DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171256

Comparative study of various supraglottic devices with clinical and fiber optic assessment in elective laparoscopic procedures

Bhushan M. Ambare, S. P. Manjrekar, Monika S. Masare

Abstract


Background: Aim of present study was to compare the efficacy and safety of supraglottic devices (LMA supreme, LMA proseal and I-Gel) by clinical and fiberoptic evaluation in elective laparoscopic surgeries under general anaesthesia with controlled ventilation.

Methods: The design was a prospective, randomized study enrolling total 105 patients of either sex, (age 18-65 years), ASA grade I/II and mallampati score I and II, were randomly allocated to LS (LMAS), LP (PLMA), and IG (I-Gel) groups according to the supraglottic device applied. The three devices were compared as regards insertion parameters, adequacy of ventilation (oxygen saturation, endtidal carbon dioxide and air leak), fibreoptic vision and intra or postoperative complications.

Results: The overall ease of insertion of LMAS was found to be better than the other two devices. Adequacy of ventilation was comparable in all the study groups. Safety of these devices was found to be comparable but if OLP was considered as a marker of safety of the device, LMA proseal was a better option than the other two devices. There was no significant difference in the fiberoptic view of the laryngeal inlet between the three study groups but the number of patients with grade 4 view of laryngeal inlet fiberoptic was more in I gel than LMA proseal and LMA supreme.

Conclusions: It was concluded that the LMAS, PLMA and I-Gel are effective ventilatory devices during controlled ventilation, without major complications. But in clinical practice it is advisable to monitor peak airway pressure, OLP and laparoscopic view of gastric distension whenever these devices are used in laparoscopic surgeries.


Keywords


Gastric distension, Laparoscopic surgeries, LMAS, Oropharyngeal leak pressure, PLMA and I–Gel, Supraglottic devices

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References


Seet E, Rajeev S, Firoz T, Yousaf F, Wong J, Wong DT, Chung F. Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomized controlled trial. Eur J Anaesthesiol. 2010;27:602-7.

Polat R, Aydin GB, Ergil J. Comparison of the I-gel™ and the Laryngeal Mask Airway Classic™ in terms of clinical performance. Rev Bras Anestesiol. 2015;65:343-8.

Bamgbade OA, Macnab WR, Khalaf WM. Evaluation of the I-gel airway in 300 patients. Eur J Anaesthesiol. 2008;25:865-6.

Gatward JJ, Cook TM, Seller C. Evaluation of the size 4 I-gel airways in one hundred non-paralysed patients. Anaesthesia. 2008;63:1124-30.

Schmidbauer W, Bercker S, Volk T. Oesophageal seal of the novel supralaryngeal airway device I-Gel in comparison with the laryngeal mask airways Classic and ProSeal using a cadaver model. Br J Anaesth. 2009;102:135-9.

Eschertzhuber S, Brimacombe J, Hohlrieder M, Keller C. The laryngeal mask airway supreme- a single use laryngeal mask airway with an oesophageal vent, A randomised, cross-over study with the laryngeal mask airway ProSeal in paralysed, anaesthetised patients. Anaesthesia. 2009;64:79-83.

Gupta D, Srirajakalidindi A, Habli N, Haber H. Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptic laryngoscope findings. Middle East J Anaesthesiol. 2011;21(2):283-7.

Teoh WHL, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia ATH. Comparison of the LMA Supreme vs. the I-gelTM in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia. 2010;65:1173-9.

Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, Vogt A, et al. Crossover comparison of the Laryngeal Mask Supreme™ and the I-gel™ in simulated difficult airway scenario in anesthetized patients. Anesthesiology. 2009;111:55-62.

Gasteiger L, Brimacombe J, Perkhofer D, Kaufmann M, Keller C. Comparison of guided insertion of the LMA ProSeal vs. the I-gel. Anaesthesia. 2010;65:913-6.

Van Zundert TCRV, Brimacombe JR. Similar oropharyngeal leak pressures during anaesthesia with I-gel, LMA-ProSeal and LMA-Supreme Laryngeal Masks. Acta Anaesthesiol Belg. 2012;63:35-41.

Verghese C, Ramaswamy B. LMA Supreme- a new single use LMA with gastric assess: a report on its clinical efficacy. Br J Anaesth. 2008;101(3):405-10.

Tham HM, Tan SM, Woon KL, Zhao YD. A comparison of the SupremeTM laryngeal mask airway with the ProsealTM laryngeal mask airway in anesthetized paralyzed adult patients: a randomized crossover study. Can J Anesth. 2010;57:672-8.

Singh I, Gupta M, Tandon M. Comparison of Clinical Performance of I-GelTM with LMA-ProsealTM in Elective Surgeries. Indian J Anaesth. 2009;53(3):302-5.

Chavan G, Nayar P, Seth A, Gupta K, Pawar M, Aggrawal N. Comparison of clinical performance of the I gel with LMA proseal. J anaesthesiol Clin Pharmacol. 2013;29(1):56-60.

Sharma B, Sehgal R, Sahai C, Sood J. PLMA vs. I-gel: A comparative evaluation of respiratory mechanics in laparoscopic cholecystectomy. J Anaesth Clin Pharmacol. 2010;26(4):451-7.

Hussein KA, Alhusainey AM. Comparison of laryngeal mask airway supreme and endotracheal tube in adult patients undergoing laparoscopic surgeries. Ains Shams J Anaesthesiol. 2009;2(2):73-85.

Abdi W, Amathieu R, Adhoum A, Poncelet C, Slavov V, Kamoun W, et al. Sparing the larynx during Gynaecological laparoscopy: a randomized trial comparing the LMA supreme and the ETT. Acta anaesthesiol Scand. 2010;54(2):141-6.

Lopez M, Valero R, Hurtado P, Gambus P, Pons M, Anglada T. Comparison of the LMA SupremeTM with the LMA ProsealTM for airway management in patients anaesthetized in prone position. Br J Anaesth. 2011;104:1-7.

Yao WY, Li SY, Sng BL, Lim Y, Sia ATH. The LMA SupremeTM in 700 parturients undergoing Cesarean delivery: an observational study. Can J Anesth. 2012;59:648-54.

Beleña JM, Núñez M, Gracia JL, Pérez JL, Yuste J. The laryngeal mask airway Supreme™: safety and efficacy during gynaecological laparoscopic surgery. South Afr J Anaesth Analg. 2012;18(3):144-7.

Maharjan SK. I-gel for positive pressure ventilation. J Nepal Med Assoc. 2013;52(189):255-9.

Zhang L, Seet E, Mehta V, Subramanyam R, Ankichetty SP, Wong DT, et al. Oropharyngeal leak pressure with the laryngeal mask airway SupremeTM at different intracuff pressures: a randomized controlled trial. Can J Anesth. 2011;58:624-9.

Brimacombe J, Berry A. A proposed fiberoptic scoring system to standardized the position of laryngeal mask airway position. Anaesth Analg. 1993;76:450-71.

Wong DT, Yang JJ, Jagannathan N. Brief review: The LMA SupremeTM supraglottic airway, Can J Anaesth. 2012;59:483-93.