1
|
Chaki T, Koizumi M, Tachibana S, Matsumoto T, Kumagai T, Hashimoto Y, Yamakage M. Comparing leak pressure of LMA ® ProSeal™ versus i-gel ® at head rotation: a randomized controlled trial. Can J Anaesth 2024; 71:66-76. [PMID: 38017196 DOI: 10.1007/s12630-023-02648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/12/2023] [Accepted: 07/12/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE The effect of head rotation on supraglottic airway (SGA) oropharyngeal leak pressure (OPLP) has not been well elucidated. The aim of this study was to help clarify which SGA device provides higher OPLP at head-rotated position. METHODS Patients who underwent elective surgery under general anesthesia were enrolled and randomly divided into laryngeal mask airway (LMA®) ProSeal™ and i-gel® groups. The allocated SGA device was inserted under anesthesia. The primary outcome was OPLP, and secondary outcomes were ventilation score, expiratory tidal volume, and maximum pressure under volume-controlled ventilation (VCV) with an inspiratory tidal volume of 10 mL·kg-1 ideal body weight and fibreoptic view of the vocal cords at 0°, 30°, and 60° head rotation. RESULTS Data from 78 and 76 patients were analyzed in the LMA ProSeal and i-gel groups, respectively. The mean (standard deviation) OPLP of the LMA ProSeal was significantly higher than that of the i-gel at the 60° head-rotated position (LMA ProSeal, 20.4 [6.5] vs i-gel, 16.9 [7.8] cm H2O; difference in means, 3.6; adjusted 95% confidence interval, 0.5 to 6.6; adjusted P = 0.02, adjusted for six comparisons). The maximum pressure under VCV at 60° head rotation was significantly higher in the LMA ProSeal group than in the i-gel group. The expiratory tidal volume of the LMA ProSeal did not significantly change with head rotation and was significantly higher than that of the i-gel at 60° head rotation. Ventilation score, fibreoptic view of the vocal cords, and complications were not significantly different between the ProSeal and i-gel groups. CONCLUSIONS The LMA ProSeal provides higher OPLP than the i-gel at a 60° head-rotated position under general anesthesia. TRIAL REGISTRATION Japan Registry of Clinical Trials (https://jrct.niph.go.jp) (JRCT1012210043); registered 18 October 2021.
Collapse
Affiliation(s)
- Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Masatsugu Koizumi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shunsuke Tachibana
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomomi Matsumoto
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoe Kumagai
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Hashimoto
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
2
|
Raman R, Prabha R, Rampal S, Tiwari T, Gautam S, Prakash R. Comparison of clinical performance of Baska mask and Ambu AuraGain in patients undergoing surgery: A single-blinded, randomised comparative trial. Indian J Anaesth 2023; 67:S227-S231. [PMID: 38187974 PMCID: PMC10768903 DOI: 10.4103/ija.ija_152_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims The Baska mask (BM) and the Ambu AuraGain (AAG) have shown promising results in recent trials but have not been compared. Therefore, we aimed to compare the clinical performance of the BM and the AAG for airway management of adult patients. Methods In this randomised comparative study, patients aged 18-60 years and with an expected surgical duration of less than 2 h were enroled. Patients were randomly allocated to AAG (Group A, n = 37) and BM (Group B, n = 37) for airway management. After induction of anaesthesia, an allocated supraglottic airway device (SAD) was inserted. Oropharyngeal leak pressure (OLP), time taken to insert SAD, number of insertion attempts, leak fraction (LF), first-attempt success rate, overall success rate, ease of insertion, fiberoptic view of the glottis, and complications were compared. The data were analysed using Student's t-test, Mann-Whitney U test, and Fisher's exact tests. Results Baseline and demographic characteristics were comparable. OLP (31.32 ± 2.59 versus 27.54 ± 1.32 cmH2O) was higher (P < 0.001), and LF (6.19% ± 1.20% versus 7.24% ± 1.72%) was lower (P = 0.003) in the BM group. First-attempt and overall success rate, time taken to insert, number of insertion attempts, ease of insertion, and fibreoptic view of glottis through the SADs were statistically similar between groups. However, the incidence of sore throat (P = 0.007) and cough (P = 0.028) was higher with AAG. Conclusion Clinical performance of BM was better than AAG as the former had higher OLP, lower LF and complications.
Collapse
Affiliation(s)
- Rajesh Raman
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Rati Prabha
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Surbhi Rampal
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Tanmay Tiwari
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shefali Gautam
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
3
|
Bhardwaj M, Dhania S, Kaur K, Lal J, Priya, Singhal SK. Comparison of oropharyngeal leak pressure of LMA Protector and LMA ProSeal in anaesthetised paralysed patients - A randomised controlled trial. Indian J Anaesth 2023; 67:S245-S250. [PMID: 38187973 PMCID: PMC10768911 DOI: 10.4103/ija.ija_403_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims In the present study, we hypothesised that the laryngeal mask airway (LMA) Protector would provide higher oropharyngeal leak pressure (OLP) than LMA ProSeal. Thus, we planned this study to compare the clinical performance of LMA Protector and LMA ProSeal in terms of OLP as a primary objective and insertion characteristics as secondary objectives. Methods Ninety patients of either gender, aged 18-70 years, were randomised into groups PS (LMA ProSeal) and P (LMA Protector). Following anaesthetic induction, the device was inserted as per group allocation. OLP of both devices was taken as a primary objective. Secondary objectives such as insertion time, ease of insertion, number of attempts required, fibre-optic view grading, amount of air (mL) required to get a cuff pressure (CP) of 60 cm H2O, and CP adjustment required and complications, if any, were also noted. Data were analysed using coGuide statistics software, Version 1 (BDSS Corp. Bangalore, Karnataka, India). Results The median (interquartile range) OLP was significantly higher with LMA protector than with LMA ProSeal [33.00 (27.0, 36.0) versus [29.50 (26.0, 32.0) (P = 0.009)]. First-attempt success rate was 95.4% (42/44) in group PS and 93% (40/43) in group P. Insertion time, ease of insertion, and fibre-optic view grading were not different between the groups. Gastric tube placement failed in one patient in group PS and in three patients in group P (P = 0.606). The median amount of air (mL) required to get a CP of 60 cm H2O was 26.5 (20, 28) in group PS and 12 (8,13) in group P (95% confidence interval [CI] =10.808-14.575) (P < 0.001). At all time points, CP was significantly higher, and more CP adjustments were needed in group PS than in group P (P < 0.001). Incidence of blood staining and post-operative sore throat at 1 and 24 h were not different between the groups. Conclusion LMA Protector provided a significantly higher OLP and less requirement of CP adjustments but comparable first-attempt success rate, mean insertion time, fibre-optic view, and gastric tube insertion as compared to LMA ProSeal.
Collapse
Affiliation(s)
- Mamta Bhardwaj
- Department of Anaesthesiology and Critical Care, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sunny Dhania
- Department of Anaesthesiology and Critical Care, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Kiranpreet Kaur
- Department of Anaesthesiology and Critical Care, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Jatin Lal
- Department of Anaesthesiology and Critical Care, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Priya
- Department of Anaesthesia, ABVIMS and Dr. RML Hospital, Delhi, India
| | - Suresh K. Singhal
- Department of Anaesthesiology and Critical Care, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| |
Collapse
|
4
|
Ahuja S, Kaur G, Garg K, Grewal A. Conventional versus reverse insertion of i-gel® in overweight and obese patients - Interventional randomised controlled trial. Indian J Anaesth 2023; 67:708-713. [PMID: 37693036 PMCID: PMC10488578 DOI: 10.4103/ija.ija_749_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Aims The supraglottic airway device, i-gel, is used in obese patients for short- to medium-duration surgical procedures. Insertion techniques have contributed to the successful and proper placement of i-gel in the first attempt. This study aims to compare two techniques for successfully inserting i-gel in the first attempt in overweight and obese patients as measured by oropharyngeal leak pressure (OLP). Methods This interventional, randomised, controlled study was conducted after ethical approval, and trial registration in overweight and obese patients. Patients were randomised into two groups: In Group C, the conventional technique was used, while in Group R, the reverse technique was used to insert i-gel. OLP, successful placement, required manipulations, time taken for insertion, number of attempts, and intraoperative and postoperative complications were studied. The collected data were analysed statistically. Results The mean OLP (30.46 ± 3.76 vs. 32.12 ± 3.10 mmHg, P = 0.018) and the mean time of insertion (16.42 ± 1.86 vs. 13.98 ± 1.97 s, P = 0.001) for conventional and reverse techniques, respectively, were statistically significant and favourable for Group R compared to Group C. Successful placement of i-gel at the first attempt, ease of insertion, number of attempts and all the manipulations except withdrawal and advancement were comparable in both the groups. No postoperative complications were noted. Conclusion The reverse technique significantly favoured the actual OLP values and the mean insertion time. Successful placement of i-gel at the first attempt was observed with both conventional and reverse techniques.
Collapse
Affiliation(s)
- Sonali Ahuja
- Department of Anaesthesiology, DMCH Ludhiana, Punjab, India
| | - Gurpreeti Kaur
- Department of Anaesthesiology, DMCH Ludhiana, Punjab, India
| | - Kamakshi Garg
- Department of Anaesthesiology, DMCH Ludhiana, Punjab, India
| | - Anju Grewal
- Department of Anaesthesiology, DMCH Ludhiana, Punjab, India
| |
Collapse
|
5
|
Kumar KR, Soni L, Sinha R, Muthiah T, Patel N, Shende DK, Subramaniam R. Comparison of Ambu AuraGain and BlockBuster laryngeal mask for controlled ventilation in children undergoing minor surgical procedures under general anesthesia: A prospective randomized controlled study. Paediatr Anaesth 2023; 33:474-480. [PMID: 36866955 DOI: 10.1111/pan.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Ambu AuraGain has proven to be better compared with other supraglottic airway devices in terms of higher first-attempt insertion success rate, time and ease of insertion, high oropharyngeal leak pressure, and fewer complications in children. The performance of the BlockBuster laryngeal mask has not been evaluated in children. AIMS The primary objective of this study was to compare the oropharyngeal leak pressure of the BlockBuster laryngeal mask with those of the Ambu AuraGain during controlled ventilation in children. METHODS Fifty children aged 6 months to 12 years with normal airways were randomized into group A (Ambu AuraGain) and group B (BlockBuster laryngeal mask). After administration of general anesthesia, an appropriate size supraglottic airway (size 1.5/2.0/2.5) was inserted according to the groups. Oropharyngeal leak pressure, success and ease of supraglottic airway insertion, gastric tube insertion, and ventilatory parameters were noted. The glottic view was graded by fiberoptic bronchoscopy. RESULTS Demographic parameters were comparable. The mean oropharyngeal leak pressure in the BlockBuster group (24.72 ± 6.81 cm H2 O) was significantly higher than Ambu AuraGain group (17.20 ± 4.28 cm H2 O) by 7.52 cm H2 O (95% CI 4.27 to 10.76; p = 0.001). The mean time for supraglottic airway insertion in the BlockBuster and Ambu AuraGain group was 12.04 ± 2.55 s and 13.64 ± 2.76 s, respectively (mean difference- 1.6 s, 95% CI 0.09-3.12; p = 0.04). Ventilatory parameters, first-attempt supraglottic airway insertion success rate, and ease of gastric tube insertion were comparable between the groups. The BlockBuster group showed easy supraglottic airway insertion compared with the Ambu AuraGain group. The BlockBuster group had better glottic views with only the larynx seen in 23 out of 25 children compared to the Ambu AuraGain with only the larynx seen in 19 out of 25 children. No complication was noted in either group. CONCLUSIONS We found that the BlockBuster laryngeal mask has higher oropharyngeal leak pressure compared with Ambu AuraGain in a pediatric population.
Collapse
Affiliation(s)
- Kanil Ranjith Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Lipika Soni
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Sinha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Thilaka Muthiah
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Patel
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip K Shende
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Gao X, Liu JH, Chen CM, Wang Y, Wang ZY, Yan CL, Zuo MZ, Cao Y, Qiao X, Huang YQ, Liu PC, Zhang H, Zhang JQ, Shen JM, Li C, Wang Y, Sun YY, Song JN, Zhang XZ, Zhang YL, Luo XT, Wu LN, Zhang Y, Shi L, Zhang Y, Xue FS, Tian M. Comparison of the supraglottic airway device BlockBusterTM and laryngeal mask airway Supreme in anaesthetised, paralyzed adult patients: a multicenter randomized controlled trial. Expert Rev Med Devices 2022; 19:649-656. [PMID: 36200143 DOI: 10.1080/17434440.2022.2130048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This multicenter prospective, randomized controlled clinical trial compared the clinical performance of supraglottic airway device (SAD) BlockBusterTM and laryngeal mask airway (LMA) Supreme for airway maintenance in anesthetized, paralyzed adult patients. METHODS A total of 651 adult patients scheduled for elective surgery in 13 hospitals were randomly allocated into BlockBuster group (n = 351) or Supreme group (n = 300). The primary outcome was oropharyngeal leak pressure (OLP). Duration and ease of insertion, fiberscopic view of positioning, airway manipulations, and complications were also assessed. RESULTS The OLP was significantly higher in BlockBuster group compared with Supreme group (29.9 ± 4.2 cmH2O vs 27.4 ± 4.3 cmH2O, p < 0.001). Success rate of insertion at the first attempt (90.2% vs 85.1%, p = 0.027), rate of optimal fiberscopic view (p = 0.002) and satisfactory positioning of SAD (p < 0.001) were significantly increased in BlockBuster group. CONCLUSIONS Both SAD BlockBusterTM and LMA Supreme are safe, effective, and easy-to-use devices for airway maintenance in anesthetized, paralyzed adult patients, but the SAD BlockBusterTM is superior to LMA Supreme in terms of OLP, success rate at the first attempt, and fiber-optic view of positioning. TRIAL REGISTRATION The trial is registered at www.chictr.org.cn (ChiCTR-ONC-16009105).
Collapse
Affiliation(s)
- Xue Gao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ju-Hui Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Mei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Wang
- Department of Anesthesiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhong-Yu Wang
- Department of Anesthesiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chun-Ling Yan
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Zhang Zuo
- Department of Anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Cao
- Department of Anesthesiology, Chongqing People's Hospital, Chongqing, China
| | - Xin Qiao
- Department of Anesthesiology, Chongqing People's Hospital, Chongqing, China
| | - Ya-Qi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pei-Chang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hui Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-Qiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun-Mei Shen
- Department of Anesthesiology, the Fourth Hospital of Hebei Medical University, Shi-Jia-Zhuang, China
| | - Chao Li
- Department of Anesthesiology, the Fourth Hospital of Hebei Medical University, Shi-Jia-Zhuang, China
| | - Yi Wang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Yan-Yan Sun
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Jian-Nan Song
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, China
| | - Xi-Zhe Zhang
- Department of Anesthesiology, Chifeng Municipal Hospital, Chifeng, China
| | - Yun-Long Zhang
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiao-Ting Luo
- Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Lu-Nan Wu
- Department of Anesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ye Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Shi
- Department of Anesthesiology, Nanjing First Hospital, Nanjing, China
| | - Yuan Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Wan Y, Liu Y, Yang W, Cui X. A prospective randomized study for the placement of flexible laryngeal airway mask with two-step jaw-thrust technique by both hands for adults. Am J Transl Res 2022; 14:1060-1067. [PMID: 35273708 PMCID: PMC8902529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/18/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A prospective, randomized, and controlled study was conducted to investigate the effect of two-step jaw-thrust technique on the placement of flexible laryngeal mask (FLMA) with both hands. METHODS Between November 2019 and January 2020, 160 patients scheduled for functional endoscopic sinus surgery with general anesthesia were enrolled in this study and were divided into two groups (n=80 each) using a random number table method: control group (group C) and test group (group T). After the induction of general anesthesia, the traditional method was applied to insert the flexible laryngeal airway mask in patients of group C, and the two-step jaw-thrust technique with both hands by the nurse was applied to help place the laryngeal mask in patients of group T. The success rate, alignment status by fibroscope (FOB) score, oropharyngeal leak pressure (OLP) of the laryngeal mask, oropharyngeal cavity soft tissue injury and postoperative sore throat, and the incidence of adverse airway event were compared between the two groups. (The registry of clinical trial: Chinese Clinical Trial Register, ChiCTR2100053017, https://www.chictr.org.cn). RESULTS 78 patients in group C and 79 patients in group T were in includedfinal analysis. The success rates of the first placement of flexible laryngeal masks in patients of group C and group T were 73.81% and 97.52%, respectively. The final success rates were 97.52% and 98.81%, respectively. The success rate of first placement in group T was significantly higher than that of group C. There was no significant difference in the final success rate between the two groups (P=0.561). The alignment score showed that the placement of group T was significantly better than that of group C. The OLP of group T (25.43±3.82 cm) was significantly higher than that of group C (22.13±2.62 cm). The incidences of mucosal injury and postoperative sore throat in group T were 2.52% and 5.01%, which were significantly lower than those of 23.02% and 16.72% in group C. There was no adverse airway event in each group. CONCLUSION The two-step jaw-thrust technique with both hands can improve the success rate of the first placement of the flexible laryngeal mask and the positioning of the laryngeal mask, increase the sealing pressure of the laryngeal mask, and reduce the incidence of oropharyngeal soft tissue injury and postoperative pharyngeal pain.
Collapse
Affiliation(s)
- Ying Wan
- Operation Center, Beijing Tongren Hospital, Capital Medical UniversityBeijing 100730, China
| | - Ying Liu
- Operation Center, Beijing Tongren Hospital, Capital Medical UniversityBeijing 100730, China
| | - Wenjing Yang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical UniversityBeijing 100730, China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical UniversityBeijing 100730, China
| |
Collapse
|
8
|
Kumar CM, Van Zundert TC, Seet E, Van Zundert AA. Time to consider supraglottic airway device oropharyngeal leak pressure measurement more objectively. Acta Anaesthesiol Scand 2021; 65:142-145. [PMID: 33141956 DOI: 10.1111/aas.13727] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
Oropharyngeal leak pressure (OLP) is considered a measure of successful placement, adequate performance and is a useful comparator between supraglottic airway devices (SADs). OLP measurement is based on the premise that the SAD is sited properly in the hypopharynx after blind placements, but the evidence suggests otherwise. Several limitations and controversies surround OLP. This editorial addresses the uses and pitfalls of OLP, the rationale for and methods of ascertaining OLP, the pros and cons of OLP measurement and newer modalities to improve its accuracy.
Collapse
Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia Khoo Teck Puat Hospital Yishun Singapore
- Newcastle University Newcastle upon Tyne UK
| | - Tom C. Van Zundert
- Department of Anaesthesia & Critical Care Onze‐Lieve‐Vrouw Hospital Aalst Belgium
| | - Edwin Seet
- Department of Anaesthesia Khoo Teck Puat Hospital Yishun Singapore
- National University of Singapore Singapore
| | - André A. Van Zundert
- Department of Anaesthesia and Perioperative Medicine Royal Brisbane and Women’s Hospital The University of Queensland & Queensland University of Technology Brisbane QLD Australia
| |
Collapse
|
9
|
Kapoor D, Singh J, Mitra S, Viswanath O, Kaye AD, Urits I, Orhurhu V. Gnana Laryngeal Airway in Clinical Practice: A Prospective Observational Study. Turk J Anaesthesiol Reanim 2019; 48:280-287. [PMID: 32864642 PMCID: PMC7434353 DOI: 10.5152/tjar.2019.00243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The Gnana Laryngeal Airway (GLA) device, a novel supraglottic airway device, is similar to the LMA-Classic in basic design, but with an additional suction port on the convex portion of the laryngeal mask to remove the saliva. We evaluated the GLA device in terms of ease and time to insertion, the number of attempts, oropharyngeal leak pressure (OLP), correct placement, and complications in adult patients undergoing elective surgical procedures. Methods After general anaesthesia, the GLA device was inserted in ASA Class I–II consecutive patients aged 18–60 years, who were scheduled for elective surgeries lasting <2h. An independent observer noted (1) 10 consecutive successful GLA device insertions, all on the first attempt; (2) 10 consecutive device insertions, each <20 second in duration; and (3) 10 consecutive patients with the mean leak <10%. The criteria were fulfilled in 50 consecutive patients. Results In 72% of patients, the GLA device was successfully placed on the first attempt and was effortless in 64%. Between the first 10 and last 10 consecutive patients of the total 50, the ease-of-insertion grade progressively decreased (mean±standard deviation [SD]: 2.80±0.25 to 1.30±0.15, p<0.0001) and so did insertion time in seconds (28.70±1.87 to 14.20±0.79, p<0.0001). The post-insertion, OLP and airway compliance progressively increased, while the cuff inflation volume, peak airway pressure and airway resistance progressively decreased, along with minimal side effects and malposition. Conclusion The GLA device insertion became progressively easier and faster; thus, such a device is promising and warrants further clinical evaluation.
Collapse
Affiliation(s)
- Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Omar Viswanath
- Valley Anaesthesiology and Pain Consultants, Phoenix, AZ; Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Alan David Kaye
- Department of Anaesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, Louisiana, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anaesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anaesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Moser B, Keller C, Audigé L, Bruppacher HR. Oropharyngeal leak pressure of the LMA Protector™ vs the LMA Supreme™; a prospective, randomized, controlled clinical trial. Acta Anaesthesiol Scand 2019; 63:322-328. [PMID: 30229857 DOI: 10.1111/aas.13256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/11/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical characteristics such as oropharyngeal leak pressure (OLP) and ventilation peak pressure are important factors for successful use of supraglottic airway devices in general anaesthesia. We hypothesized that the LMA Protector™ compared to the LMA Supreme™ may develop a higher OLP, which could be of clinical significance. METHODS Ninety-six patients were randomized to the LMA Protector™ or LMA Supreme™ groups. We measured oropharyngeal leak pressure within 5 minutes after insertion of the supraglottic airway device with a standardized cuff pressure at 60 cm H2 O. Secondary parameters, such as insertion time of the supraglottic airway device, the number of attempts inserting the supraglottic airway device and the gastric tube, volume of gastric contents, and maximum airway pressure, as well as pulse oximetry throughout the operation were measured. Further, blood staining after removal of the supraglottic airway device and postoperative airway morbidity 3 hours after surgery were determined. RESULTS The mean difference of oropharyngeal leak pressure was 5.2 (95% CI 2.8-7.6), ie, 30.9 (7.4) cmH2 O for the LMA Protector™ vs 25.6 (4.4) cmH2 O for the LMA Supreme™ (P < 0.001; mean(SD)). Similarly, there was a mean difference between OLP and maximal ventilation peak pressure 5.6 (95% CI 3.1-8.2) ie 19.6 (7.7) cmH2 O for the LMA Protector™ vs 14.0 (4.4) cmH2 O for the LMA Supreme™ (P < 0.001). No difference was found between the groups for other secondary parameters, as well as postoperative airway morbidity. CONCLUSION The LMA Protector™ enabled a higher OLP compared to the LMA Supreme™. This finding may be important for patients requiring a higher peak pressure for sufficient supraglottic airway device ventilation.
Collapse
Affiliation(s)
- Berthold Moser
- Department of Anaesthesia; Schulthess Clinic; Zurich Switzerland
| | - Christian Keller
- Department of Anaesthesia; Schulthess Clinic; Zurich Switzerland
| | - Laurent Audigé
- Research and Development Department; Schulthess Clinic; Zurich Switzerland
| | | |
Collapse
|
11
|
Foo LL, Shariffuddin II, Chaw SH, Lee PK, Lee CE, Chen YS, Chan L. Randomized comparison of the Baska FESS mask and the LMA Supreme in different head and neck positions. Expert Rev Med Devices 2018; 15:597-603. [PMID: 30095289 DOI: 10.1080/17434440.2018.1506329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Baska functional endoscopic sinus surgery (FESS) mask is a new supraglottic airway designed for head and neck procedures. This prospective, randomized controlled trial compared the oropharyngeal leak pressure (OLP) of the Baska FESS mask with the laryngeal mask airway (LMA) Supreme in different head and neck positions. METHODS One hundred patients undergoing elective surgery were recruited. OLP was compared in supine position, 45° lateral rotation, 45° neck extension, and 30° neck flexion. Glottic view, insertion time, ease of insertion, number of attempts, ease and time of insertion of gastric tube, and complications were also compared. RESULTS The OLP of the Baska FESS was higher than the LMA Supreme in all head and neck positions studied (p < 0.001). Glottic views were better in the Baska FESS in supine and lateral rotation. LMA Supreme was easier (p = 0.046) and faster (p < 0.001) to insert. First attempt insertion success rates were 91.8% for Baska FESS and 98% for LMA Supreme. Gastric drain was easier and faster to insert (p < 0.001) in the LMA Supreme. CONCLUSIONS The Baska FESS provides a superior airway seal with higher mean OLP than the LMA Supreme in all head and neck positions studied. However, LMA Supreme was superior in terms of ease and speed of insertion.
Collapse
Affiliation(s)
- Li Lian Foo
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Ina Ismiarti Shariffuddin
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Sook Hui Chaw
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Pui Kuan Lee
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Chong En Lee
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Yi Shang Chen
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| | - Lucy Chan
- a Anaesthesiologist, Department of Anaesthesia , University Malaya Medical Centre , Kuala Lumpur , Malaysia
| |
Collapse
|
12
|
Damodaran S, Sethi S, Malhotra SK, Samra T, Maitra S, Saini V. Comparison of oropharyngeal leak pressure of air-Q™, i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial. Saudi J Anaesth 2017; 11:390-395. [PMID: 29033717 PMCID: PMC5637413 DOI: 10.4103/sja.sja_149_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Study Objective: Various randomized controlled trials and a meta-analysis have compared i-gel™ and laryngeal mask airway Supreme™ (LMA-S™) in adult patients and found that both the devices provided equivalent oropharyngeal leak pressure (OLP). However, no randomized controlled trial has compared air-Q™ with i-gel™ and LMA-S™ in adult patient. Hence, we designed this study to compare air-Q™ with LMA-S™ and i-gel™ in adult patients. Materials and Methods: A total of 75 adult patients of the American Society of Anesthesiologists physical status I/II of both sexes, between 18 and 60 years, were included in this prospective randomized controlled trial conducted in a tertiary care center. Randomization of patients was done in three equal groups according to the insertion of supraglottic airway device by a computer-generated random number sequence: group air-Q™ (n = 25), group i-gel™ (n = 25), and group LMA-S™ (n = 25). Primary outcome of this study was OLP. We also recorded time for successful placement of device, ease of device insertion, number of attempts to insert device, and ease of gastric tube insertion along with postoperative complications. Results: The mean ± standard deviation OLP of air-Q™, i-gel™, and LMA-S™ was 26.13 ± 4.957 cm, 23.75 ± 5.439 cm, and 24.80 ± 4.78 cm H2O (P = 0.279). The first insertion success rate for air-Q™, i-gel™, and LMA-S™ was 80%, 76%, and 92%, respectively (P = 0.353). The insertion time of air-Q™, i-gel™, and LMA-S™ was 20.6 ± 4.4, 14.8 ± 5.4, and 15.2 ± 4.7 s, respectively (P = 0.000). Time taken for air-Q™ insertion was significantly higher than time taken for i-gel™ (mean difference 5.8 s, P < 0.0001) and LMA-S™ (mean difference 5.4 s, P = 0.0001) insertion. Postoperative complications were similar with all three devices. Conclusions: We concluded that air-Q™, i-gel™, and LMA-S™ were equally efficacious in terms of routine airway management in adult patients with normal airway anatomy.
Collapse
Affiliation(s)
- Srinath Damodaran
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surender Kumar Malhotra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Souvik Maitra
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Saini
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
13
|
Singh K, Gurha P. Comparative evaluation of Ambu AuraGain™ with ProSeal™ laryngeal mask airway in patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 2017; 61:469-474. [PMID: 28655951 PMCID: PMC5474914 DOI: 10.4103/ija.ija_163_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: Second generation supraglottic airways are increasingly being used in surgical patients undergoing laparoscopic surgery. Preventing aspiration at higher airway pressures may be at the expense of a higher cuff pressure which can impair mucosal perfusion. We attempted to elucidate whether Ambu AuraGain™ (AAU) would provide a higher oropharyngeal leak pressure (OLP) with a lower mucosal pressure in comparison to ProSeal™ laryngeal mask airway (PLMA). Methods: This was a prospective randomised study involving sixty patients undergoing laparoscopic cholecystectomy under general anaesthesia, using either AAU (Group AAU [n = 30]) or PLMA (Group PLMA [n = 30]) for elective ventilation. Primary outcome measure was the OLP. Number of insertion attempts, ease of insertion, time required for placement and calculated pharyngeal mucosal pressure were the secondary outcome measures. Data were analysed using Student's t-test and Chi-square test. Results: No significant difference in the OLP was noted in both groups. The ease of insertion and success rate at first attempt was similar between the groups. Time taken for insertion in Group AAU was longer than Group PLMA (13.57 ± 1.94 vs. 11.60 ± 2.22 s). The calculated pharyngeal mucosal pressures were lower with Group AAU than Group PLMA for all 3 sizes. The minimum cuff pressure and minimum cuff volume required to prevent leak were found similar in both groups. Conclusion: AAU provides adequate sealing pressures and effective ventilation with lower calculated pharyngeal mucosal pressure, compared to PLMA.
Collapse
Affiliation(s)
- Kriti Singh
- Department of Anaesthesia and Critical Care, Batra Hospital and Medical Research Centre, New Delhi, India
| | - Pavan Gurha
- Department of Anaesthesia and Critical Care, Batra Hospital and Medical Research Centre, New Delhi, India
| |
Collapse
|
14
|
Gill RK, Tarat A, Pathak D, Dutta S. Comparative Study of Two Laryngeal Mask Airways: Proseal Laryngeal Mask Airway and Supreme Laryngeal Mask Airway in Anesthetized Paralyzed Adults Undergoing Elective Surgery. Anesth Essays Res 2017; 11:23-27. [PMID: 28298751 PMCID: PMC5341671 DOI: 10.4103/0259-1162.177184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Supraglottic airway devices can act as an alternative to endotracheal intubation in both normal and difficult airway. LMA Proseal (P-LMA) and LMA Supreme (S-LMA) alongwith acting as effective ventilating device, provide port for gastric drainage. Aim: The objective of this study was to compare the two devices for effective ventilation and complications. Setting and Design: A prospective, randomized, single-blinded study was conducted in a tertiary care teaching hospital. Methods: 100 patients of ASA grade I–II undergoing elective surgery under general anaesthesia were included after ethical committee clearance and written consent. Patients were randomly allocated size 4 P-LMA (Group P) or S-LMA (Group S) (50 patients in each group). Insertion attempt, insertion time, oropharyngeal leak pressure (OLP) and complications were compared. Results: There was no difference demographically. The first insertion attempts were successful in 92% with P-LMA and 96% with S-LMA. Insertion time was faster in S-LMA. The mean OLP was 24.04 cmH2O in Group P and 20.05 cmH2O in Group S. Complications were cough, mild blood staining. Conclusion: Both can act as an effective ventilatory devices. But where LMA Proseal provides a more effective glottic seal by having a greater OLP, single use LMA Supreme provides acceptable glottic seal with easier and faster insertion, therefore, it can be accepted as better alternative to LMA Proseal.
Collapse
Affiliation(s)
- Ravneet Kaur Gill
- Department of Anaesthesiology and Critical Care, Silchar Medical College, Silchar, Assam, India
| | - Abhijit Tarat
- Department of Anaesthesiology and Critical Care, Silchar Medical College, Silchar, Assam, India
| | - Debagopal Pathak
- Department of Anaesthesiology and Critical Care, Silchar Medical College, Silchar, Assam, India
| | - Suneeta Dutta
- Department of Anaesthesiology and Critical Care, Silchar Medical College, Silchar, Assam, India
| |
Collapse
|
15
|
Gupta S, Dogra N, Chauhan K. Comparison of i-gel™ and Laryngeal Mask Airway Supreme™ in Different Head and Neck Positions in Spontaneously Breathing Pediatric Population. Anesth Essays Res 2017; 11:647-650. [PMID: 28928564 PMCID: PMC5594783 DOI: 10.4103/aer.aer_238_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although the advantages of ventilation with i-gel™ and laryngeal mask airway Supreme (LMA-Supreme™) has been well documented, they are still under debate for surgeries requiring flexion and extension of neck such as thyroid surgery, tonsillectomy, and neck exploration. Hence, we conducted a study to demonstrate the effect of neck flexion and extension in spontaneously breathing anesthetized pediatric patients utilizing i-gel™ and LMA-Supreme™. METHODS A prospective, randomized comparative study was conducted on sixty children, thirty each in i-gel™ and LMA-Supreme™ group. Oropharyngeal leak pressure (OPLP), fiberoptic view of vocal cords, and exhaled tidal volume were evaluated in neutral, flexion, and extension neck positions in spontaneously breathing children. RESULTS OPLP for i-gel™ was found to be significantly higher in flexion (29.00 ± 1.95 cmH2O, P < 0.001) and lower in extension (21.07 ± 2.08 cmH2O, P < 0.001) as compared to neutral (24.67 ± 2.08 cmH2O). Similar results were observed for LMA-Supreme™ which showed significantly higher OPLP in flexion (24.73 ± 2.26, P < 0.001 respectively) and lower in extension (18.67 ± 1.42 cmH2O, P < 0.001) as compared to neutral (20.87 ± 1.80 cmH2O). Worsening of fiberoptic view occurs for i-gel™ and LMA-Supreme™ in flexion (10/12/5/3/0 and 11/14/2/2/1, P < 0.05) as compared to neutral position (17/10/2/1/0 and 15/12/1/1/1), respectively. Significant change did not occur in extension. Ventilation worsening occurred in flexion as compared to neutral position evidenced by significant decrease in exhaled tidal volume (92.90 ± 11.42 and 94.13 ± 7.75 ml, P < 0.05) as compared to neutral (100.23 ± 12.31 and 101.50 ± 8.26 ml) for i-gel™ and LMA-Supreme™, respectively. CONCLUSION Neck flexion caused a significant increase in leak pressure in both i-gel™ and LMA-Supreme™. With deterioration of fiberoptic view and ventilation, both devices should be used cautiously in pediatric patients in extreme flexion.
Collapse
Affiliation(s)
- Swati Gupta
- Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Neelam Dogra
- Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Kanchan Chauhan
- Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
16
|
Zhu W, Wei X. A randomized comparison of pediatric-sized Streamlined Liner of Pharyngeal Airway and Laryngeal Mask Airway-Unique in paralyzed children. Paediatr Anaesth 2016; 26:557-63. [PMID: 27012370 DOI: 10.1111/pan.12883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The pediatric-sized Streamlined Liner of Pharyngeal Airway (SLIPA) is a new supraglottic airway device for children. AIMS The aim of this study was to compare the clinical performance of the pediatric-sized SLIPA with the Laryngeal Mask Airway-Unique in paralyzed children under positive pressure-controlled ventilation (PCV). METHODS One hundred children, aged 2 months to 12 years with American Society of Anesthesiologists physical status I-II were enrolled and randomly allocated to the SLIPA group or the Laryngeal Mask Airway-Unique group (50 patients in each group). The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were first insertion success rate, insertion time, minor airway interventions required for successful insertion, intraoperative dislodgement, ventilatory data, and perioperative complications. RESULTS The insertion characteristics, ventilation data, and perioperative complications were comparable between the two groups. The leak pressure of the SLIPA was significantly higher than that of the Laryngeal Mask Airway-Unique [median (IQR): 25 (22-30) cm H2O vs. 21 (19-26) cm H2O, respectively; mean ± sd: 25.3 ± 4.6 cm H2O vs. 22.6 ± 4.8 cm H2O, respectively; P = 0.006]. The incidence of intraoperative dislodgment was significantly lower in the SLIPA group than in the Laryngeal Mask Airway-Unique group (0 vs. 6 patients, respectively; P = 0.027). CONCLUSIONS In conclusion, both the SLIPA and the Laryngeal Mask Airway-Unique can be used effectively without severe complications in paralyzed children. Additionally, the SLIPA provides a better airway seal and better intraoperative position stability than the Laryngeal Mask Airway-Unique.
Collapse
Affiliation(s)
- Wenxiu Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinchuan Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
17
|
Nirupa R, Gombar S, Ahuja V, Sharma P. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients. Indian J Anaesth 2016; 60:726-731. [PMID: 27761035 PMCID: PMC5064696 DOI: 10.4103/0019-5049.191670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar.
Collapse
Affiliation(s)
- R Nirupa
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Satinder Gombar
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Preeti Sharma
- Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| |
Collapse
|
18
|
Darlong V, Biyani G, Baidya DK, Pandey R, Chandralekha, Punj J, Upadhyay AD. Comparison of air-Q and Ambu Aura-i for controlled ventilation in infants: a randomized controlled trial. Paediatr Anaesth 2015; 25:795-800. [PMID: 25917434 DOI: 10.1111/pan.12663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The air-Q is a new supraglottic airway device (SAD) and has been increasingly used as a primary airway device and as a conduit for tracheal intubation in children as well as in adults. This device has either performed equally or better than other SADs in children. The Ambu Aura-i is a commonly used SAD in children undergoing various short surgical procedures. However, limited literature is available evaluating the safety and efficacy of the air-Q and the Ambu Aura-i in small children. We, therefore, conducted this study to compare the clinical performance of these two airway devices in infants weighing up to 10 kg. Our hypothesis is that air-Q, due to its improved and larger cuff design will yield better airway seal pressures as compared with the Ambu Aura-i. METHODS Sixty-four ASA I-II infants weighing <10 kg undergoing elective ophthalmic surgery were randomly assigned to receive either an air-Q or the Ambu Aura-i. After induction of general anesthesia (GA) and muscle relaxation, we measured oropharyngeal leak pressure (OLP) as the primary outcome. The secondary end points measured were time to insert, first insertion success rate, fiberoptic grade (FO) of laryngeal view and any other airway complications like trauma, laryngospasm, and desaturation. RESULTS The air-Q ILA provided significantly higher OLP as compared with the Ambu Aura-i [20.2 ± 4.6 cm H2 O, CI 18.55-21.88; vs 16.2 ± 5.6 cmH2 O, CI 14.27-18.25, P = 0.003; mean difference 4 ± 1.29 cm H2 O, CI 1.41-6.58]. However, the Ambu Aura-i required significantly less time for its insertion (14.6 ± 2.8 s, CI 13.66-15.70; vs 16.3 ± 1.5 s, CI 15.75-16.86, P = 0.005; mean difference 1.625 ± 0.56 s, CI 0.48-2.76). There were no differences in first insertion success rate, FO view, and postoperative complications. CONCLUSION We conclude that air-Q may be considered superior to Ambu Aura-i in infants for controlled ventilation as it provides higher airway sealing pressures.
Collapse
Affiliation(s)
- Vanlal Darlong
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ghansham Biyani
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K Baidya
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Pandey
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandralekha
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish D Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
19
|
Arslan Zİ, Balcı C, Oysu DA, Yılmaz M, Gürbüz N, Ilce Z. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial. Balkan Med J 2013; 30:90-3. [PMID: 25207076 DOI: 10.5152/balkanmedj.2012.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/07/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. STUDY DESIGN Randomized clinical trial. MATERIAL AND METHODS Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. RESULTS There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01). CONCLUSION As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.
Collapse
Affiliation(s)
- Zehra İpek Arslan
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Canan Balcı
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Duygu Akalın Oysu
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Mehmet Yılmaz
- Clinic of Anesthesiology and Reanimation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Necla Gürbüz
- Clinic of Pediatric Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Zekeriya Ilce
- Clinic of Pediatric Surgery, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| |
Collapse
|