The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation

Airway Management During Diagnostic Laparoscopic Surgery: A Comparison of I-Gel and Proseal Laryngeal Mask Airway

Background

Supraglottic airway devices (SADs) may be used during laparoscopic procedures in place of the often utilised endotracheal tube. The Proseal laryngeal mask airway (PLMA) is designed with an inflatable cuff, which provides an excellent oropharyngeal seal, and the I-gel is a newer SAD designed with a softer and noninflatable cuff and sharing similar features with PLMA.

Aim and Objectives

This study compared the ease of insertion, haemodynamic and ventilatory parameters as well as morbidities associated with these SADs when used for airway management during diagnostic laparoscopic procedures.

Patients and Methods

Eighty American Society of Anaesthesiologist I and II patients aged 18-60 years undergoing diagnostic laparoscopic surgery under controlled ventilation had either I-gel or PLMA used for airway management. Anaesthesia was induced with standard dose of propofol, patient received atracurium, fentanyl and the SAD inserted. Pulse oximetry, capnography, noninvasive blood pressure, oropharyngeal leak pressure (OLP), and evidence of pharyngolaryngeal morbidity were assessed. Data were analysed using the Statistical Package for Social Sciences version 21.0. The quantitative variables were analysed using the Student's t test and the qualitative using the Chi-square test. A P value of less than 0.05 was considered significant.

Results

The success rates at first insertion for I-gel and PLMA were 95% and 80%, respectively (P = 0.04). The mean changes in mean arterial pressure following insertion were 9.6 mmHg (±4.7) and 10.6 mmHg (±8) for I-gel and PLMA, respectively (P = 0.02). The OLP during insufflation was higher in the PLMA (35.8 cmH2O) than in the I-gel group (27.9 cmH2O) (P = 0.57). In the I-gel group, 12.5% of the patients had oropharyngeal morbidities compared with 37.5% in the PLMA group (P = 0.009).

Conclusion

Both I-gel and PLMA provide optimal ventilation during abdominal insufflation, with PLMA providing a better oropharyngeal seal, whereas I-gel has a better haemodynamic profile.

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

BACKGROUND

Conflicting outcomes have been reported for the i-gel™ and laryngeal mask airway (LMA) ProSeal™ in children and adults during general anesthesia. Randomized controlled trials (RCTs) that yielded wide contrast outcomes between i-gel™ and LMA ProSeal™ were included in this meta-analysis.

METHODS

Two authors independently identified RCTs that compared i-gel™ with LMA ProSeal™ among patients receiving general anesthesia by performing searches in EMBASE, Cochrane, PubMed, and ScienceDirect. Discussion was adopted to resolve disagreements. Data were counted with Review Manger 5.3 and pooled by applying weighted mean difference (MD) and rlsk ratio (RR), and related 95% confidence intervals.

RESULTS

A total of 33 RCTs with 2605 patients were included in the meta-analysis. I-gel™ provided a considerably lower oropharyngeal leak pressure [weighted average diversity (MD) = -1.53 (-2.89, -0.17), P = 0.03], incidence of blood staining on the supraglottic airway devices [RR = 0.44, (0.28, 0.69), P = 0.0003], sore throat [RR = 0.31 (0.18, 0.52), P<0.0001], and a short insertion time [MD = -5.61 (-7.71, -3.51), P<0.00001] than LMA ProSeal™. Compared with LMA ProSeal™, i-gel™ offered a significantly higher first-insertion success rate [RR = 1.03 (1.00, 1.06), P = 0.03] and ease of insertion [RR = 1.06 (1.01, 1.11), P = 0.03]. The gastric-tube-placement first insertion rate [RR = 1.04 (0.99, 1.10), P = 0.11], laryngospasm [RR = 0.76 (0.17, 3.31), P = 0.72], and cough [RR = 1.30 (0.49, 3.44), P = 0.60] between the two devices were similar.

CONCLUSIONS

Both devices could achieve a good seal to provide adequate ventilation. Compared with the used LMA ProSeal™, the i-gel™ was found to have fewer complications (blood stainning, sore throat) and offers certain advantages (short insertion time, higher first-insertion success rate and ease of insertion) in patients under general anesthesia.

Activation of dopamine D2 receptor promotes pepsinogen secretion by suppressing somatostatin release from the mouse gastric mucosa

In vivo administration of dopamine (DA) receptor (DR)-related drugs modulate gastric pepsinogen secretion. However, DRs on gastric pepsinogen-secreting chief cells and DA D2 receptor (D2R) on somatostatin-secreting D cells were subsequently acquired. In this study, we aimed to further investigate the local effect of DA on gastric pepsinogen secretion through DRs expressed on chief cells or potential D2Rs expressed on D cells. To elucidate the modulation of DRs in gastric pepsinogen secretion, immunofluorescence staining, ex vivo incubation of gastric mucosa isolated from normal and D2R-/- mice were conducted, accompanied by measurements of pepsinogen or somatostatin levels using biochemical assays or enzyme-linked immunosorbent assays. D1R, D2R, and D5R-immunoreactivity (IR) were observed on chief cells in mouse gastric mucosa. D2R-IR was widely distributed on D cells from the corpus to the antrum. Ex vivo incubation results showed that DA and the D1-like receptor agonist SKF38393 increased pepsinogen secretion, which was blocked by the D1-like receptor antagonist SCH23390. However, D2-like receptor agonist quinpirole also significantly increased pepsinogen secretion, and D2-like receptor antagonist sulpiride blocked the promotion of DA. Besides, D2-like receptors exerted an inhibitory effect on somatostatin secretion, in contrast to their effect on pepsinogen secretion. Furthermore, D2R-/- mice showed much lower basal pepsinogen secretion but significantly increased somatostatin release and an increased number of D cells in gastric mucosa. Only SKF38393, not quinpirole, increased pepsinogen secretion in D2R-/- mice. DA promotes gastric pepsinogen secretion directly through D1-like receptors on chief cells and indirectly through D2R-mediated suppression of somatostatin release.

Comparison of the standard and triple airway maneuvering techniques for i-gel™ placement in patients undergoing elective surgery: a randomized controlled study

PURPOSE

The i-gel is a supraglottic airway device with non-inflatable cuff which can suffer insertion failure if its standard placement technique is implemented. The aim of this study was to compare the placement technique proposed by the manufacturer of i-gel with the triple airway maneuver in terms of successful device insertion time and first-attempt success.

METHODS

After ethics committee approval, 103 ASA I-III patients were randomly allocated to the standard or triple airway maneuver groups. In the standard Group, the i-gel was inserted in the sniffing position while, in the triple group, it was inserted using the triple airway maneuver consisting of head tilt, jaw thrust, and open mouth. The time taken for successful insertion, first-attempt success rate, i-gel position, airway complications, and hemodynamic responses were assessed.

RESULTS

Between the two groups patient characteristics were similar. Time for successful insertion was significantly shorter in the triple group (20 ± 7 s) than with the standard technique (32 ± 11 s; p < 0.001). Successful insertion at the first attempt was 78% and 92% for the standard and triple group, respectively (p = 0.092). The i-gel position, airway complications, and hemodynamic responses were similar in both groups.

CONCLUSION

The triple airway maneuver required less i-gel insertion time as compared with the standard placement technique. First-attempt success rates were similar with both techniques, although the triple airway maneuver was superior to the standard method as a rescue technique in failed insertions. We therefore recommend use of the triple airway maneuver in i-gel insertion.

I-gel™ May be the Device of Choice for Controlled Ventilation in Patients with Hemophilia Undergoing Abdominal Laparoscopic Surgery

Haemophilia is an inherited bleeding disorder with variable deficiency of Factor VIII in the plasma and is characterised by bleeding into joints, muscles and tissues either spontaneously or in response to trivial trauma. Perioperative care requires multidisciplinary involvement. Perioperative management involves the risk of excessive bleeding from surgical site as well as spontaneous bleeding into the brain in response to surgical stress in patients with previous history of intracerebral haemorrhage. Airway management of such patients during anaesthetic intervention is a challenge and entails the risk of life threatening haemorrhage into the airway. The I gel Supraglottic airway device may be best suited for the purpose considering its soft elastomeric non-inflatable cuff, ease of insertion, availability of gastric suction port and minimal leak fraction on controlled ventilation. The I Gel may be solution to avoiding airway instrumentation in patients with bleeding disorders. It may be an alternative to endotracheal intubation in patients with Haemophilia undergoing surgery.