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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] [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.
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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
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Klementova O, Bhoday TK, Werner J, Lopez AM, Donaldson W, Lichnovsky E, Gaszyński T, Henlin T, Bruthans J, Ulrichova J, Lukes M, Blaha J, Kral M, Gomez L, Berge R, Holland J, McAleavey F, Arava S, Merjava Skripecka L, Sobczyk S, Tyll T, Michalek P. Evaluation of the insertion parameters and complications of the i-gel Plus airway device for maintaining patent airway during planned procedures under general anaesthesia: a protocol for a prospective multicentre cohort study. BMJ Open 2021; 11:e053215. [PMID: 34930740 PMCID: PMC8689171 DOI: 10.1136/bmjopen-2021-053215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalisation of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this cohort study is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications. METHODS AND ANALYSIS This is a multicentre, prospective, interventional cohort study. The enrolment will take place in seven centres in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months. ETHICS AND DISSEMINATION The cohort study has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences. TRIAL REGISTRATION NUMBER ISRCTN86233693;Pre-results.
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Affiliation(s)
- Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Taranpreet Kaur Bhoday
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jakub Werner
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Ana M Lopez
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Will Donaldson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Erik Lichnovsky
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | - Tomasz Gaszyński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomas Henlin
- Department of Anesthesia and Intensive Medicine, Military University Hospital Prague, Praha, Czech Republic
| | - Jan Bruthans
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jitka Ulrichova
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Martin Lukes
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Jan Blaha
- Department of Anesthesiology and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
| | - Michal Kral
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lidia Gomez
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Raquel Berge
- Department of Anesthesia, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Shiva Arava
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | | | - Sebastian Sobczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomas Tyll
- Department of Anesthesia and Intensive Medicine, Military University Hospital Prague, Praha, Czech Republic
| | - Pavel Michalek
- Anaesthesia and Intensive Medicine, General University Hospital in Prague, Praha, Czech Republic
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