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VERDİKHANOV R, KARACA N, ALPER I. I-Gel ve laringeal mask airway-supreme’in klinik performans yönünden karşılaştırılması: prospektif çalışma. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1209018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Amaç: Çalışmamızda; genel anestezi altında ürolojik cerrahi girişim planlanan hastalarda, ikinci jenerasyon supraglottik havayolu gereçlerinden I-gel ve LMA-Supreme’in (Laringeal Mask Airway- Supreme) klinik performans ve postoperatif faringolaringeal komplikasyonlar açısından karşılaştırılmasını amaçladık.
Gereç ve Yöntem: Hastane etik kurul onayı (19-8.1T/53) ve hasta yazılı onamı alındıktan sonra, genel anestezi altında elektif ürolojik cerrahi planlanan, 18-65 yaş arası, ASA (The American Society of Anesthesiologists) skoru I-II olan, 120 hasta prospektif olarak çalışmamıza dahil edildi. Hastalar randomize olarak I-gel (n=60) ve LMA-Supreme (n=60) olarak iki gruba ayrıldı. İki grup; supraglottik havayolu gereci yerleştirme kolaylığı, yerleştirme süresi, ilk yerleştirmede başarı oranı, deneme sayısı, gastrik tüp yerleştirme kolaylığı, orofaringeal kaçak basıncı, intraoperatif ve postoperatif komplikasyonlar açısından karşılaştırıldı.
Bulgular: Supraglottik havayolu gereci yerleştirme süresi I-gel grubunda anlamlı olarak daha kısa bulundu (p: 0,039). Tüm ölçüm zamanlarında, orofaringeal kaçak basıncı ‘mükemmel’ olan hasta sayısı I-gel grubunda daha yüksekti (p<0,05). Gastrik tüp yerleştirme, LMA-Supreme grubunda anlamlı olarak daha kolay bulundu (p: 0,029). Postoperatif 12. saat boğaz ağrısı (p: 0,049) ve ses kısıklığı (p:0,046) LMA-Supreme grubunda daha fazla görüldü. LMA-Supreme ve I-gel; yerleştirme kolaylığı, ilk yerleştirmede başarı oranı, deneme sayısı ve intraoperatif komplikasyonlar açısından benzer özelliklere sahipti.
Sonuç: I-gel’de yerleştirme süresinin daha kısa, orofaringeal kaçağın ve postoperatif komplikasyonların daha az olması LMA-Supreme’e göre tercih nedeni olabilir.
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Affiliation(s)
- Ramin VERDİKHANOV
- EGE ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI
| | - Nursen KARACA
- EGE ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI
| | - Işık ALPER
- EGE ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI
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Cho CK, Change M, Lee SJ, Sung TY. Effects of neuromuscular blocking agents on the clinical performance of i-gel ® and surgical condition in elderly patients undergoing hand surgery: a prospective randomized controlled trial. Int J Med Sci 2021; 18:2381-2388. [PMID: 33967615 PMCID: PMC8100647 DOI: 10.7150/ijms.57489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The effects of neuromuscular blocking agents on the clinical performance of supraglottic airway devices and surgical condition in elderly patients undergoing hand surgery have not been established. We evaluated the effects of rocuronium on the clinical performance of an i-gel® supraglottic device and surgical condition in elderly patients undergoing orthopedic hand surgery. Methods: Patients aged 65-85 years were randomized to receive either rocuronium (rocuronium group) or saline (control group). We compared the rates of successful insertion of the i-gel on the first attempt as a primary outcome and also assessed the adequacy of i-gel maintenance during controlled ventilation, anesthetic requirement, surgical condition, and recovery time. Results: The rates of successful insertion of the i-gel on a first attempt were 93.1% in the rocuronium group versus 82.1% in the control group (P = 0.423). Peak inspiratory pressure (PIP) was lower in the rocuronium group than in the control group (15.2 vs. 17.9 cmH2O, respectively, P = 0.028). Spontaneous breathing was less common in the rocuronium group (24.1% vs. 57.1%, respectively, P = 0.011). The requirement of additional fentanyl to suppress spontaneous breathing or patient movement was less in the rocuronium group than in the control group (24.1% vs. 50.0%, respectively, P = 0.043). Surgical condition did not differ between the two groups. Recovery time was shorter in the rocuronium group than in the control group (8.4 vs. 9.9 min, respectively, P = 0.030). Conclusions: Rocuronium did not enhance the success rate of inserting the i-gel® or the surgical condition in elderly patients. However, using rocuronium reduced PIP, the frequency of spontaneous breathing, the requirement for additional fentanyl and patients' recovery time.
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Affiliation(s)
- Choon-Kyu Cho
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Minhye Change
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
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Garg A, Lamba NS, Ajai Chandra NS, Singhal RK, Chaudhary V. Supraglottic airway devices in short gynecological procedures: A randomized, clinical study comparing the Baska ® mask and I-Gel ® device. J Family Med Prim Care 2019; 8:1134-1137. [PMID: 31041263 PMCID: PMC6482730 DOI: 10.4103/jfmpc.jfmpc_359_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Supraglottic airway devices are used for anesthesia in elective surgical procedures circumventing the need for intubation. We investigated the efficacy and safety of Baska® mask in comparison to an I-Gel® device. Methods In this cross-sectional, observational study, we randomized 100 female patients (age 18-45 years, American Society of Anaesthesiologists grade I or II) undergoing elective short gynecological procedures into two groups, to receive ventilation with either Baska mask® (group 1, n = 50) or an I-Gel® device (group 2, n = 50). We excluded patients with obesity, short neck, and known systemic and upper airway disorders. The primary outcome was the oropharyngeal airway seal pressure, and the secondary outcomes were the ease of insertion and the complication rate. The results were analyzed using Mann-Whitney U-test and Fisher's exact test, and correlation analysis was done by Spearman's correlation test. Results A total of 56 patients underwent dilatation and curettage, whereas the remaining had hysteroscopy in the study. The airway seal pressure achieved was higher with Baska® mask than I-Gel® device (35.8 ± 10.3 and 26.9 ± 7.5 of cm H2O, respectively; P < 0.0001). The ease of insertion (P < 0.0001) was better in group 1 and the complication rates were similar in both the groups (P > 0.05). Conclusion Baska® mask offers a superior airway seal pressure with minimum complications in comparison to an I-Gel® device. Further studies with a large number of patients in different surgical settings are required to confirm our findings.
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Affiliation(s)
- Anurag Garg
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - N S Lamba
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - N S Ajai Chandra
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - R K Singhal
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
| | - Vishal Chaudhary
- Department of Anesthesiology and Critical Care, Command Hospital, Chandimandir, Panchkula, Haryana, India
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In CB, Cho SA, Lee SJ, Sung TY, Cho CK. Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway SupremeTM in geriatric patients: a prospective and randomized study. Korean J Anesthesiol 2018; 72:39-46. [PMID: 30343563 PMCID: PMC6369341 DOI: 10.4097/kja.d.18.00121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/19/2018] [Indexed: 12/15/2022] Open
Abstract
Background Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA SupremeTM) in geriatric patients. Methods The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA SupremeTM group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. Results Insertion time was significantly shorter for the i-gel® than the LMA SupremeTM (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA SupremeTM (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA SupremeTM (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. Conclusions Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA SupremeTM in geriatric patients.
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Affiliation(s)
- Chi Bum In
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | | | | | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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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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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] [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.
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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
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Liew GHC, Yu ED, Shah SS, Kothandan H. Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery. Singapore Med J 2017; 57:432-7. [PMID: 27549212 DOI: 10.11622/smedj.2016133] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia. METHODS 150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety. RESULTS Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel. CONCLUSION The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.
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Affiliation(s)
| | | | - Shitalkumar Sharad Shah
- Department of Anaesthesiology, Singapore General Hospital, Singapore.,National Heart Centre, Singapore
| | - Harikrishnan Kothandan
- Department of Anaesthesiology, Singapore General Hospital, Singapore.,National Heart Centre, Singapore
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Shariffuddin II, Teoh WH, Tang EBK, Hashim NHM, Loh PS. Ambu® Auragain™ versus LMA Supreme™ Second Seal™: A Randomised Controlled Trial Comparing Oropharyngeal Leak Pressures and Gastric Drain Functionality in Spontaneously Breathing Patients. Anaesth Intensive Care 2017; 45:244-250. [DOI: 10.1177/0310057x1704500215] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Newer second generation supraglottic airway devices may perform differently in vivo due to material and design modifications. We compared performance characteristics of the Ambu® AuraGain™ and LMA Supreme™ Second Seal™ in 100 spontaneously breathing anaesthetised patients in this randomised controlled study. We studied oropharyngeal leak pressures (OLP) (primary outcome) and secondarily, ease of insertion, success rates, haemodynamic response, time to insertion, and complications of usage. We found no significant difference in OLP between the AuraGain versus the LMA Supreme, mean (standard deviation, SD) 24.1 (7.4) versus 23.6 (6.2) cmH2O, P=0.720. First-attempt placement rates of the AuraGain were comparable to the LMA Supreme, 43/50 (86%) versus 39/50 (78%), P=0.906, with an overall 98% insertion success rate for the AuraGain and 88% for the LMA Supreme after three attempts, P=0.112. However, the AuraGain was deemed subjectively harder to insert, with only 24/50 (48%) versus 37/50 (74%) of AuraGain insertions being scored 1 = easy (on a 5 point scale), P=0.013, and also took longer to insert, 33.4 (SD 10.9) versus 27.3 (SD 11.4) seconds, P=0.010. The AuraGain needed a smaller volume of air (16.4 [SD 6.8] versus 23.0 [SD 7.4] ml, P <0.001) to attain intracuff pressures of 60 cmH2O, facilitated more successful gastric tube insertion (100% versus 90.9%, P=0.046), and had significantly decreased sore throat incidence (10% versus 38%, P=0.020). One AuraGain and six LMA Supremes failed to be placed within the stipulated 120 seconds trial definition of ‘success’; these patients had risk factors for failed supraglottic insertion. In conclusion, both devices had similar OLPs and performed satisfactorily. However, the AuraGain resulted in less postoperative sore throat despite being harder to, and taking longer to, insert.
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Affiliation(s)
- I. I. Shariffuddin
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - W. H. Teoh
- Senior Consultant Anaesthetist, Private Anaesthesia Practice, Singapore
| | - E. B. K. Tang
- Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N. H. M. Hashim
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P. S. Loh
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Radhika KS, Sripriya R, Ravishankar M, Hemanth Kumar VR, Jaya V, Parthasarathy S. Assessment of suitability of i-gel and laryngeal mask airway-supreme for controlled ventilation in anesthetized paralyzed patients: A prospective randomized trial. Anesth Essays Res 2016; 10:88-93. [PMID: 26957697 PMCID: PMC4767080 DOI: 10.4103/0259-1162.167849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Laryngeal mask airway supreme (LMA-S) has an inflatable cuff while i-gel has a noninflatable cuff made of thermoplastic elastomer. AIMS To study the efficacy of ventilation and the laryngeal seal pressures (LSPs) with either device. Our secondary objectives were to compare the ease of insertion, adequacy of positioning the device, hemodynamic response to device insertion, and any postoperative oropharyngeal morbidity. SETTINGS AND DESIGN A prospective, randomized, single-blinded study at Teaching Medical School in South India. MATERIALS AND METHODS Forty-two patients posted for surgery under general anesthesia were randomly divided into two groups - LMA-S and i-gel. After a standardized premedication and anesthesia induction sequence, the supra-glottic devices were introduced. Ease of insertion was assessed from the number of attempts taken to insert, insertion time, and any maneuvers required to insert the device. Position of the device was assessed by the ease of gastric catheter placement and the fibreoptic grading of laryngeal visualization. Efficacy of ventilation was determined from the LSP, peak inspiratory pressure (PIP), and end-tidal carbon dioxide (EtCO2)values. Any postoperative oropharyngeal morbidity was also recorded. STATISTICAL ANALYSIS Descriptive analysis was reported as a mean and standard deviation, median, and range of continuous variables. Demographics were analyzed using a unpaired t-test for parametric data and Chi-square test for nonparametric data. Respiratory and hemodynamic data was analyzed using one-way ANOVA to find statistical difference within and between the two groups. RESULTS LMA-S was successfully inserted in 95% of patients and i-gel in 85.5% of patients. There was a significant difference (P = 0.021) in the LSPs between the two groups (18.15 cmH2O in LMA-S and 21.28 cmH2O in the i-gel group). There was no significant difference in the PIPs, leak fraction, and the EtCO2values. CONCLUSION Both devices are suitable for positive pressure ventilation (PPV) in anesthetized paralyzed patients. However, i-gel gives a better laryngeal seal when compared to LMA-S and may be chosen preferentially for PPV.
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Affiliation(s)
| | - R Sripriya
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - M Ravishankar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - V R Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - V Jaya
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - S Parthasarathy
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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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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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: 1190] [Impact Index Per Article: 132.2] [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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Komasawa N, Nishihara I, Tatsumi S, Minami T. Prewarming of the i-gel facilitates successful insertion and ventilation efficacy with muscle relaxation: a randomized study. J Clin Anesth 2014; 26:663-7. [DOI: 10.1016/j.jclinane.2014.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
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Joly N, Poulin LP, Tanoubi I, Drolet P, Donati F, St-Pierre P. Randomized prospective trial comparing two supraglottic airway devices: i-gel™ and LMA-Supreme™ in paralyzed patients. Can J Anaesth 2014; 61:794-800. [DOI: 10.1007/s12630-014-0198-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
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de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel®vs laryngeal mask airway in adults. Anaesthesia 2014; 69:1151-62. [DOI: 10.1111/anae.12772] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. de Montblanc
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - L. Ruscio
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - J. X. Mazoit
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
| | - D. Benhamou
- Hôpitaux Universitaires Paris-Sud (AP-HP); Hôpital de Bicêtre; Le Kremlin Bicetre Cedex France
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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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Chen X, Jiao J, Cong X, Liu L, Wu X. A comparison of the performance of the I-gel™ vs. the LMA-S™during anesthesia: a meta-analysis of randomized controlled trials. PLoS One 2013; 8:e71910. [PMID: 23951266 PMCID: PMC3741209 DOI: 10.1371/journal.pone.0071910] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 07/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Conflicting results were found between the I-gel™ and the LMA-Supreme™ during anesthesia, so we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness and safety of the I-gel™ vs. the LMA-Supreme™during anesthesia. METHODS A comprehensive search was conducted using Pubmed, EMbase, ISI Web of Knowledge, the Cochrane Library, China Journal Full-text Database, Chinese Biomedical Database, Chinese Scientific Journals Full-text Database, CMA Digital Periodicals, and Google scholar to find RCTs that compare the LMA-S™ with the i-gel™during anesthesia. Two reviewers independently selected trials, extracted data, and assessed the methodological qualities and evidence levels. Data were analyzed by RevMan 5.0 and comprehensive meta-analysis software. RESULTS Ten RCTs were included. There were no significant differences in oropharyngeal leak pressures (mean difference [MD] 0.72, 95% confidence interval [CI] -1.10 2.53), device placement time (MD -1.3, 95%CI -4.07 1.44), first attempt insertion success (risk ratio [RR] 1.01, 95% CI 0.9 1.14), grade 3 and 4 fiberoptic view (RR 0.89, 95%CI 0.65 1.21), and blood on removal (RR 0.62, 95%CI 0.32 1.22) between the i-gel™ and the LMA-Supreme™, respectively. However, the LMA-Supreme™was associated with easier gastric tube insertion (RR 1.17, 95%CI 1.07 1.29), and more sore throat (RR 2.56, 95%CI 1.60 4.12) than the i-gel™ group. CONCLUSIONS The LMA-Supreme™ and i-gel™ were similarly successful and rapidly inserted. However, the LMA-Supreme™ was shown to be easier for gastric tube insertion and associated with more sore throat compared with the i-gel™.
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Affiliation(s)
- Xiaoguang Chen
- Department of Anesthesiology, The First Hospital of China Medical University, Shenyang, China.
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Nishiyama T, Kohno Y, Kim HJ, Shin WJ, Yang HS. The effects of prewarming the I-gel on fitting to laryngeal structure. Am J Emerg Med 2012; 30:1756-9. [DOI: 10.1016/j.ajem.2012.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/12/2012] [Accepted: 02/17/2012] [Indexed: 11/26/2022] Open
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Schälte G, Stoppe C, Rossaint R, Gilles L, Heuser M, Rex S, Coburn M, Zoremba N, Rieg A. Does a 4 diagram manual enable laypersons to operate the Laryngeal Mask Supreme®? A pilot study in the manikin. Scand J Trauma Resusc Emerg Med 2012; 20:21. [PMID: 22453060 PMCID: PMC3375204 DOI: 10.1186/1757-7241-20-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 03/27/2012] [Indexed: 01/26/2023] Open
Abstract
Background Bystander resuscitation plays an important role in lifesaving cardiopulmonary resuscitation (CPR). A significant reduction in the "no-flow-time", quantitatively better chest compressions and an improved quality of ventilation can be demonstrated during CPR using supraglottic airway devices (SADs). Previous studies have demonstrated the ability of inexperienced persons to operate SADs after brief instruction. The aim of this pilot study was to determine whether an instruction manual consisting of four diagrams enables laypersons to operate a Laryngeal Mask Supreme® (LMAS) in the manikin. Methods An instruction manual of four illustrations with speech bubbles displaying the correct use of the LMAS was designed. Laypersons were handed a bag containing a LMAS, a bag mask valve device (BMV), a syringe prefilled with air and the instruction sheet, and were asked to perform and ventilate the manikin as displayed. Time to ventilation was recorded and degree of success evaluated. Results A total of 150 laypersons took part. Overall 145 participants (96.7%) inserted the LMAS in the manikin in the right direction. The device was inserted inverted or twisted in 13 (8.7%) attempts. Eight (5.3%) individuals recognized this and corrected the position. Within the first 2 minutes 119 (79.3%) applicants were able to insert the LMAS and provide tidal volumes greater than 150 ml (estimated dead space). Time to insertion and first ventilation was 83.2 ± 29 s. No significant difference related to previous BLS training (P = 0.85), technical education (P = 0.07) or gender could be demonstrated (P = 0.25). Conclusion In manikin laypersons could insert LMAS in the correct direction after onsite instruction by a simple manual with a high success rate. This indicates some basic procedural understanding and intellectual transfer in principle. Operating errors (n = 91) were frequently not recognized and corrected (n = 77). Improvements in labeling and the quality of instructional photographs may reduce individual error and may optimize understanding.
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Affiliation(s)
- Gereon Schälte
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany.
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Ragazzi R, Finessi L, Farinelli I, Alvisi R, Volta CA. LMA Supreme™vs i-gel™- a comparison of insertion success in novices. Anaesthesia 2012; 67:384-8. [DOI: 10.1111/j.1365-2044.2011.07002.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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