Supraglottic Airway Devices Research Articles

Validation of manufacturers’ laryngeal mask airway size selection standard: a large retrospective study

BackgroundLaryngeal mask airway (LMA) is a prominent supraglottic airway device, widely used especially in difficult airway management. However, the LMA sizes recommended by the manufacturers are not always well matched in clinical practice, which leads to complications. To date, there are rare models to validate whether the manufacturers’ standard is suitable for use in clinical practice.MethodsA total of 58,956 patients undergoing general anesthesia using LMA device were included in the study between January 1, 2011 and December 31, 2018, to validate the adherence rate of LMA sizes according to the manufacturers’ recommendations. A logistic regression analysis was performed based on the actual LMA size used in clinical practice to establish separately size selection guidelines with gender, weight, and age as variables in adults, adolescents, and children.ResultsLMA insertions were analyzed in 50,776 (86.1%) adults, 3,548 (6%) adolescents, and 4,632 (7.9%) children. Suitability of manufacturers’ recommendations was higher in children [male: 86.02%; female: 85.09%] than adults [male: 72.75%; female: 78.13%] or adolescents [male: 73.4%; female: 70.79%]. For adults and adolescents, LMA size was better predicted using the regression model rather than the manufacturers’ recommendations [male adults: 82.4% (81.16–83.57%) vs. 73.21% (71.79–74.59%), P<0.05; female adults: 87.82% (86.65–88.9%) vs. 77.07% (75.6–78.48%), P<0.05; male adolescents: 79.45% (74.86–83.4%) vs. 72.05% (67.09–76.53%), P<0.05; female adolescents: 78.4% (71.11–84.31%) vs. 72.22% (64.54–78.82%), P<0.05]. For children, there was equal performance suitability using the regression model and the manufacturers’ recommendations.ConclusionsThe model-based guidelines may provide more accurate directions for LMA size selection for adolescents and adults than the manufacturers’ weight-based recommendations, whereas the manufacturers’ recommendation in children is consistent with clinical practice.

Comparative study of two supraglottic airway devices- LMA Supreme and I-Gel in adult patients undergoing general anaesthesia at a tertiary hospital

Background: The LMA Supreme is a supraglottic airway device made of medical grade PVC and is latex-free. The I-Gel is a new supraglottic airway device with a non-inflatable cuff, composed of soft gel like, transparent thermoplastic elastomer. The main aim of present study was to compare the LMA Supreme with the I-Gel LMA in terms of the success of insertion of the device, hemodynamic changes and postoperative device related complications. Material and Methods: Present study was a prospective, randomized, comparative, observational study conducted in patients admitted for various elective surgeries, were randomly divided (by envelope selection) as I-Gel LMA and Supreme LMA insertion for general anaesthesia. Results: The mean age in group I and S were 41.26 ± 10.22 and 44.86 ± 10.1 years respectively. The mean body weight in Group I was 55.51 ± 9.61 kgs and in Group S it was 53.12 ± 9.65 kgs. There was no significant difference in the age, gender, body weight, ASA Grades of the patients between Group 1 and Group 2 .Statistically there was no significant difference in the SAD Sizes, Surgical Procedures, ease of insertion in both the groups. The basal heart rate was, mean SBP, mean basal DBP, mean basal MAP and mean SpO2 were comparable in both groups. Blood Tinged SAD was noted in 6 patients in both group I (I-Gel) and group S (SLMA). None of the patients in group I (I-Gel) out of 43 patients had Lip or Dental Injury, whereas 2 patients in group S (SLMA) out of 43 patients had Lip or Dental Injury. Only 4 of the patients in group I (I-Gel) out of 43 patients had Sore Throat within 24 hours post removal of SAD, whereas 6 patients in group S (SLMA) out of 43 patients had Sore Throat within 24 hours post removal of SAD. Conclusion: Both LMA Supreme and I-Gel can be used effectively and comfortably in selected adult patients during general anaesthesia. Both LMA Supreme and I-Gel are easy to insert, both are almost inserted in first attempt, no significant difference in hemodynamic changes during usage is noted.

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 &gt; 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.

Comparison between I-gel and Classic Laryngeal Mask Airway for Airway Management of Patients with Anticipated Difficult Airway: A Randomised Clinical Trial

Introduction: I-gel and classic Laryngeal Mask Airway (cLMA) are two Supraglottic Airway Devices (SAD) used for management of airway in various situations, including for management of difficult airway. Despite widespread use of these devices, there are very few trials studying I-gel and classic LMA for management of patients with difficult airway. The outcome of present study determines which SAD is better for managing difficult airway. Aim: To compare I-gel and cLMA in managing anticipated difficult airway. Materials and Methods: This randomised and single blinded clinical trial study was conducted in King George’s Medical University, Lucknow, Uttar Pradesh, India, between February 2019 to January 2020. Adult patients with Mallampati class 3 or 4, thyromental distance &lt;6 cm, sternomental distance &lt;12 cm, restricted neck movement, micrognathia/retrognathia or short/thick neck undergoing elective short duration surgery under general anaesthesia were included in this study. Total 50 patients divided into group C received cLMA while group I patients received I-gel for airway management. Fifty patients were recruited in each group. Nominal variables were analysed using chi-squared test. A two-sided p&lt;0.05 were considered significant for all the tests. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 25.0 for windows. Results: Mean age in group C was 40.38±12.96 (years) and in group I was 37.94±11.77 (years) with p-value 0.327. Overall (n=44 in group C, 50 in group I, p-value=0.012) and first attempt (n=10 in group C, 40 in group I, p-value &lt;0.001) success rate of device placement was higher for I-gel. Number of attempts, manipulations, time needed to insert and Leak Fraction was significantly lower for I-gel (p-value &lt;0.001). Compared to cLMA, Oropharyngeal Leak Pressure (OLP) was higher with I-gel. Fibreoptic view on a four-point scale was better with I-gel. Desaturation, tachycardia, bradycardia, and postoperative sore throat was more frequent with cLMA. Conclusion: Compared to cLMA, I-gel has higher success rate of insertion in patients with difficult airway and has added advantage of more rapid insertion, higher OLP and need for fewer insertion attempts and manipulations with lower rates of complications.

Standalone use of Laryngeal mask airway supreme for primary airway management in adults undergoing laparoscopic surgeries: A prospective observational study

Background: Laryngeal mask airway (LMA) does not provide definitive airway protection from pulmonary aspiration of potential regurgitated gastric contents. LMA supreme, a recent supraglottic (extraglottic) airway device, shows promising results. Thus, aim of study to evaluate the role of supreme laryngeal mask airway (SLMA) in airway management of patients operated with laparoscopic procedures under general Anaesthesia. Methods: The prospective observational study comprised of 274 patients of ASA grade 1 and 2 scheduled for short elective laparoscopic procedures (&lt;1hr.30min) who provided consent. Patients were anaesthetised according to standard protocol, appropriate size of SLMA was chosen and inserted; and complications were noted. Post SLMA removal, recovery and trauma of throat were noted. Postoperative complications such as nausea, vomiting, and throat pain were noted. Binary logistic regression model and Chi-square test of association was performed to analyse data (P&lt;0.05). Results: Most participants were female (n=260) with mean age of 31.42±7.24 years. Mean duration of surgery and recovery time was 37.3±5.84 min and 5.85±1.93 min respectively. SLMA size 3 was commonly used (n=245) and majority of insertions were successful in the first attempt (n=244). Post insertion, SLMA had adequate length (n=208) Throat pain (n=37) and vomiting (n=38) were common post-operative complications observed in the patients. A significant association was observed between operative procedure and complication (P=0.0004) and number of attempts (P=0.0004) with trauma being significant (P=0.0039). Trauma was associated with gender (P=0.08) and body weight (P=0.006). Conclusion: SLMA can be used as a standalone supraglottic (extraglottic) airway device for airway management in laparoscopic surgeries.

Effect of Nebulised Lignocaine on the Quality of I-gel Insertion: A Randomised Controlled Trial

Introduction: Supraglottic Airway Devices (SAD) are integral part of airway management during General Anaesthesia (GA) and are less invasive than endotracheal intubation. I-gel is a novel and innovative SAD, with non inflating cuff and it is widely used among available devices. Various drug combinations are being studied to obtain better insertion conditions. Lignocaine nebulisation is popularly used as topical anaesthesia for the airway. Authors hypothesised that it could improve the insertion conditions of the airway in addition to induction agents. Aim: To assess the efficacy of lignocaine nebulisation for I-gel insertion conditions in terms of the frequency of optimal insertion conditions and haemodynamic changes observed during and after the insertion of I-gel. Materials and Methods: This randomised controlled trial was conducted for one year from January 2019 to January 2020 in Karnataka Institute of Medical sciences, Hubli, Karnataka, India. Ninety patients of age group 18 to 45 years, belonging to American Society of Anaesthesiologists’ (ASA) grade I and II, undergoing minor surgical procedures were included. They were randomised into two equal groups, group L received 5 mL of 4% lignocaine and group D received 5 mL of normal saline nebulisation 5 minutes before induction of GA. Optimal insertion conditions (successful insertion at the first attempt without adverse response) and haemodynamic responses were noted down as primary and secondary outcomes respectively. The data was analysed using Chi-square test and Student’s t-test according to parameters. Results: A total of 43 patients were in group lignocaine nebulisation (Group L) and 44 in the normal saline nebulisation group (Group D) and they had the mean age of 28.8±6.3 and 29.0±5.1 respectively. The optimal insertion (p-value 0.26), successful first attempt insertion (p-value 0.175) and time for insertion (p-value 0.512) were not statistically significant between the two groups. In group L at 1 and 5 minutes, fall in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was noted and compared with other group which was not statistically significant. Conclusion: Preinduction lignocaine nebulisation doesn’t improve optimal insertion conditions of I-gel statistically. Even though better haemodynamic were noted with the same, it cannot be recommended for the sole purpose by nebulisation route.

A Randomised Control Trial Comparing the Efficacy of LMA-Supreme and I-Gel as Rescue Ventilatory Device in Patients with Simulated Difficult Airway Undergoing Anaesthesia with Controlled Ventilation

Introduction: In an unanticipated difficult airway or in an emergency situation of cannot-intubate-cannot-ventilate scenario, Supraglottic Airway Devices (SGD) are recommended as rescue devices for establishing airway quickly to prevent hypoxia. Aim: To compare efficacy of i-gel airway and Laryngeal Mask Airway supreme (LMA supreme) as ventilatory devices and the time taken for their insertion in anaesthetised and paralysed patients with simulated difficult airway. Materials and Methods: One hundred and eighty adult patients with simulated difficult airway were randomly allocated to two groups of 90 patients each. In group I: i-gel and in group S: LMA supreme was inserted. Primary outcome studied was time taken for insertion of SGD. Secondary outcomes were the number of attempts taken for insertion of device, oropharyngeal leak pressure, ease of gastric catheter insertion, fibreoptic bronchoscopic view of anatomical alignment of device with glottic opening. Quantitative variables were compared using unpaired t-test/Mann-Whitney Test, between the two groups. Qualitative variable were compared using Chi-Square test/Fisher’s-exact test. Results: Total time taken for successful insertion was significantly shorter with group i-gel as compared to group LMA supreme {median (IQR) {19 (18.25-21)} versus {24 (23-24)} with p-value ≤0.0001. Overall success rate of insertion (96.67% vs 97.78%, p=1.000) and oropharyngeal leak pressure (p-value=0.555) of i-gel and LMA-S were comparable. i-gel has better anatomic alignment with glottic opening as compared to LMA-S (p-value ≤0.0001). Gastric tube insertion was easy in all patients in both the groups. Conclusion: Shorter time for the insertion of i-gel was observed due to absence of inflatable cuff, although both LMA-S and i-gel are equally efficacious as ventilatory devices in patients with simulated difficult airway under general anaesthesia with controlled ventilation.

Airway Challenges in a Preterm Neonate with Undiagnosed Complete Tracheal Rings Posted for Surgery

Preterm neonates are defined as those born before 37 weeks. The anatomical features of preterm neonates vary from that of an adult, such that they have a large tongue, an anterior funnel shaped larynx, angled vocal cords and an omega shaped epiglottis. Their physiological development also differ as they have a greater risk for apnoea of prematurity, airflow obstruction, bronchopulmonary dysplasia, low functional residual capacity and decreased transient oxygen tension. Congenital airway anomalies have a prevalence rate of 0.2-1 in 10,000 live births. Congenital Tracheal Stenosis (CTS) caused by complete tracheal rings is one of the rarest forms of all the airway anomalies that occur, which is characterised by presence of complete ‘O’ shaped cartilaginous rings of trachea devoid of a membranous part. The case discussed in the article is that of a day 26 preterm neonate with increasing abdominal distension and failure to thrive. The neonate was posted for an urgent exploratory laparotomy for abdominal decompression and ileostomy. Patient was kept on Continuous Positive Airway Pressure (CPAP) support for four days immediately after birth; however, intubation was never attempted nor required. With a history of respiratory depression and lack of history of previous intubation, difficult airway cart was kept ready prior to surgery. Supraglottic Airway (SGA) devices were at the core of airway rescue in this case of undiagnosed CTS. This case report shows how and why a preparation for difficult airway in preterm neonates is a necessity. It will provide as a guide if a similar case is encountered by the anaesthetist.

Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies.

To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir's subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

Effects of neuromuscular blocking agents on the clinical performance of i-gel® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial.

Background: The effects of neuromuscular blocking agents on the clinical performance of supraglottic airway devices and surgical condition in elderly patients undergoing hand surgery have not been established. We evaluated the effects of rocuronium on the clinical performance of an i-gel® supraglottic device and surgical condition in elderly patients undergoing orthopedic hand surgery.Methods: Patients aged 65-85 years were randomized to receive either rocuronium (rocuronium group) or saline (control group). We compared the rates of successful insertion of the i-gel on the first attempt as a primary outcome and also assessed the adequacy of i-gel maintenance during controlled ventilation, anesthetic requirement, surgical condition, and recovery time.Results: The rates of successful insertion of the i-gel on a first attempt were 93.1% in the rocuronium group versus 82.1% in the control group (P = 0.423). Peak inspiratory pressure (PIP) was lower in the rocuronium group than in the control group (15.2 vs. 17.9 cmH2O, respectively, P = 0.028). Spontaneous breathing was less common in the rocuronium group (24.1% vs. 57.1%, respectively, P = 0.011). The requirement of additional fentanyl to suppress spontaneous breathing or patient movement was less in the rocuronium group than in the control group (24.1% vs. 50.0%, respectively, P = 0.043). Surgical condition did not differ between the two groups. Recovery time was shorter in the rocuronium group than in the control group (8.4 vs. 9.9 min, respectively, P = 0.030).Conclusions: Rocuronium did not enhance the success rate of inserting the i-gel® or the surgical condition in elderly patients. However, using rocuronium reduced PIP, the frequency of spontaneous breathing, the requirement for additional fentanyl and patients' recovery time.

Blind and lightwand guided tracheal intubation: Incidence of esophageal intubation

The ILMA is a modification of the laryngeal mask airway and performs as an effective supraglottic airway device. It is also designed to serve as a conduit for orotracheal intubation. Intubation through the ILMA is usually a blind procedure. However, blind intubation may at times be unsuccessful. Devices such as the fibreoptic bronchoscope and the lightwand have been shown to improve success rates of intubation through the ILMA. This randomized study was conducted on 60 adult patients with normal airways undergoing scheduled surgery under general anaesthesia. Patients in the blind group (n = 30) were intubated blindly through the ILMA and patients in the lightwand group (n = 30) were intubated via the ILMA using lightwand without the inner stylet. Five patients had modified Mallampati equivalent to class III, and they were evenly distributed between the two groups. Other airway parameters in these five patients were within normal limits and they were not anticipated to have difficult airways. No patient belonging to modified Mallampati class 1V was involved in the study.

Baska mask versus endotracheal tube in laparoscopic cholecystectomy surgery: a prospective randomized trial

ABSTRACT Background: Supraglottic airway devices have increasingly been used as the airway technique of choice in laparoscopic surgeries. This study compared the efficacy and safety of the Baska Mask with endotracheal tube (ETT) in patients undergoing elective laparoscopic cholecystectomy. Research design and methods: This single-center, prospective, randomized controlled trial recruited 60 patients aged 18–75 years with American Society of Anesthesiologists’ classifications I to III. The time taken to achieve effective airway, number of attempts, ease of insertion, ventilation parameters, hemodynamics data, and pharyngolaryngeal complications were recorded. Results: The time taken to achieve effective airway was shorter for the Baska group (26.6 ± 4.7 vs. 47.2 ± 11.8 s; p < 0.001), although the first-time insertion success rate was ≥90% for both groups. The ETT group experienced more pharyngolaryngeal complications, including cough, trauma, spasm, dysphonia, and sore throat, during device insertion and removal and had higher systolic and diastolic blood pressures during intubation (p = 0.001). The Baska Mask achieved significantly lower peak airway pressure (p = 0.024) with stable oropharyngeal leak pressure ≥33 cmH2O throughout the surgery. Conclusions: The Baska Mask is a suitable alternative to endotracheal intubation in selected patients undergoing laparoscopic cholecystectomy, with shorter insertion times, fewer perioperative complications, and improved ventilatory performance and hemodynamic response. Trial registration: The trial is registered at ClinicalTrials.gov (NCT03045835), 8 February 2017.

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

BackgroundWe examined the association between emergent postoperative tracheal intubation and the use of supraglottic airway devices (SGAs) vs tracheal tubes. MethodsWe included data from adult noncardiac surgical cases under general anaesthesia between 2008 and 2018. We only included cases (n=59 991) in which both airways were deemed to be feasible options. Multivariable logistic regression, instrumental variable analysis, propensity matching, and mediation analysis were used. ResultsUse of a tracheal tube was associated with a higher risk of emergent postoperative intubation (adjusted absolute risk difference [ARD]=0.80%; 95% confidence interval (CI), 0.64–0.97; P<0.001), and a higher risk of post-extubation hypoxaemia (ARD=3.9%; 95% CI, 3.4–4.4; P<0.001). The effect was modified by the use of non-depolarising neuromuscular blocking agents (NMBAs); mediation analyses revealed that 28.9% (95% CI, 14.4–43.4%; P<0.001) of the main effect was attributable to NMBA. Airway management modified the association of NMBA and risk of emergent postoperative intubation (Pinteraction=0.02). Patients managed with an SGA had higher odds of NMBA-associated reintubation compared to patients managed with a tracheal tube (adjusted odds ratio [aOR]=3.65, 95% CI, 1.99–6.67 vs aOR=1.68, 95% CI, 1.29–2.18 [P<0.001], respectively). ConclusionsIn patients undergoing procedures under general anaesthesia that could be managed with either SGA or tracheal tube, use of an SGA was associated with lower risk of emergent postoperative intubation. The effect can partly be explained by use of NMBAs. Use of NMBAs in patients with an SGA appears to increase the risk of emergent postoperative intubation.

Baska mask®-A third generation supraglottic airway device in clinical practice- A prospective observational study

Introduction and Aim: Supraglottic airway devices are safer alternatives to endotracheal intubation during general anaesthesia. The recently introduced Baska mask is a third generation supraglottic airway device available now in India. As there are no studies about Baska mask published in India, this study was undertaken to evaluate the efficacy and safety of using the Baska mask in patients with no predictors of difficult airway. Materials and Methods: Hundred patients belonging to American society of Anesthesiologists physical status class I and II with no predictors of difficult airway undergoing elective surgery under general anaesthesia were included for the study. The patients were classified as normal and overweight depending on the body mass index (2 – normal and >25 kg/m2 - overweight). The ease of successfully securing the airway with the device was evaluated using the time, the number of attempts and ease of insertion. The correct placement was confirmed by fibre-optic assessment using the Brimacombe scoring system. The airway sealing pressure and leak fraction were estimated. Complications like airway trauma, sore throat, dysphagia and dysphonia were noted after removal. Statistical analysis was done using SPSS software version 22 and assessed by t-test and chi square test. Results: Mean time of insertion was 9.7±1.9sec. In 97% (n=97) of patients the mask was placed successfully in the first attempt. Airway sealing pressure was 42.46±19.11 cmH2O and the leak fraction was 8.81±0.03%. Effective ventilation was present in all grades of Brimacombe scoring. Minimal postoperative airway trauma and sore throat were noticed. Conclusions: Baska® mask is an effective supraglottic airway device which is easy to insert, provides good ventilation and has minimal complications. Keywords: Supraglottic airway device, Baska mask, Airway sealing pressure, Leak fraction, Brimacombe scoring.

Comparison of supraglottic airway devices I-Gel and LMA-Supreme in adults

Whenever the conventional laryngoscopy fails, insertion of supraglottic airway device may be indicated. The I-Gel and LMA-Supreme are both novel supraglottic airway devices which are disposable, cheap and aids the passage of gastric tube which helps in gastric drainage. Both the devices can be used as an adjunct to endotracheal intubation in patient with difficult airway. This prospective randomized, single blind study was designed to compare the supraglottic airway devices I-Gel and LMA-Supreme in patients undergoing general anaesthesia for elective surgeries. After obtaining the institutional ethical committee approval, 60 adult patients of ASA I and II physical status of either sex undergoing elective surgical procedures under general anaesthesia were randomly allocated into 2 groups. Group A I-Gel group (n=30) and Group B LMA-Supreme (n=30). The study showed no significant difference between the two groups based on demographic variables. The mean insertion time for LMA-Supreme is significantly lower than I-Gel (P

Comparison of clinical performance of laryngeal mask airway supremeTM and I-gelTM in patients undergoing elective non-laparoscopic surgeries

Supraglottic airway devices have a special niche for themselves with regards to airway management in modern anaesthesia practice. They have become a very good alternative to mask ventilation and tracheal intubation in elective surgeries and have an important place in the emergency settings. The single-use supraglottic airway devices I-gel™ and LMA-Supreme™ have been developed with the aim to overcome the limitations and improve the efficacy of currently available supraglottic airway devices like there airway sealing pressure, ease of placement but with discordant results with regards to airway sealing pressure, ease and success of placement and airway morbidity. The aim of this prospective, randomized trial was to evaluate these two airway devices in routine clinical practice. Materials and Methods: 80 patients (ASA grade1-2) were randomly allocated to two groups; Group I (I-gelTM; n=40) and Group S (LMA-SupremeTM; n=40). A size 3 or 4 (I-gelTM and LMA-SupremeTM) was used in patients and inserted by experienced anaesthesiologists who had 3 years’ experience and had performed 20 successful insertions with each device. First attempt success rate, time for insertion and airway sealing pressure of each device was measured. Airway sealing pressure with LMA-SupremeTM was measured at an intracuff pressure of 60cmH2O. Patients were enquired after surgery for the presence of any dysphagia, sore-throat or hoarseness of voice. Data were analyzed statistically using unpaired ‘t’ test and Chi-square test. A p value of < 0> Results: The first attempt success rate for I-gelTM was 92.5% and for LMA-SupremeTM was 87.5%. Ventilation was established in 19.7 seconds (range 14-24 seconds) in the I-gelTM group and in 24.2 seconds (range 19-29seconds) in LMA-SupremeTM group (pTM 23.2 cmH2O; LMA-SupremeTM 22.4 cmH2O; p>0.001). Conclusion: Both I-gelTM and LMA SupremeTM are disposable, latex-free devices which do not need any digital or introducer tool for insertion. They have

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.

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.

Performance of the laryngeal tube for airway management during cardiopulmonary resuscitation.

Sudden cardiac arrest is one of the leading causes of death in Europe and the whole world. Effective chest compressions and advanced airway management have been shown to improve survival rates. Supraglottic airway devices such as the laryngeal tube (LT) are a well-known strategy for patients with cardiac arrest during both basic (BLS) and advanced life support (ALS). This systematic literature review aimed to summarize current data for using the LT when performing BLS and ALS. Recent data on the use of the LT during cardiopulmonary resuscitation (CPR) was gathered by using the Medline database and a specific search strategy. Terms were used in various order and combinations without time restrictions. A total of N.=1005 studies were identified and screened by two experienced anesthesiologists/emergency physicians independently. Altogether, data of N.=19 relevant papers were identified and included in the analysis. Using the LT showed fast and easy placement with high success rates (76% to 94%) and was associated with higher short-term survival as compared to other strategies for initial airway management (2.2% vs. 1.4%). Quality of CPR such as chest compression fraction (CCF) before and after LT-insertion is improved (75% vs. 59%). For long-term survival, the LT showed lower survival rates. Especially as initial device of airway management (for inexperienced staff), the use of a LT is easy and results in a fast insertion. The advantages of the LT as compared to bag mask ventilation and endotracheal intubation are inhomogeneous in recent literature.