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LMA Supreme™ – a new single-use LMA™ with gastric access: a report on its clinical efficacy

Authors

Verghese C., Ramaswamy B.

Publication

Br J Anaesth 2008; 101 (3): 405-410.

Summary

  • A study to compare the clinical efficacy of the LMA Supreme™ and the LMA ProSeal™ in female patients undergoing surgery requiring general anaesthesia with neuromuscular block and positive pressure ventilation
  • Insertion of the LMA Supreme™ was successful on the first attempt in the overwhelming majority of patients
  • The LMA Supreme™ was easy and quick to insert and had a glottic seal pressure that was similar to the LMA ProSeal™

Objectives:

  • To compare the clinical efficacy of the LMA Supreme™ and the LMA ProSeal™ in female patients undergoing surgery requiring general anaesthesia with neuromuscular block and positive pressure ventilation

Method:

  • This was a randomised, crossover study
  • Eligible patients were required to be American Society of Anesthesiologists class 1-3 and be in a fasted state
  • Patients had both the LMA Supreme™ and the LMA ProSeal™ devices inserted during the course of the study
    • Patients were initially randomised to receive either the LMA Supreme™ or the LMA ProSeal™ device
    • After relevant measurements had been secured, the comparator device was inserted and remained in situ until the end of the surgical procedure
  • The endpoints of the study were
    • Ease of insertion and number of insertion attempts
    • Volume of air required to maintain a cuff pressure of 60 cm H2O
    • Glottic seal pressure
    • Passage of a gastric tube
    • View of the glottis (determined using fibreoptic laryngoscopy)

Results:

  • Overall, 36 patients with a mean age and body mass index of 48.8-51.1 years and 29.2-30.3 kg/m2, respectively, were included in the study
  • The LMA Supreme™ and LMA ProSeal™ devices were successfully inserted in all patients
    • Insertion of the LMA Supreme™ and the LMA ProSeal™ was successful on the first attempt in 35 of 36 patients
    • Three insertion attempts with the LMA Supreme™ were required in one patient (likely because the device was too big for the patient)
  • Insertion of the LMA Supreme™ was successful on the first attempt in the overwhelming majority of patients
  • The volume of air required to maintain a cuff pressure of 60 cm H2O was similar in patients who received the LMA Supreme™ and the LMA ProSeal™ in the first period (mean 21.9 vs. 22.4 ml; p=0.78)
  • The use of both devices resulted in a similar fibreoptic laryngoscopy score
    • Scores of 1 (full view of the arytenoids and glottis) to 2 (arytenoids and glottis partly visible) were recorded in 29 of 36 patients treated with the LMA Supreme™ and the LMA ProSeal™
  • A gastric tube was successfully passed through the drain tube into the stomach on the first attempt in all patients
    • The median volume of gastric aspirate with the LMA Supreme™ and the LMA ProSeal™ was 17.5 and 15 ml, respectively, while the median pH was 1.5 and 3, respectively

Conclusions:

  • The LMA Supreme™ is easy and quick to insert, has a glottic seal pressure similar to the LMA ProSeal™ and allows easy access to liquid gastric contents