intubation. As there is limited data on Air-Q blocker, the present study was performed to compare the efficacy of Air-Q blocker and Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery.Methods:A total of 90 American Society of Anesthesiologists (ASA) physical status I and II patients were randomly allocated to Air-Q blocker or PLMA group. Oropharyngeal leak pressure (OLP), insertion success, insertion time, ease of orogastric tube (OGT) insertion, fibreoptic visualisation of the glottis, haemodynamic and ventilation parameters, and complications at emergence and postoperatively were investigated.Results:OLPs were higher in PLMA group as compared to Air-Q blocker group (P = 0.002). Still, the OLP (27.5 ± 5.8 cm H2O) was clinically effective in Air-Q blocker group. The mean time for successful insertion was significantly shorter for Air-Q blocker than PLMA (P = 0.019). The number of attempts to insert both the devices was comparable (P ≥ 0.05). Air-Q blocker provided a significantly better fibreoptic score than PLMA (P = 0.038). The two groups were comparable in terms of ease of OGT insertion, haemodynamics and ventilation parameters, and complications at emergence and postoperatively.Conclusions:Air-Q blocker provides a clinically effective OLP though PLMA provides a slightly better sealing function in patients undergoing laparoscopic and non-laparoscopic surgeries under general anaesthesia requiring neuromuscular blockade. Air-Q blocker has shorter insertion time and a better fibreoptic view of glottis as compared to PLMA.

Clinical Efficacy of Ambu Aura Gain vs Laryngeal Mask Airway Proseal in Paediatric Patients Undergoing Elective Surgery under General Anaesthesia: A Randomised Controlled Trial

Introduction: Laryngeal Mask Airway ProSeal (LMA-P) is considered a gold standard among second generation supra glottis airway devices as an effective, safe and reusable ventilatory device. Ambu Aura Gain (AAG) is a newer single use second generation airway device with a soft inflatable cuff and preformed shape. Aim: To compare the clinical effectiveness and oral pharyngeal seal pressures between LMA ProSeal and AAG in children receiving controlled ventilation. Materials and Methods: This study was conducted in 100 paediatric patients in age group of 1 to 12 years, weighing 5 to 30 kg, fulfilling the criteria of American Society of Anaesthesiologists (ASA) Physical Status I and II and undergoing elective surgical procedures. Patients were randomised into two groups. Secondary objective was to compare the ease, success and total time for achieving effective ventilation and ease of placement of gastric tube and fibreoptic visualisation of glottis view in both the groups. Quantitative variables were compared using Independent t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test/Fisher’s-Exact test. Results: The median (IQR) Oropharyngeal Seal Pressure (OSP) was much higher with AAG 22 cm (21-23) of water as compared to LMA ProSeal 21 cm (20-22) of water and the difference was statistically significant (p-value <0.0001). Time taken for achieving effective ventilation {median (IQR)} was significantly less with AAG {18 (17-19) seconds} as compared to that with LMA ProSeal {19 (18-20) seconds} (p=0.0005). The two devices were comparable in terms of success and ease of insertion of device, ease of placement of gastric tube and fibreoptic visualisation of glottis view. Conclusion: The study suggests that AAG, a single use device, is a useful substitute to LMA ProSeal to ventilate paediatric patients undergoing elective surgical procedures.

Fast Tracking in Off Pump CABG with Supraglottic Airway and TIVA

AbstractThe standard goals of anesthetic management for an off pump coronary artery bypass (OPCAB) surgery are that it should be safe, provide cardiac and other organ protection and stability, preserve neurocognitive integrity, maintain hemodynamics, allow early emergence and ambulation, and offer pain relief in the postoperative period. The cardiac surgical team should collaborate and plan the best preoperative strategy, so as to provide optimal care and a rapid and expeditious recovery of these patients. Scientific evidence and practical experience make total intravenous anesthesia (TIVA) the recommended choice for cardiac surgery. Use of endotracheal tube (ETT) is associated with certain drawbacks which can be overcome with judicious use of ProSeal laryngeal mask airway (PLMA) for cardiac surgeries too. The core principles of ultrafast track anesthetic (UFTA) technique are choice and titration of short-acting anesthetic drugs, postoperative normothermia, multimodal analgesia, early extubation, ambulation, and discharge. Fast tracking with use of TIVA and PLMA in patients undergoing OPCAB at our center offers certain advantages over other techniques in terms of reduced airway and lung trauma, improved cardiac output and renal perfusion with spontaneous respiration, decreased stress and discomfort of ETT suctioning and weaning from ventilation, substantially reduced requirement of dosages of analgesics, anesthetics and opioids, resulting in better patient hemodynamics, alert and pain-free patient that are more amenable and cooperative for early feeds, postoperative chest physiotherapy and lung recruitment strategies, and early ambulation and discharge.

Yaşlı Hastalarda Supraglottik Hava Yolu Gereçlerinin Klinik Performanslarının Karşılaştırılması: Prospektif Randomize Çalışma

INTRODUCTION: Airway management in the elderly may be challenging. Supraglottic airway devices (SADs) may be used to provide airway security. The aim of study was to compare the efficacy and safety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised and non-paralysed elderly patients. METHODS: The study was approved by a local ethics committee. Eighty patients, aged older than 65 years, who were scheduled to undergo elective urological or orthopaedic surgery participated in the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n = 26), Group P: p-LMA (n = 27) or Group I: i-gel (n = 27). The primary outcome was oropharyngeal sealing pressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, ease of insertion, success rates, time to insertion, haemodynamic response and complications such as sore throat and dysphagia. RESULTS: There were no significant differences among the groups with respect to OSP (p=0.852), whereas there was a statistically significant difference between Group I and Group C in terms of leak volume and leak fraction ( p= 0.042 and p = 0.020, respectively ). Adverse events were similar among the groups (p > 0.05). DISCUSSION AND CONCLUSION: In this study, although the leak volume and leak fraction were lower in i-gel inserted patients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patients who were not applied muscle relaxants and will be operated under general anesthesia.

Proseal Laryngeal Mask Gel vs I-gel- A Randomised Clinical Trial among Paediatric Patients

Introduction: A Supraglottic Airway Device (SAD) is placed above the larynx to form a seal around it. SADs like paediatric Proseal Laryngeal Mask Airway (P-LMA) and I-geltm are increasingly used in recent times. Aim: To compare the efficacy of paediatric P-LMA and I-gel in clinical practise. Materials and Methods: After obtaining ethical committee clearance and parent/guardian consent, 60 paediatric patients aged 2-12 years belonging to ASA grade I and II posted for elective surgeries under general anaesthesia, were included in the study. After induction of general anaesthesia, either of the SAD was inserted and study parameters namely ease and number of attempts of insertion of the device, ease of insertion of gastric tube, leak airway pressure, efficacy during positive pressure ventilation and postoperative complications were evaluated. Statistical comparison was performed by repeated measures of variance followed by Unpaired Student t-test and Chi-square test. A probability value p-value less 0.05 was regarded as statistically significant. Results: The device was easily inserted in 90% of the patients in both study groups (p-value 0.99). In P-LMA group, the device was inserted in first attempt in 83.33% against 90% in the I-gel group (p-value 0.70). In P-LMA group, gastric tube insertion was graded easy in 80% children while in I-gel group it was 90% children (p-value 0.47). The leak airway pressure measured at two different time intervals was statistically insignificant. Intra-operative dislodgement of the device was noted in one child in each group. Postoperative complications like sore throat and dysphagia were reported in four and two children, respectively in P-LMA group, while it was reported in two and one child in the I-gel group. Complications with P-LMA and I-gel were statistically insignificant. Conclusion: Paediatric P-LMA and I-gel are safe and non-invasive methods of securing the airway with regard to clinical safety parameters and hence can be used in paediatric population.

Ease of ProSeal laryngeal mask airway insertion in children (after placement) using suction catheter: A comparison with conventional techniques

Objectives: The ProSeal Laryngeal Mask Airway (PLMA) mostly inserted by finger technique and by an introducer tool method. Recently a newer Suction Catheter Guided (SC) insertion technique has been successfully used in children. We performed a study in children with aims and objective to compare the ease of PLMA insertion using SC and conventional techniques. Methods: 126 American Society of Anaesthesiologist’s class I and II children in age group of 1-12 years weighing 10-50 kg, admitted in our hospital, undergoing an elective surgery in under general anaesthesia in supine position were included in our study. An appropriate size PLMA was inserted using Suction Catheter, introducer tool or digital technique in Groups SC, I and D respectively (n=42) after induction of general anaesthesia. Correct placement of the PLMA was confirmed by using appropriate clinical tests. Ease of PLMA insertion with hemodynamic response was done by time to insertion, number of insertion attempts to achieve effective ventilation and number of cases which required lateral approach of insertion. Results: In Group SC, PLMA device was inserted after a single attempt in 41 (97.6%) patients, but PLMA insertion was failed in 5 patients in Group I (11.9%) and 6 patients in Group D (14.3%) even after two attempts, and the difference was statistically significant (p=0.044). Time taken for successful placement was statistically shorter in the SC-guided group (SC 22.5±4.021 seconds, I 31.4± 17.57 seconds, D 27.10±12.9 seconds, p value Conclusion: Suction Catheter guided ProSeal LMA insertion was an easier, faster, more successful and a relatively atraumatic technique which also ensures correct placement of the PLMA in the hypopharynx as compared to the routine conventional PLMA insertion techniques with no hemodynamic pressor response to PLMA insertion using any of the three techniques. Keywords: ProSeal LMA, Suction Catheter insertion.

Comparison of oxygenation and ventilation parameters between proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries: a prospective observational study

Introduction: Use of endotracheal tube (ETT) has many limitations. There is a need for an airway device with similar safety and good side effect profile. In this prospective observational study, the oxygenation and ventilation parameters between patients who were inserted Proseal laryngeal mask airway (PLMA) or ETT for laparoscopic surgeries were compared. Materials and Methods: After ethical committee approval, informed consent was obtained from sixty patients (thirty in each group) posted for elective laparoscopic surgery. Following induction of general anaesthesia and paralysis, PLMA or ETT was inserted and pressure control mode was used for ventilation. The following parameters were measured: a. Oxygen saturation and changes in FiO2 needed to ensure a target SpO2> 95%, EtCO2 and changes in respiratory rate and inspiratory pressure needed to ensure a target EtCO2 between 35-45 mmHg. b. Insertion characteristics of airway device and gastric tube, hemodynamic responses, incidence of complications. Statistical Analysis: Chi-square test was used to analyze qualitative data. Independent t test was used to assess quantitative variables. Repeated measures ANOVA was used to compare the outcome measures over time adjusted for duration of surgery and anaesthesia. P values Results: Both groups were comparable with respect to age, gender and weight. Oxygenation and ventilation parameters achieved with both ETT and PLMA were comparable and satisfactory. Haemodynamic parameters increased significantly in ETT group compared to PLMA group during airway insertion and removal. Also, postoperative sore throat was comparatively less in the PLMA group. Conclusion: Hence we conclude that PLMA may be considered as an alternative to ETT in airway management of patients undergoing laparoscopic surgeries with comparable oxygenation and ventilation parameters and improved side effect profile. Keywords: Endotracheal tube, Proseal laryngeal mask airway, Laryngoscopy, Pneumoperitoneum.

Comparison of I-gel and Proseal LMA for airway management in pediatric patients under controlled ventilation - A prospective, randomized, single blind clinical study

Introduction: The Proseal Laryngeal Mask Airway (PLMA) and I-gel are two novel supraglottic devices available for airway management and can be used safely in paediatric patients. The primary aim of our study was to compare the efficacy of PLMA and I-gel in providing adequate airway seal in paediatric patients under controlled ventilation. Materials and Methods: A prospective, randomized, single blind clinical study was carried out during October 2014 to September 2015. A total of 64 ASA PS grade I and II paediatric patients (Aged 3-9 years) undergoing elective general surgery were included. Patients with upper respiratory tract infection and difficult intubation were excluded. The patients were randomly assigned into two groups PLMA Group and I-gel Group using randomizer software. We assessed airway insertion time, ease of insertion and number of attempts for airway control and gastric tube placement, oropharyngeal seal pressure, hemodynamic parameters and complications. Results: The oropharyngeal seal pressure was significantly higher (p=0.0025) in group PLMA (29.1±3.7cm of H2O) than in group I-gel (26.3±3.5 cm of H2O). Hemodynamic parameters, success rate and postoperative complications were comparable among both the groups. Conclusion: Both, PLMA and I-gel can be used safely and effectively for airway management in paediatric patients under controlled ventilation. Keywords: I-gel, PLMA, Paediatric patient, Controlled ventilation.

A Comparative Evaluation of Respiratory Parameters Spo2 and Etco2 with Paediatric I-Gel, Proseal LMA Vs Endotracheal Tube

Introduction: Supra Glottic Airway devices have set a new trend in airway maintenance since their invention. Availability of these devices in the paediatric sizes has revolutionized their use. Endo Tracheal Tubes have always been considered “Gold Standard” owing to their ability of maintaining stable respiratory parameters and in prevention of aspiration. We have compared the repiratory parameters achieved with Paediatric I-Gel, Proseal -LMA and Endo Tracheal Tube. Description: 120 children aged 2 to 12 years, both sex, ASA 1 and 2, posted for elective surgery were included in the study. They were divided into 3 groups of 40 each - Endo Tracheal Tube (E), Proseal LMA (P-LMA) and I-GEL respectively. The device was inserted after induction of anaesthesia and the respiratory parameters namely SpO2 and EtCO2 were recorded at various time intervals. Result: All values were analysed and expressed as mean +/– SD. Statistical comparison was done by unpaired student “t”- test and chi square test. The values obtained for various time intervals were found to be statistically insignificant for all the three devices. Conclusion: PaediatricProseal LMA (P-LMA) and I-GEL are very much comparable with Endo Tracheal Tube (E) with regard to respiratory parameters and hence can be safely used as an alternative airway in the paediatric population.

Intra operative temporomandibular joint dislocation during use of proseal LMA

General anaesthesia is associated with several common complications, TMJ dislocation is one of the rare complications encountered during airway management. Usually occurs during endotracheal intubation but other factors such as force full laryngoscopy, manual attempt to complete intubation or duration for which TMJ was stressed may also be responsible. The incidence of TMJ dysfunction is reported to be 5% following endotracheal intubation,1 but less cases have been reported during LMA insertion. We report a case of TMJ dislocation in a 25 year old female patient during general anaesthesia after use of proseal LMA. Keywords: Proseal LMA, TMJ, Isoflurane, Propofol, General anaesthesia.

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 prospective randomised comparative study of proseal LMA, I-gel and endotracheal tube in laparoscopic cholecystectomy

A prospective randomised comparative study of proseal LMA, I-gel and endotracheal tube in laparoscopic cholecystectomy - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/2394-4994.2018.0008, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

A prospective study to compare haemodynamic and respiratory parameters using proseal laryengeal mask airway and endotracheal intubation in children undergoing videoendoscopic surgery

Proseal laryngeal mask airway (PLMA) is being used increasingly apart from its gold standard alternative endotracheal tube (ETT) in airway management during paediatric laparoscopy. Limited data is available on effects of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients. We aimed to assess effect of carboperitoneum on hemodynamics and pulmonary mechanics in paediatric patients undergoing video-endoscopic surgeries when PLMA and ETT are used. After ethics committee approval and consent, 60 patients aged 1-10 years scheduled for laparoscopic surgeries were included in study and randomly allocated to two groups of 30 each. Airway maintained with PLMA in first group and ETT in group II. Hemodynamic parameters and ventilatory parameters were recorded at different time intervals from prior to insertion of airway device till deflation of carboperitoneum. Statistically significant increased heart rate, systolic, diastolic, mean blood pressure was observed in ETT group as compared to PLMA group during airway insertion and during rest of study period changes were analogous in both groups. Ventilatory parameters saturation, peak inspiratory pressure (PIP), plateau pressure (PP) and ETCO2 were comparable in both groups except during post deflation period where PP, PIP and ETCO2 remained elevated. Proseal-LMA can be equally good option in paediatric laparoscopy with better hemodynamic stability and ventilatory parameters as degree of changes caused by carboperitoneum in PLMA group was insignificant compared to ETT.

To study the effect of intravenous dexmedetomidine and clonidine for attenuating hemodynamic response with proseal LMA in pneumoperitoneum

Background: 75 individuals in the age group between 18-50 years belonging to ASA class I and II undergoing laparoscopic upper and lower abdominal surgeries were selected. A detailed history, complete physical examination and baseline investigations were done for all patients. Method: Data was collected in pretested proforma meeting the objectives of study. Preoperative assessment was done for each patient and written informed consent was taken. Proper nil per oral status was checked before proceeding for each case. No hypnotic medication was given on the evening before surgery. Patients were pre medicated with injection glycopyrrolate 0.2milligrams in the preoperative room. Result: In the dexmedetomidine group, the mean pulse rate reduced at 0 min in comparison and continued its fall it 45 minutes, then showed a slight rise till end of the 180 minutes. In the clonidine group, the mean pulse rate keep on increasing till 25 minutes in comparison to the preoperative value, then slight reduction at 35 minutes, then increased at 45 min, then reduced at 60 min, then increased till 180 minutes.Conclusion: In our present study we found easy insertion of proseal laryngeal mask airway with no complications. We used dexmedetomidine and clonidine @ 1 mcg/kg body weight to attenuate hemodynamic response to pneumoperitoneum during laparoscopic surgery and we found better control of heart rate, systolic blood pressure, diastolic bloodpressure and mean arterial pressure with dexmedetomidine group than with clonidine group. In our present study we found no change in oxygen saturation and endtidal carbon dioxide.

A randomized controlled trial to compare the auricle size-based method for ProSeal laryngeal mask airway selection with the weight-based method among paediatric patients

BackgroundWeight-based method is the most common method used to select the size of ProSeal Laryngeal Mask Airway (PLMA). This method of selection is not always fool proof. AimTo compare the auricle size of patient with weight-based method to select appropriate size of PLMA in paediatric population. Materials and methodsA prospective study was performed on 102 children undergoing elective surgical procedures under general anethesia. Enrolled participants were randomized into two groups; Group W and Group A, where PLMA size was determined by weight-based method and auricle-based method respectively. The size of external ear was measured in both vertical and horizontal dimensions. The correct placement of PLMA was assessed using predefined criteria. ResultsIn 73 patients, both methods of PLMA size selection showed a moderate level of agreement (kappa coefficient - 0.52). No significant difference between groups were observed in the insertion related parameters and fibreoptic view of glottis. ConclusionAuricle-based method for the selection of ProSeal laryngeal mask airway in paediatric patients is in moderate level of agreement with weight-based method and can be used in clinical practice as an alternative method.

Comparing I-Gel to Proseal Laryngeal Mask Airways in Infants: A Prospective Randomised Clinical Study.

ObjectiveLaryngeal mask airways and the I-gel have become increasingly popular for children undergoing minor surgery. The goal of our study is to compare I-gel and ProSeal laryngeal mask airways (LMA) in infants by analysing different parameters, such as insertion success, ventilation, haemodynamic changes and postoperative complications.MethodsFor this prospective, randomised study, we selected 123 infants with an American Society of Anaesthesiologists (ASA) status I, who were undergoing minor elective lower abdominal surgery. After obtaining verbal and written informed consent from the parents, the infants were divided into two groups: the I-gel group (n=60) and the ProSeal LMA group (n=63). The times and ease of insertion, percentages of tidal volume leakage, and means and leakage pressures of these two supraglottic airways were noted. The complications and side-effects of each method were also recorded.ResultsThe insertion time of the ProSeal group was statistically shorter than that of the I-gel group. The peak and mean pressures and the leakage percentage of the ProSeal group were statistically lower than those of the I-gel group. The leakage pressure of the ProSeal group was statistically higher than the I-gel group.ConclusionIn comparison with I-gel, the use of ProSeal LMA in infants’ anaesthesia presents many advantages, such as the ease of its insertion, better oropharyngeal leakage pressure and less mucosal hyperaemia.

Evaluation of the efficacy of proseal LMA versus endotracheal intubation for laparoscopic surgeries

Open surgeries which were done predominantly in previous days are progressing to minimally invasive keyhole laparoscopic surgeries. In same way, airway management has been also progressed from ETT to lesser invasive Laryngeal Mask Airway (LMA). This was a prospective observational study which was conducted in patients who came for lower abdominal laparoscopic surgeries during study period of 3 year. All patients were divided into 2 groups with 30 patients in each group (group A- PLMA, group B - ETT). Age, weight, type of surgery, time required for insertion of device, hemodynamic monitoring, ventilatory parameters, postoperative complications in the form of laryngopharyngeal morbidity were recorded. : In total 60 patients, between the age group of 18-65 year were included which were divided into 2 groups with 30 patients in each group. PLMA required 15.13 seconds as compared to ETT which required 13.33 seconds for insertion of device. The sealing pressure for PLMA was measured by leak test and the average was 32.2 cmH2O. The mean heart rate, systolic BP, Diastolic BP and MAP at various interval was significantly higher in group B as compared to group A (P-value<0.001 for all). The mean ± SD of ETCO2 among the cases studied in Group A and Group B was 36.53 ± 1.87% and 35.13 ± 2.51% respectively. Mean of Peak airway pressure (PAP) among the cases studied in PLMA (Group A) and ETT (Group B) was 22.53 mmHg and 18.97 mmHg respectively No complication or adverse event was noted during post-operative period in PLMA group but in Group ETT, 2 cases were found having blood staining of tube with sore throat in same 2 cases. PLMA is also proved to be an equally effective airway device in laparoscopic surgeries in the form of adequate oxygenation and ventilation. Also PLMA is associated with minimal intraoperative and postoperative complications. PLMA provided equally effective pulmonary ventilation despite of high airway pressures without significant gastric distension, aspiration and regurgitation.

Comparison of Clinical Performance of I-Gel With Proseal Laryngeal Mask Airway in Surgical Procedures

Comparison of Clinical Performance of I-Gel With Proseal Laryngeal Mask Airway in Surgical Procedures

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

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