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Kuşderci HS, Torun MT, Öterkuş M. Comparison of the Baska Mask® and Endotracheal Tube on Hemodynamic and Respiratory Parameters in Septoplasty Cases. Prague Med Rep 2021; 122:5-13. [PMID: 33646937 DOI: 10.14712/23362936.2021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Laryngeal mask (LM) types have been used as an airway device for an alternative to the standard endotracheal tube (ETT). One of the novel type of LM, the Baska Mask®, can be a safe alternative among the airway devices. The purpose of this study is to compare the effects of the new generation supraglottic airway device the Baska Mask® and the ETT on hemodynamic parameters (heart rate, mean arterial pressure), airway pressure and end tidal carbon dioxide (EtCO2) in patients undergoing general anesthesia. After the approval of the ethics committee, 70 patients who underwent septoplasty were included in the study. Written informed consent forms were taken from these patients. Demographic data of the patients were recorded. Hemodynamic data of patients were measured and recorded preoperative, during induction, at the time of intubation 1th, 3th and 5th minute and during extubation. Also, airway pressure and EtCO2 values of the patients were measured and recorded at the time of intubation, 1th, 3th and 5th minutes. Demographic data were similar in both groups. Mean arterial pressure, heart rate and airway pressure were lower in the group 2 (the Baska Mask® group) than in the group 1 (ETT group) and the difference was statistically significant (p<0.05). EtCO2 values were similar in both groups. No patients had tube leakage. In terms of hemodynamic and respiratory parameters the Baska Mask® is more advantageous than the ETT in short-term surgeries.
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Affiliation(s)
| | - Mümtaz Taner Torun
- Department of Otolaryngology, Bandırma State Hospital, Balıkesir, Turkey.
| | - Mesut Öterkuş
- Department of Anesthesia and Reanimation, Kafkas University, Kars, Turkey
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Sood S, Chahar S, Thakur A, Gupta M, Saxena A, Subramanian S. Comparison and evaluation of single-use LMA supreme versus the reusable proseal LMA in paralyzed patients undergoing surgery with controlled ventilation. J Anaesthesiol Clin Pharmacol 2021; 36:494-499. [PMID: 33840930 PMCID: PMC8022041 DOI: 10.4103/joacp.joacp_298_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/13/2020] [Accepted: 03/06/2020] [Indexed: 11/05/2022] Open
Abstract
Background and Aims: The objective of this prospective randomized blinded study was to assess the safety and efficacy of the laryngeal mask airway (LMA) Supreme as compared with the LMA Proseal. Material and Methods: A total of 60 patients were randomised into two groups to either receive a Proseal LMA (PLMA) or Supreme LMA (SLMA) for airway management. The primary outcome was to measure oropharyngeal leak pressure (OLP) in both groups. The secondary outcomes were the measurement of insertion time, insertion success rate, fibreoptic grading, intracuff pressure, ease of ventilation, and airway pressure on standard ventilatory settings and postoperative complications. Results: Intracuff pressure increase after 60 minutes of induction was significantly higher in the PLMA group (PLMA 97.43 ± 11.03 cm of H2O and SLMA 75.17 ± 8.95 cm of H2O). OLP was recorded after device insertion, after 30 min and after 60 min in each group and was found to be 28.71 ± 2.97, 30.93 ± 2.87, and 31.93 ± 2.72 cm of H2O in PLMA and 24.84 ± 2.08, 26.73 ± 2.26, and 27.95 ± 2.55 cm of H2O in SLMA group, respectively. The mean OLP with the SLMA was significantly (p=<.001) lower than PLMA. All the other parameters were comparable in both groups. Conclusion: PLMA is better than SLMA as airway device to ventilate at higher airway pressure in paralyzed adult patients. On the basis of our study, we recommend Proseal over Supreme LMA.
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Affiliation(s)
- Suvidha Sood
- Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Shikha Chahar
- Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Anil Thakur
- Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Madhu Gupta
- Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Anupriya Saxena
- Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - Shalini Subramanian
- Department of Anesthesiology, Narayana Nethralaya, Bengaluru, Karnataka, India
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Wang MH, Zhang DS, Zhou W, Tian SP, Zhou TQ, Sui W, Zhang Z. Effects of Peak Inspiratory Pressure-Guided Setting of Intracuff Pressure for Laryngeal Mask Airway Supreme™ Use during Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J INVEST SURG 2020; 34:1137-1144. [PMID: 32354298 DOI: 10.1080/08941939.2020.1761487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the effects of peak inspiratory pressure (PIP)-guided intracuff pressure (ICP) modulation of laryngeal mask airway (LMA) Supreme™ during laparoscopic cholecystectomy. METHODS Totally 120 patients were randomly divided using computer-generated numbers into a control group (n = 60; ICP, 60 cmH2O) and a PIP group (n = 60), in which ICP was increased with 5 cmH2O each time from PIP level until no air leaks from the oropharynx. PIP, ICP, cuff volume (CV), oropharyngeal leak pressure (OLP) and leak fraction (LF) were recorded before and after pneumoperitoneum establishment. Postoperative pharyngolaryngeal complications (sore throat, dysphagia, pharyngeal hematoma, and dysphonia) were also recorded. RESULTS Demographic data were similar in the two groups. The CV and ICP before and after pneumoperitoneum were significantly lower in the PIP group (CV: 15.6 ± 2.3 mL and 21.0 ± 2.6 mL; ICP: 14.3 ± 2.9 cmH2O and 20.5 ± 3.4 cmH2O) than in the control group (CV: 33.0 ± 2.8 mL and 32.8 ± 1.9 mL; ICP: 60.0 ± 0.1 cmH2O and 60.0 ± 0.1 cmH2O) (P < 0.05). Although OLP was lower in the PIP group (P < 0.05), the LF was similar in the two groups (P > 0.05). There were fewer postoperative pharyngolaryngeal complications in the PIP group (P < 0.05). CONCLUSIONS Compared with a fixed ICP of 60 cmH2O, PIP-guided ICP modulation during LMA Supreme™ use provided effective airway sealing at a lower CV and ICP, and produced fewer postoperative pharyngolaryngeal complications in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Mao-Hua Wang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Dong-Sheng Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei Zhou
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Shun-Ping Tian
- School of Medicine, Yangzhou University, Yangzhou, China
| | - Tian-Qi Zhou
- Preventive Health Care Office, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei Sui
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Zhuan Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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Comparison of LM-Supreme™ and endotracheal tube in patients undergoing gynecological laparoscopic surgery. J Clin Monit Comput 2020; 34:295-301. [PMID: 30968326 DOI: 10.1007/s10877-019-00310-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/01/2019] [Indexed: 01/29/2023]
Abstract
While laryngeal mask is widely used for laparoscopic interventions in some countries, concerns exist regarding pulmonary aspiration and inadequate ventilation. We compared the LM-Supreme™ (LM-S) with the endotracheal tube (ETT) for laparoscopic gynecological interventions in terms of ventilation parameters and gastric distention. This prospective randomized and double-blind study. The patients were divided into two groups: ETT (n = 50) and LM-S group (n = 50). All patients in the LM-S and ETT groups recieved total intravenous general anaesthesia and standard ventilation protocols. Ventilation parameters (airway peak pressure, mean airway pressure, end-tidal carbon dioxide, total volume, oropharyngeal leak pressure) and perioperative laryngopharyngeal morbidity were recorded before peritoneal insufflation, during and after the peroperative period. The mean airway pressure values in the ETT group 2 min after airway device insertion were significantly higher. The gastric distension after the laparoscope entered the abdomen in the LM-S group was found to be significantly lower. In the first hour postoperative sore throat, disphonia and dysphagia were statistically significantly higher in the ETT group. In our study we concluded that LM-S provides reliable endotracheal intubation in ASA I & II patients undergoing laparoscopic gynecological surgery under positive pressure ventilation.ClinicalTrials.gov ID NCT02127632.
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Yoon SW, Kang H, Choi GJ, Ryu C, Park YH, Baek CW, Jung YH, Woo YC. Comparison of supraglottic airway devices in laparoscopic surgeries: A network meta-analysis. J Clin Anesth 2019; 55:52-66. [DOI: 10.1016/j.jclinane.2018.12.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
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Wong DT, Ooi A, Singh KP, Dallaire A, Meliana V, Lau J, Chung F, Singh M, Wong J. Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial. Can J Anaesth 2018; 65:797-805. [DOI: 10.1007/s12630-018-1120-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022] Open
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Ali A, Altun D, Sivrikoz N, Yornuk M, Turgut N, Akıncı İÖ. Comparison of Different Cuff Pressure Use with the Supreme Laryngeal Mask Airway on Haemodynamic Response, Seal Pressure and Postoperative Adverse Events: A Prospective Randomized Study. Turk J Anaesthesiol Reanim 2017; 46:151-157. [PMID: 29744251 DOI: 10.5152/tjar.2017.89587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 07/14/2017] [Indexed: 11/22/2022] Open
Abstract
Objective The Supreme™ laryngeal mask airway (SLMA) is a supra glottic airway (SGA) device that is used as an alternative to endotracheal tubes. In the present study, we aimed to compare the use of the SLMA with normal cuff pressure and low cuff pressure, primarily for haemodynamic response. Methods In the present study, 120 patients diagnosed with hypertension and scheduled for varicose vein or inguinal hernia operation were enrolled and 99 patients finished. Using randomization, patients were divided into two groups according to cuff pressure as a low-pressure group (Group L, 45 cm H2O) and a normal-pressure group (Group N, 60 cm H2O). Demographics, Mallampati score and the type and duration of surgery, heart rate (HR), mean arterial pressure (MAP), percentage of tidal volume leakage, Ppeak, Pmean, etCO2, seal pressure, fibreoptic scores and postoperative adverse effects of all patients were recorded. Results MAP and HR values immediately and 2 minutes after SLMA insertion were significantly lower in Group L (p<0.001). In Group L and Group N, the seal pressures were 24.1±3.1 cm H2O and 26.2±3.9 cm H2O, respectively (p=0.003). Also, blood staining and sore throat occurred less frequently in Group L (p<0.05). The fibreoptic average score, insertion features and ventilation parameters were similar between the groups (p>0.05). Conclusion SLMA use with a cuff pressure of 45 cm H2O significantly decreases haemodynamic response and post-operative side effects compared with a normal cuff pressure. Therefore, except for some specific surgeries that require higher seal pressures, we recommend the use of the SLMA with cuff pressures as low as 45 cm H2O.
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Affiliation(s)
- Achmet Ali
- Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Demet Altun
- Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Nukhet Sivrikoz
- Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mesut Yornuk
- Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Namigar Turgut
- Department of Anaesthesiology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Özkan Akıncı
- Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Lan S, Zhou Y, Li JT, Zhao ZZ, Liu Y. Influence of lateral position and pneumoperitoneum on oropharyngeal leak pressure with two types of laryngeal mask airways. Acta Anaesthesiol Scand 2017; 61:1114-1121. [PMID: 28741716 DOI: 10.1111/aas.12943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND An important parameter to monitor adequate ventilation for laryngeal mask airway (LMA) is its oropharyngeal leak pressure (OLP). This study was designed to evaluate and compare the effect of lateral position and pneumoperitoneum on the OLP and ventilation efficiency between LMA™ Proseal (PLMA) and LMA™ Supreme (SLMA). METHODS Patients were randomized to receive either the PLMA or the SMLA. The OLP was assessed in both the supine position and the lateral position with or without pneumoperitoneum. Minute ventilation was increased to maintain normal EtCO2 as far as possible. Ventilatory efficiency was scored as Class I (optimal, EtCO2 35-45 mmHg), Class II (suboptimal, EtCO2 45-55 mmHg) and Class III (poor, EtCO2 >55 mmHg). Adverse events associated with LMA such as blood staining on the mask and sore throat were also recorded. RESULTS Within each group, the OLP was higher in the supine position than that in the lateral position with or without pneumoperitoneum (P < 0.01). However, pneumoperitoneum did not further decrease the OLP. The OLP with PLMA was higher compared with SLMA regardless of the position and pneumoperitoneum (P < 0.05 or 0.01). There was no significant difference in the number of patients in Class I/II/III for ventilation scores in the lateral position with pneumoperitoneum (83/7/2 in PLMA group and 76/14/2 in SLMA group, respectively). The incidence of adverse events was comparable in both groups. CONCLUSION Our data demonstrate that the PLMA has a higher OLP in comparison with the SLMA in the lateral position for laparoscopic surgery. Both devices provide comparably adequate ventilatory efficiency.
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Affiliation(s)
- S. Lan
- Department of Anesthesiology; Shanghai Changhai Hospital; The Second Military Medical University; Shanghai China
| | - Y. Zhou
- Department of Anesthesiology; Shanghai Changhai Hospital; The Second Military Medical University; Shanghai China
| | - J. T. Li
- Department of Anesthesiology; Shanghai Changhai Hospital; The Second Military Medical University; Shanghai China
| | - Z. Z. Zhao
- Department of Anesthesiology; Shanghai Changhai Hospital; The Second Military Medical University; Shanghai China
| | - Y. Liu
- Department of Anesthesiology; Shanghai Changhai Hospital; The Second Military Medical University; Shanghai China
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Tian Y, Wu XY, Li L, Ma L, Li YF. A clinical trial evaluating the laryngeal mask airway-Supreme in obese children during general anesthesia. Arch Med Sci 2017; 13:183-190. [PMID: 28144270 PMCID: PMC5206376 DOI: 10.5114/aoms.2017.64719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/31/2015] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The laryngeal mask airway (LMA)-Supreme is a disposable double-lumen laryngeal mask airway that is widely used in clinical practice. However, its use in obese children has not been evaluated. The aim of this study was to determine whether the LMA-Supreme could perform equally as well as endotracheal intubation in obese children having a minor surgical procedure. MATERIAL AND METHODS After ethical board approval, 100 obese male children receiving non-emergent appendectomy for chronic appendicitis or surgery to correct concealed penis were randomly divided into an endotracheal intubation group and an LMA-Supreme group. Endotracheal intubation was performed under direct vision laryngoscopy. In the LMA group, a size-3 LMA-Supreme was placed and a stomach tube inserted via the drainage tube of the mask. Cardiovascular and respiratory parameters, time taken for placement, placement attempts, time to removal of the endotracheal tube/LMA, length of stay in the post-anesthesia care unit (PACU), and complications were recorded. RESULTS Insertion time was significantly longer (p < 0.001) in the LMA-Supreme group than in the endotracheal intubation group. Peak airway pressure was significantly higher, and pulmonary compliance and PACU stay time lower in the LMA-Supreme group. No significant differences between endotracheal intubation and the LMA-Supreme were seen in other parameters, except for a higher incidence of coughing in the endotracheal intubation group. CONCLUSIONS The LMA-Supreme can be easily inserted and effectively used for airway management in obese children undergoing minor surgery.
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Affiliation(s)
- Yue Tian
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Herping District, Shenyang, China
| | - Xiu-Ying Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Herping District, Shenyang, China
| | - Lu Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Herping District, Shenyang, China
| | - Ling Ma
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Herping District, Shenyang, China
| | - Yun-Feng Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Herping District, Shenyang, China
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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] [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.
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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
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A randomized comparison of the Ambu AuraGain versus the LMA supreme in patients undergoing gynaecologic laparoscopic surgery. J Clin Monit Comput 2016; 31:1255-1262. [DOI: 10.1007/s10877-016-9963-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
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The AMBU® Aura-i™ Laryngeal Mask and LMA Supreme™: A Randomized Trial of Clinical Performance and Fibreoptic Positioning in Unparalysed, Anaesthetised Patients by Novices. Anesthesiol Res Pract 2016; 2016:4717061. [PMID: 27847515 PMCID: PMC5099491 DOI: 10.1155/2016/4717061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022] Open
Abstract
Introduction. Manikin studies' data cannot accurately be extrapolated to real-life scenarios and inherent differences in design and materials of newer products may affect their clinical performance. Methods. Hence, we compared the AMBU® Aura-i™ and LMA Supreme™ in this randomized trial involving 100 ASA 1-2 unparalysed anaesthetised patients undergoing minor gynaecological surgery. Investigators had <20 Aura-i insertions. Primary outcome was time to achieve effective ventilation and secondarily insertion parameters, oropharyngeal leak pressures (OLP), fibreoptic positioning, and pharyngeal morbidity. The position of the Ambu Aura-i was evaluated with the Ascope; the fiberoptic view of the glottis was scored on a five-point scale. Results. 43 (86%) AMBU Aura-i and 44 (88%) LMA Supremes were successfully inserted on first attempt (p = 0.59), with similar ease (p = 0.79), and comparable times to first capnogram, mean (SD) 18.2 (6.0) versus 17.3 (6.4) sec, p = 0.9. The Aura-i needed significantly less volume of air to inflate its cuff to 60 cmH2O on the manometer, 17.7 (3.5) versus 23.1 (4.4) mL, p < 0.001. Both devices exhibited similar OLP, Aura-i versus LMA Supreme, mean (SD) 28.8 (7.1) versus 27.3 (5.3) cmH2O, p = 0.24. There was no difference in ease of insertion or adjustment manoeuvres to aid ventilation. 90% of patients had good positioning of Aura-i on fibreoptic check, yielding a view of the vocal cords and epiglottis. In 5 patients (10%), the vocal cords were not seen, but ventilatory function was unaffected. Conclusions. The Aura-i handled well in novices hands, with comparable times to insert and establish ventilation, similar leak pressures, and successful first attempt insertion rates compared to the LMA Supreme.
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Somri M, Vaida S, Fornari GG, Mendoza GR, Charco-Mora P, Hawash N, Matter I, Swaid F, Gaitini L. A randomized prospective controlled trial comparing the laryngeal tube suction disposable and the supreme laryngeal mask airway: the influence of head and neck position on oropharyngeal seal pressure. BMC Anesthesiol 2016; 16:87. [PMID: 27716165 PMCID: PMC5054611 DOI: 10.1186/s12871-016-0237-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 08/23/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Laryngeal Tube Suction Disposable (LTS-D) and the Supreme Laryngeal Mask Airway (SLMA) are second generation supraglottic airway devices (SADs) with an added channel to allow gastric drainage. We studied the efficacy of these devices when using pressure controlled mechanical ventilation during general anesthesia for short and medium duration surgical procedures and compared the oropharyngeal seal pressure in different head and-neck positions. METHODS Eighty patients in each group had either LTS-D or SLMA for airway management. The patients were recruited in two different institutions. Primary outcome variables were the oropharyngeal seal pressures in neutral, flexion, extension, right and left head-neck position. Secondary outcome variables were time to achieve an effective airway, ease of insertion, number of attempts, maneuvers necessary during insertion, ventilatory parameters, success of gastric tube insertion and incidence of complications. RESULTS The oropharyngeal seal pressure achieved with the LTS-D was higher than the SLMA in, (extension (p=0.0150) and right position (p=0.0268 at 60 cm H2O intracuff pressures and nearly significant in neutral position (p = 0.0571). The oropharyngeal seal pressure was significantly higher with the LTS-D during neck extension as compared to SLMA (p= 0.015). Similar oropharyngeal seal pressures were detected in all other positions with each device. The secondary outcomes were comparable between both groups. Patients ventilated with LTS-D had higher incidence of sore throat (p = 0.527). No major complications occurred. CONCLUSIONS Better oropharyngeal seal pressure was achieved with the LTS-D in head-neck right and extension positions , although it did not appear to have significance in alteration of management using pressure control mechanical ventilation in neutral position. The fiberoptic view was better with the SLMA. The post-operative sore throat incidence was higher in the LTS-D. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02856672 , Unique Protocol ID:BnaiZionMC-16-LG-001, Registered: August 2016.
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Affiliation(s)
- Mostafa Somri
- Anesthesiology Department, Bnai Zion Medical Center and Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Sonia Vaida
- Anesthesiology Department, Penn State College of Medicine, Hershey, PA USA
| | - Gustavo Garcia Fornari
- Anesthesiology Department, Hospital Universitario Italiano, Buenos Aires, Argentina
- International Program of Teaching and Investigation in Airway Management – FIDIVA, Haifa, Israel
| | - Gabriela Renee Mendoza
- Anesthesiology Department, Hospital Universitario Italiano, Buenos Aires, Argentina
- International Program of Teaching and Investigation in Airway Management – FIDIVA, Haifa, Israel
| | - Pedro Charco-Mora
- Anesthesiology Department, Hospital Universitario de Valencia, Valencia, Spain
- International Program of Teaching and Investigation in Airway Management – FIDIVA, Haifa, Israel
| | - Naser Hawash
- Anesthesiology Department, Bnai Zion Medical Center and Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ibrahim Matter
- Surgery Department, Bnai Zion Medical Center and Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Forat Swaid
- Surgery Department, Bnai Zion Medical Center and Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Luis Gaitini
- Anesthesiology Department, Bnai Zion Medical Center and Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
- International Program of Teaching and Investigation in Airway Management – FIDIVA, Haifa, Israel
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14
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Comparison of the Supreme and the ProSeal laryngeal mask airway in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial. ACTA ACUST UNITED AC 2016; 54:44-50. [DOI: 10.1016/j.aat.2016.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 12/18/2015] [Accepted: 03/07/2016] [Indexed: 11/23/2022]
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Weng M, Ding M, Xu Y, Yang X, Li L, Zhong J, Miao C. An Evaluation of Thyromental Distance-based Method or Weight-based Method in Determining the Size of the Laryngeal Mask Airway Supreme: A Randomized Controlled Study. Medicine (Baltimore) 2016; 95:e2902. [PMID: 26945383 PMCID: PMC4782867 DOI: 10.1097/md.0000000000002902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The successful placement of Laryngeal Mask Airway (LMA) Supreme in adults largely depends on right selection of its size. Most anesthesiologists determine the size of LMA according to patients' body weight, which does not always work well. An alternative method should be established to guarantee higher efficacy of ventilation through LMA Supreme placement. This controlled study was designed to compare the efficacy of LMA Supreme placement, when the size of it is determined by body weight or by thyromental distance. Eighty healthy individuals with American Society of Anesthesiologists physical status 1 to 2 scheduled for elective ambulatory surgery were randomly allocated into 2 groups: thyromental distance-based group (n = 40) and weight-based group (n = 40). Efficacy of controlled ventilation through LMA, easy of device placement, and pharyngeal sealing were evaluated between the groups. The tidal volume under 10 cm H2O pressure-controlled ventilation in thyromental distance-based group was significantly higher than that in weight-based group (523.9 ± 135.4 vs 477.1 ± 185.6; P = 0.031). The number of patients who achieved "excellent" tidal volume (>8 mL/kg) were significantly more in the thyromental distance-based group (24/40 vs 13/40; P = 0.019). Among overweight patients (body mass index >23), those who achieved "excellent" tidal volume (>8 mL/kg) under 10 cm H2O pressure-controlled ventilation were also more in thyromental distanced-based group than in weight-based group (11/24 vs 2/24; P = 0.031). The time taken for successful insertion was shorter with the thyromental distance-based group compared with the weight-based group (54.6 ± 33.6 vs 87.8 ± 98.9; P = 0.021). Oropharyngeal leak pressure was pretty close between the 2 groups (26.4 ± 5.1 vs 25.0 ± 5.7 cm H2O; P = 0.180). In terms of guaranteeing better positive pressure ventilation, facilitating device placement, and reliable pharyngeal sealing, thyromental distance-based method can be a better option compared with the weight-based method for LMA Supreme size selection.
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Affiliation(s)
- Meilin Weng
- From the Department of Anaesthesiology, Fudan University Shanghai Cancer Centre; Department of Oncology, Shanghai Medical College Fudan University, Shanghai, China (MLW, YJX, XJY, LHL, JZ, CHM); and Department of Anaesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (MD)
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Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient with Sjögren’sSyndrome. Case Rep Anesthesiol 2016; 2016:8185628. [PMID: 28018681 PMCID: PMC5149601 DOI: 10.1155/2016/8185628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 11/07/2016] [Indexed: 12/02/2022] Open
Abstract
Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient with Sjögren's syndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings.
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Mishra SK, Sivaraman B, Balachander H, Naggappa M, Parida S, Bhat RR, Yuvaraj K. Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™ and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial. Anesth Essays Res 2015; 9:353-8. [PMID: 26712973 PMCID: PMC4683478 DOI: 10.4103/0259-1162.159771] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: A sustained and effective oropharyngeal sealing with supraglottic airway (SGA) is required to maintain the ventilation during laparoscopic gynecological surgery in the Trendelenburg position. This study was conducted with I-gel™ and ProSeal LMA™, two prototype SGA devices with a gastric access. Materials and Methods: We enrolled 60 American Society of Anesthesiologists physical status I and II patients and randomized to either I-gel or ProSeal LMA (PLMA) group. After induction of anesthesia using a standardized protocol, one of the SGA devices was inserted. The primary objective of this study was to compare the oropharyngeal leak (sealing) pressure of I-gel™ and ProSeal LMA™ after pneumoperitoneum and Trendelenberg position. The secondary objectives were to compare ease of insertion, cuff position as assessed by the fiberoptic view of the glottis, adequacy of ventilation and incidence of complication. Results: The baseline (before pneumoperitoneum) oropharyngeal leak pressure of I-gel was less than the PLMA (mean (standard deviation [SD]) 24 (4) vs. 29 (4) cmH2O, respectively; P < 0.001). After pneumoperitoneum, the leak airway pressure in I-gel group was significantly less than that of PLMA group (mean [SD] 27 (3) vs. 34.0 (4) cmH2O, respectively; P < 0.001). Peak airway pressure was increased after pneumoperitoneum compared to baseline in both the groups. However, end-tidal carbon dioxide was maintained within normal limits. The insertion parameters, fiberoptic view of the glottis, fiberoptic view of the drain tube, and complications were comparable between the groups. Conclusion: Both I-gel and PLMA are effective for ventilation in gynecological laparoscopic surgeries. However, PLMA provides better sealing as compared to I-gel.
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Affiliation(s)
| | - B Sivaraman
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | | | - Mahesh Naggappa
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - Satyen Parida
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
| | - Ravindra R Bhat
- Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India
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Kömür E, Bakan N, Tomruk ŞG, Karaören G, Doğan ZT. Comparison of the Supraglottic Airway Devices Classic, Fastrach and Supreme Laryngeal Mask Airway: A Prospective Randomised Clinical Trial of Efficacy, Safety and Complications. Turk J Anaesthesiol Reanim 2015; 43:406-11. [PMID: 27366537 DOI: 10.5152/tjar.2015.97830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/04/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This prospective randomised study was designed to compare the Laryngeal Mask Airway (LMA) Classic, LMA Fastrach and LMA Supreme regarding ease of insertion and insertion time as primary outcomes and reposition, success rate of trials, effects on haemodynamic parameters, provision of an adequate and safe airway, amount of leakage and oropharyngeal and systemic complications as secondary outcomes. METHODS In this clinical trial, 90 patients aged 18-70 years of American Society of Anesthesiologists (ASA) group I-II were randomised into three groups as providing airway via LMA Classic, LMA Fastrach or LMA Supreme instead of tracheal intubation. No muscle relaxant was used. The allocated LMA was inserted by the same anaesthetist; bispectral index (BIS) was between 40% and 60%. RESULTS There was no statistical difference among the groups regarding the ease of insertion and insertion time as primary outcomes; the incidence of repositioning during placement was significantly higher in the LMA Classic group than that in other groups (p<0.05) and the rates of bloodstain on the device as well as oropharyngeal mucosal oedema were higher in the LMA Fastrach group than those in other groups (p<0.05) as secondary outcomes. CONCLUSION We suggest that LMA Classic, LMA Supreme and LMA Fastrach had similar effectiveness regarding efficiency and airway safety. However, LMA Supreme seems to be more advantageous as it is more appropriate for fewer oropharyngeal complications and there was no repositioning.
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Affiliation(s)
- Erdal Kömür
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Nurten Bakan
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Şenay Göksu Tomruk
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Gülşah Karaören
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Zelin Topaç Doğan
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, O'Sullivan EP, Woodall NM, Ahmad I. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115:827-48. [PMID: 26556848 PMCID: PMC4650961 DOI: 10.1093/bja/aev371] [Citation(s) in RCA: 1194] [Impact Index Per Article: 132.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.
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Affiliation(s)
- C Frerk
- Department of Anaesthesia, Northampton General Hospital, Billing Road, Northampton NN1 5BD, UK
| | - V S Mitchell
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - A F McNarry
- Department of Anaesthesia, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK
| | - C Mendonca
- Department of Anaesthesia, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - R Bhagrath
- Department of Anaesthesia, Barts Health, West Smithfield, London EC1A 7BE, UK
| | - A Patel
- Department of Anaesthesia, The Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London WC1X 8DA, UK
| | - E P O'Sullivan
- Department of Anaesthesia, St James's Hospital, PO Box 580, James's Street, Dublin 8, Ireland
| | - N M Woodall
- Department of Anaesthesia, The Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK
| | - I Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
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Michalek P, Jindrova B, Kriz P, Stritesky M, Sedlar M. A pilot evaluation of the 3gLM-R - A new supraglottic airway device. Adv Med Sci 2015; 60:186-90. [PMID: 25827129 DOI: 10.1016/j.advms.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 01/08/2015] [Accepted: 02/03/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Supraglottic airway devices are designed for airway management during anaesthesia. The 3gLM is a novel device with a non-inflatable soft cuff and separate channels for gas delivery and drainage of gastric content. MATERIAL AND METHODS This prospective observational study of the 3gLM, version R, size 4 in 40 adult patients scheduled for elective surgery, evaluated the insertion success rate at the 1st attempt as the primary outcome. Secondary aims included insertion parameters, such as total success rate, insertion time, oropharyngeal seal pressures, postoperative complications and a comparison between males and females. RESULTS First attempt insertion success rate was 80% (70% in males, 90% in female patients, p=0.24), while total insertion success rate was 92.5% (85% in males, 100% in females, p=0.23). The oropharyngeal seal pressures were 27cmH2O, higher in females (29.4cmH2O) than in males (24.2cmH2O) - p=0.002. Postoperative complications were only temporary and included sore throat (24.3%), hoarseness (10.8%), pain on swallowing (10.8%) and minor tongue haematoma (2.5%). There was no difference in the incidence of postoperative complications between the genders apart from hoarseness. No aspiration of gastric contents or other long-term complications occurred in this cohort. CONCLUSIONS The 3gLM exhibited oropharyngeal seal pressures adequate for the controlled ventilation in most patients. Size 4 of the device showed higher pressures in females than in men.
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Randomized comparison of the i-gel(TM) with the LMA Supreme (TM) in anesthetized adult patients. Anaesthesist 2015; 64:271-6. [PMID: 25801488 DOI: 10.1007/s00101-015-0020-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND The LMA Supreme(TM) (LMA-S) and i-gel(TM) are two of the most commonly used supraglottic airway devices (SADs) with an inbuilt drain channel. These devices are particularly indicated for performing certain procedures accompanied by high peak airway pressure, such as laparoscopy. This study compared the devices regarding efficacy, safety, ease of use and incidence of adverse events, focusing on the postoperative rate of sore throat, dysphagia or dysphonia and development with time, in patients undergoing laparoscopic cholecystectomy procedures under general anesthesia. METHODS This was a prospective, randomized, controlled clinical study including 140 patients randomized into 2 groups undergoing elective laparoscopic cholecystectomy to use either i-gel or LMA-S. After the general anesthesia procedure, the speed of insertion, success rates, ease of insertion of the drain tube, leak pressure and tidal volume achieved by the devices were evaluated. The postoperative oropharyngeal discomfort (POPD) during the period of stay of the patients in the recovery room was also recorded. RESULTS The mean leak pressure was comparable between the two groups (i-gel 28.18 ± 3.90 cmH2O and LMA-S 27.50 ± 4 cmH2O, p = 0.09), as well as maximum expiratory tidal volume provided (i-gel 559.60 ± 45.25 ml and LMA-S 548.95 ± 56.18 ml, p = 0.12). Insertion times were lower for the i-gel (10 ± 1.62 s) compared with the LMA-S (11.31 ± 2.85 s, p = 0.008). Insertion success rate at the first attempt was higher for the LMA-S (95 % compared with i-gel 79 %, p = 0.007). Drain tubes were easier to insert in the LMA-S group (p < 0.001). No differences were found between groups relating to intraoperative complications. Frequency of coughing and visible blood on removal of the device were low and comparable in both groups (p = 0.860 and p = 0.623, respectively). There were no differences relating to the incidence of sore throat, dysphagia or hoarseness at 10 min postoperatively between groups (p = 0.088). The i-gel group complained about a higher sore throat score at 2 h postoperatively (p = 0.009), specifically patients receiving i-gel suffered more from sore throats with 0.24 more points on the visual analog scale (VAS) than patients from the LMA-S group. The i-gel group also reported a lower POPD drop during the first 2 h (p < 0.001). CONCLUSION No differences were found between i-gel and LMA-S regarding leak pressure in the groups of anesthetized patients undergoing laparoscopic cholecystectomy. The LMA-S was easier to insert than the i-gel (based on its better first time success rate) and this device showed better ease of drain tube insertion, although the i-gel was quicker to insert than the LMA-S. The i-gel resulted in higher sore throat scores at 2 h postoperatively and lower POPD reduction during the 2 h period studied in the recovery room was reported.
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Beleña JM, Núñez M, Gracia JL, Pérez JL, Yuste J. The Laryngeal Mask Airway Supreme™: safety and efficacy during gynaecological laparoscopic surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2012.10872843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- JM Beleña
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - M Núñez
- Department of Anaesthesiology and Critical Care, Hospital Ramón y Cajal, Madrid, Spain
| | - JL Gracia
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - JL Pérez
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - J Yuste
- Department of Anaesthesiology and Critical Care, Hospital del Sureste, Arganda del Rey, Madrid, Spain
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Price GC, McLellan S, Paterson RL, Hay A. A prospective randomised controlled trial of the LMA Supreme vs cuffed tracheal tube as the airway device during percutaneous tracheostomy. Anaesthesia 2014; 69:757-63. [PMID: 24803133 DOI: 10.1111/anae.12595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2013] [Indexed: 12/01/2022]
Abstract
We studied the performance of the LMA Supreme against a cuffed tracheal tube, our standard method of airway control during percutaneous tracheostomy, in 50 consecutive patients from three general critical care units. The primary outcome measure was adequacy of ventilation calculated as the difference in arterial carbon dioxide tension before and after tracheostomy. On an intention-to-treat analysis, there was no difference in the increase in arterial carbon dioxide tension between groups, with a median (IQR [range]) for the LMA Supreme of 0.9 (0.3-1.6 [0-2.8]) kPa, and for the tracheal tube of 0.8 (0.4-1.2 [0-2.5]) kPa, p = 0.82. Eight patients out of 25 (32%) crossed over from the LMA Supreme group to the tracheal tube group before commencement of tracheostomy due to airway or ventilation problems, compared with none out of 25 in the tracheal tube group, p = 0.01, and tracheostomy was postponed in two patients in the LMA Supreme group due to poor oxygenation. There were more clinically important complications in the LMA Supreme group compared with the tracheal tube group.
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Affiliation(s)
- G C Price
- Department of Anaesthesia and Critical Care, St Johns Hospital, Livingston, UK; Department of Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients. Eur J Anaesthesiol 2014; 31:266-73. [DOI: 10.1097/01.eja.0000435015.89651.3d] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bergmann I, Crozier TA, Roessler M, Schotola H, Mansur A, Büttner B, Hinz JM, Bauer M. The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme® on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study. BMC Anesthesiol 2014; 14:2. [PMID: 24387685 PMCID: PMC3890616 DOI: 10.1186/1471-2253-14-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The conventional sequence when using supraglottic airway devices is insertion, cuff inflation and fixation. Our hypothesis was that a tighter fit of the cuff and tip could be achieved with a consequently lower incidence of air leak, better separation of gastrointestinal and respiratory tracts and less airway morbidity if the device were first affixed and the cuff then inflated. METHODS Our clinical review board approved the study (public registry number DRKS00003174). An LMA Supreme® was inserted into 184 patients undergoing lower limb arthroscopy in propofol-remifentanil anaesthesia who were randomly assigned to either the control (inflation then fixation; n = 92) or study group (fixation then inflation; n = 92). The cuff was inflated to 60 cmH2O. The patients' lungs were ventilated in pressure-controlled mode with 5 cmH2O PEEP, Pmax to give 6 ml kg-1 tidal volume, and respiratory rate adjusted to end-tidal CO2 of 4.8 and 5.6 kPa. Correct cuff and tip position were determined by leak detection, capnometry trace, oropharyngeal leak pressure, suprasternal notch test, and lube-tube test. Bowl and cuff position and the presence of glottic narrowing were assessed by fiberscopic examination. Postoperative dysphagia, hoarseness and sore throat were assessed with a questionnaire. Ventilatory impairment was defined as a tidal volume < 6 ml kg-1 with Pmax at oropharyngeal leak pressure, glottic narrowing was defined as an angle between the vocal cords under 16 degrees. RESULTS The incidence of incorrect device position (18% vs. 21%), failed ventilation (10% vs. 9%), leak pressure (24.8 vs. 25.2 cmH2O, p = 0.63), failed lube-tube test (16.3% vs. 17.6%) and glottic narrowing (19.3% vs. 14.1%, p = 0.35) was similar in both groups (control vs. study, resp.). When glottic narrowing occurred, it was more frequently associated with ventilatory impairment in the control group (77% vs. 39%; p = 0.04). Airway morbidity was more common in the control group (33% vs. 19%; p < 0.05). CONCLUSIONS Altering the sequence of cuff inflation and device fixation does not affect device position, oropharyngeal leak pressures or separation of gastrointestinal and respiratory tracts. It reduces the incidence of glottic narrowing with impaired ventilation and also perioperative airway morbidity.
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Affiliation(s)
- Ingo Bergmann
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str, 40, 37075 Göttingen, Germany.
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A máscara laríngea supreme™ pode ser uma opção para a intubação endotraqueal em cirurgia laparoscópica? Braz J Anesthesiol 2014. [DOI: 10.1016/j.bjan.2012.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Aydogmus MT, Turk HSY, Oba S, Unsal O, Sinikoglu SN. Can Supreme™ laryngeal mask airway be an alternative to endotracheal intubation in laparoscopic surgery? Braz J Anesthesiol 2013; 64:66-70. [PMID: 24565391 DOI: 10.1016/j.bjane.2012.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/05/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In laparoscopic surgical procedures, experts recommend tracheal intubation for airway management. Laryngeal mask airway (LMA) can be a good alternative to intubation. In this case series, we aimed to examine the use of the Supreme™ LMA (SLMA) in laparoscopic surgical practice. METHODS We planned the study for sixty patients between the ages of 18 and 60, who would undergo laparoscopic surgery. We recorded one, 15, 30, 45, and 60-minute peripheral O2 saturation (SpO2) and end-tidal carbon dioxide (EtCO2) values, heart rate and mean arterial blood pressure (MAP). We observed the duration of SLMA insertion, the rate of gastric tube applicability, whether nausea, vomiting, and coughing developed, and whether there was postoperative 1-hour sore throat. RESULTS The initial EtCO2 mean was lower than the EtCO2 means of 15, 30, 45, and 60 minutes (p < 0.0001) and the 15-minute EtCO2 mean was lower than other measured EtCO2 means. We observed the initial heart rate mean to be higher than the ones following the SLMA insertion, prior to the SLMA removal, and after the SLMA removal. The heart rate mean after the SLMA insertion was remarkably lower than the heart rate mean prior to the SLMA removal (p=0.013). The MAP after the SLMA insertion was lower than the initial MAP means, as well as the MAP averages prior to after the removal of SLMA (p=0.0001). CONCLUSION SLMA can be a suitable alternative to intubation in laparoscopic surgical procedures in a group of selected patients.
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Affiliation(s)
- Meltem Turkay Aydogmus
- Department of Anesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Hacer Sebnem Yeltepe Turk
- Department of Anesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sibel Oba
- Department of Anesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Oya Unsal
- Department of Anesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sitki Nadir Sinikoglu
- Department of Anesthesiology and Reanimation, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial. Eur J Anaesthesiol 2013; 30:119-23. [PMID: 23318811 DOI: 10.1097/eja.0b013e32835aba6a] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
CONTEXT A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. OBJECTIVES To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. DESIGN Prospective, single-blind, randomised, controlled study. SETTING The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. PATIENTS Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. INTERVENTIONS Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. MAIN OUTCOME MEASURES Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. RESULTS Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ± 6.2 versus 26.8 ± 4.1 cmH2O;P < 0.01). This was consistent with a higher maximum tidal volume achieved with the LMAP compared to the LMAS (511 ± 68 versus 475 ± 55 ml; P = 0.04). The success rate of the first attempt insertion was higher for the LMAS group than the LMAP group (96.7 and 71.2%, respectively; P < 0.01). The time taken for insertion, ease of insertion of the drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. CONCLUSION The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.
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Hoşten T, Yıldız TŞ, Kuş A, Solak M, Toker K. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy. Balkan Med J 2012; 29:314-9. [PMID: 25207022 DOI: 10.5152/balkanmedj.2012.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 01/20/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. MATERIAL AND METHODS Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. RESULTS Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH2O; P-LMA, 27.0±4.7 cmH2O; p=0.42) and did not change during the induction of and throughout pneumoperitoneum. The first attempt success rates were 93% with both S-LMA and P-LMA. Mean airway device insertion time was significantly shorter with S-LMA than with P-LMA (12.5±4.1 seconds versus 15.6±6.0 seconds; p=0.02). The first attempt success rates for the drainage tube insertion were similar (P-LMA, 93%; S-LMA 100%); however, drainage tubes were inserted more quickly with S-LMA than with P-LMA (9.0±3.2 seconds versus 14.7±6.6 seconds; p=0.001). In the PACU, vomiting was observed in five patients (three females and two males) in the S-LMA group and in one female patient in the P-LMA group (p=0.10). CONCLUSION Both airway devices can be used safely in laparoscopic cholecystectomies with suitable patients and experienced users. However, further studies are required not only for comparing both airway devices in terms of postoperative nausea and vomiting but also for yielding definitive results.
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Affiliation(s)
- Tülay Hoşten
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Tülay Şahin Yıldız
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Alparslan Kuş
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mine Solak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Kamil Toker
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Schmidbauer W, Genzwürker H, Ahlers O, Proquitte H, Kerner T. Cadaver study of oesophageal insufflation with supraglottic airway devices during positive pressure ventilation in an obstructed airway. Br J Anaesth 2012; 109:454-8. [PMID: 22661751 DOI: 10.1093/bja/aes142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Supraglottic airway devices (SADs) play an increasing role in airway management in clinical anaesthesia and emergency medicine. Until now, no data exist concerning the extent of oesophageal insufflation when oropharyngeal leak pressures are exceeded. METHODS Laryngeal masks LMA-Supreme™ and LMA-ProSeal™, laryngeal tubes LTS-D and LTS II, Combitube™, and I-Gel were inserted into unfixed human cadavers. The oesophagus was connected to a volumeter, while the trachea was closed surgically to simulate complete airway obstruction. Volumes of oesophageal insufflation resulting from pressure-controlled ventilation at inspiratory pressures of 20, 40, and 60 mbar were measured. RESULTS No oesophageal insufflation could be detected at a ventilation pressure of 20 mbar in any device. Using inspiratory pressures of 40 and 60 mbar, oesophageal insufflation occurred in all devices, with significantly higher volumes of intraoesophageal air for both laryngeal tubes. CONCLUSIONS The use of SADs with inspiratory pressures of 20 mbar appears to be safe regarding the risk of intragastric insufflation. Higher inspiratory pressures should be strictly avoided.
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Affiliation(s)
- W Schmidbauer
- Department of Emergency Medicine, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115 Berlin, Germany.
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Yao WY, Li SY, Sng BL, Lim Y, Sia ATH. The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study. Can J Anaesth 2012; 59:648-54. [PMID: 22556005 DOI: 10.1007/s12630-012-9718-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 04/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The LMA Supreme™ (SLMA) is a single-use supraglottic device that provides a good seal for positive pressure ventilation. It has a double aperture design that facilitates the introduction of an orogastric tube to aspirate gastric contents. This observational study evaluated the role of the SLMA in parturients undergoing Cesarean delivery under general anesthesia. METHODS Non-obese parturients with at least four hours of fasting and antacid prophylaxis scheduled for uncomplicated Cesarean delivery were recruited from June 2009 through May 2010 at the Quanzhou Women's and Children's Hospital, China. We recorded the number of SLMA insertion attempts, the time to effective ventilation, the incidence of aspiration, and other anesthetic and obstetric outcomes. Postoperatively, we noted the presence of blood on the SLMA, postoperative sore throat, and patient satisfaction. Analysis included comparison of results between parturients having elective and urgent Cesarean delivery. RESULTS We recruited 700 parturients (576 elective, 124 urgent). Mean (standard deviation) body mass index was 25.6 (2.5) kg·m(-2). All SLMA insertions were successful, with 686 (98%) inserted on first attempt and a time to effective airway of 19.5 (3.9) sec. We maintained ventilation and oxygenation in all parturients with a good seal and there was no evidence of aspiration. Eighteen parturients (2.6%) had blood on the SLMA upon removal, 24 (3.4%) had sore throat, and patient satisfaction was 85 (7)%. These results were similar in elective and urgent cases. CONCLUSIONS In a carefully selected group of parturients, the SLMA is a useful alternative to tracheal intubation for Cesarean delivery, providing effective ventilation and a low incidence of side effects or complications.
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Affiliation(s)
- Wei Yu Yao
- Department of Anesthesia, Quanzhou Women's and Children's Hospital, Fujian, China
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Brief review: The LMA Supreme™ supraglottic airway. Can J Anaesth 2012; 59:483-93. [DOI: 10.1007/s12630-012-9673-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022] Open
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López AM, Valero R, Hurtado P, Gambús P, Pons M, Anglada T. Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position. Br J Anaesth 2011; 107:265-71. [PMID: 21576096 DOI: 10.1093/bja/aer104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position. METHODS One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared. RESULTS There were no differences between groups in insertion time or first attempt success (100% vs. 98%). The PLMA required fewer manipulations (3% vs. 15%; P=0.02) to achieve effective ventilation and provided a higher seal pressure (mean [sd] 31 [4] vs. 27 [4] cm H2O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs. 8% and sore throat in 3% vs. 5% of patients with the PLMA and SLMA, respectively. CONCLUSIONS Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.
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Affiliation(s)
- A M López
- Department of Anaesthesiology, Hospital Clínic de Barcelona, Villarroel 170, Barcelona 08036, Spain.
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Joffe AM, Liew EC, Galgon RE, Viernes D, Treggiari MM. The second-generation air-Q intubating laryngeal mask for airway maintenance during anaesthesia in adults: a report of the first 70 uses. Anaesth Intensive Care 2011; 39:40-5. [PMID: 21375088 DOI: 10.1177/0310057x1103900106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second-generation air-Q intubating laryngeal airway is a newer commercially available supraglottic airway device. In this retrospective review, we describe our initial clinical experience of 70 insertions. The ease and number of insertion attempts, airway leak pressure, device positioning, duration of use, success of fibreoptic-aided intubation and oropharyngeal morbidity were recorded. The intubating laryngeal airway was successfully inserted in all 770 patients and functioned adequately as a primary airway in all 57 patients in which it was used. The median airway leak pressure was 25 and 30 cmH2O for the single-use and reusable devices (P = 0.001), respectively. Fibreoptic-aided intubation using the intubating laryngeal airway as a conduit was successful in 12/13 (92%) cases. One in four (26%) patients complained of mild sore throat postoperatively before discharge. In our series, the intubating laryngeal airway performed adequately as a primary airway during anaesthesia with respect to ease of insertion, adequacy of airway maintenance, and as a conduit for intubation in both anticipated and unanticipated difficult airways. Further investigation is warranted regarding the role of the intubating laryngeal airway as a conduit for both blind and fibreoptic-aided intubation. In addition, the incidence of postoperative throat complaints deserves further scrutiny.
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Affiliation(s)
- A M Joffe
- Department ofAnesthesiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
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Halaseh BK, Sukkar ZF, Hassan LH, Sia ATH, Bushnaq WA, Adarbeh H. The use of ProSeal laryngeal mask airway in caesarean section--experience in 3000 cases. Anaesth Intensive Care 2011; 38:1023-8. [PMID: 21226432 DOI: 10.1177/0310057x1003800610] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid sequence induction is currently the recommended technique in general anaesthesia for caesarean section. However, the usefulness of the ProSeal laryngeal mask airway as a rescue airway in the event of difficult or failed intubation has been recognised in numerous case reports. In this study, we report the experience of the use of the ProSeal laryngeal mask in 3000 elective caesarean sections in a single centre, using a method of insertion that allows a rapid establishment of a patent airway together with gastric drainage.
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Affiliation(s)
- B K Halaseh
- Department of Anesthesia, Farah Hospital, Amman, Jordan
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Comparison of Supreme(®) and Soft Seal(®) laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study. J Anesth 2010; 25:98-103. [PMID: 21120542 DOI: 10.1007/s00540-010-1054-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE In the 2005 American Heart Association (AHA) guidelines, the laryngeal mask (LMA) was proposed as an alternative to tracheal intubation for cardiopulmonary resuscitation (CPR). We compared the utility of a newly developed LMA, the Supreme(®) (Supreme), with a conventional LMA, the Soft Seal(®) (Soft Seal). METHODS A total of 19 novice doctors in our anesthesia department performed insertion of the Supreme or Soft Seal on a manikin with or without chest compression. Insertion time and number of attempts for successful ventilation were measured. After successful ventilation, the amount of air entering the stomach and maximum ventilation pressure were measured. The subjective difficulty of using the devices was also measured. RESULTS The ventilation success rate of first insertion did not differ between the Supreme and Soft Seal without chest compression. However, the success rate was significantly lower with the Soft Seal than the Supreme during chest compression. Insertion time was lengthened by chest compression with the Soft Seal, but not with the Supreme. Maximum ventilation pressure was higher with the Supreme than the Soft Seal. The amount of air entering the stomach was significantly lower with the Supreme than the Soft Seal. The Supreme also scored better than the Soft Seal on a visual analog scale of subjective difficulty in insertion. CONCLUSIONS The Supreme is an effective device for airway management during chest compression.
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