Comparison of LMA Supreme™ with i-gel™ and LMA ProSeal™ in children for airway management during general anaesthesia: A meta-analysis of randomized controlled trials

Comparison of four different techniques of i-gel insertion by anaesthesia trainees in children undergoing daycare surgery: A single-blind, randomised, comparative study

Background and Aims

Different techniques of i-gel insertion have been described with variable success rates. This study aimed to assess the incidence of malposition of i-gel in children with 90° rotation, 180° rotation, jaw thrust-assisted and standard insertion techniques.

Methods

The study included 132 children undergoing elective surgery under general anaesthesia without neuromuscular blockade after approval from the Institutional Ethics Committee. The i-gel was inserted using one of the four randomised techniques (90° rotation, 180° rotation, jaw thrust-assisted insertion or standard insertion technique) by anaesthesia trainees. The primary objective of this study was to assess device malposition using three alternative techniques compared to the standard insertion technique by flexible video bronchoscopy.

Results

The incidence of malposition was the least in the 180° rotation technique group (27%) versus 39% in the standard and 90° rotation technique groups and 70% in the jaw thrust technique group (P = 0.004). Oropharyngeal leak pressure (OLP) was highest in the 180° rotation technique group, that is, 27.1 (5.3) cm H2O in the 180° rotation technique group versus 23 (4.3), 25.8 (4.1) and 24.7 (5.6) cm H2O in the standard, 90° rotation and assisted jaw thrust groups, respectively (P = 0.006). The time to i-gel insertion was the least with the standard insertion technique, that is, 16.9 (3.3) s, compared to 18.4 (3.1) s in the 90° rotation group, 19.5 (3.2) s in the180° rotation group and 20.1 (3.4) s in the assisted jaw thrust technique group (P < 0.001).

Conclusion

The 180° rotation technique for i-gel placement in children by anaesthesia trainees has the lowest incidence of malposition and the best OLP versus other techniques but lacks any clear advantage in clinical performance and ventilation.

LMA® Gastro™: A paediatric experience

The laryngeal mask airway, the LMA® Gastro™ (Teleflex Medical, Athlone, Ireland), is a novel airway device which permits upper gastrointestinal (GI) endoscopy to be performed via a dedicated large calibre oesophageal lumen. It has been validated in adult studies, but to our knowledge, there have been no data published regarding its use in a paediatric population. Following a brief education programme, the LMA Gastro was introduced on a trial basis at our institution and made freely available. Over a four-month period, our pre-existing endoscopy audit framework captured data on a total of 55 patients who had the LMA Gastro device chosen as the primary airway for elective upper GI endoscopy. These data were collected prospectively by the treating anaesthetist and included a range of airway and endoscopy outcomes. Of the 55 patients, the LMA Gastro provided an adequate airway in 52 (94.5%). Forty-six (88.5%) were sited on first attempt, and 50 (96.2%) insertions were rated 'easy' by the anaesthetist. Aside from three insertion failures, there were no airway events. The endoscopy success rate was 100% in the 52 patients who had an LMA Gastro airway successfully inserted. First-pass oesophageal access was achieved in 51 (98%) cases, and 100% of insertions were rated 'easy' by the gastroenterologist. Despite our relative inexperience with it, the device had a high success rate for airway maintenance and oesophageal access in our paediatric patient population. In our institution, the LMA Gastro provided a useful airway option in older children undergoing elective upper GI endoscopy.

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

Objective

Laryngeal mask airways and the I-gel have become increasingly popular for children undergoing minor surgery. The goal of our study is to compare I-gel and ProSeal laryngeal mask airways (LMA) in infants by analysing different parameters, such as insertion success, ventilation, haemodynamic changes and postoperative complications.

Methods

For this prospective, randomised study, we selected 123 infants with an American Society of Anaesthesiologists (ASA) status I, who were undergoing minor elective lower abdominal surgery. After obtaining verbal and written informed consent from the parents, the infants were divided into two groups: the I-gel group (n=60) and the ProSeal LMA group (n=63). The times and ease of insertion, percentages of tidal volume leakage, and means and leakage pressures of these two supraglottic airways were noted. The complications and side-effects of each method were also recorded.

Results

The insertion time of the ProSeal group was statistically shorter than that of the I-gel group. The peak and mean pressures and the leakage percentage of the ProSeal group were statistically lower than those of the I-gel group. The leakage pressure of the ProSeal group was statistically higher than the I-gel group.

Conclusion

In comparison with I-gel, the use of ProSeal LMA in infants' anaesthesia presents many advantages, such as the ease of its insertion, better oropharyngeal leakage pressure and less mucosal hyperaemia.