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LMA Supreme™, i-gel™ and Laryngeal Tube Suction™ – A prospective, randomized comparative evaluation using fiberoptic and color indicator assessment techniques

Authors

Cremer S. et al.

Publication

Poster presentation at the 14th Annual Society for Airway Management Scientific Meeting, 24-26 September 2010, Chicago, IL, USA.

Summary

  • A study to compare the performances of the LMA Supreme™, i-gel™ and Laryngeal Tube Suction™ supraglottic airway devices in patients undergoing minor surgery
  • The rate of insertion success was greater with the LMA Supreme™ and the i-gel™ than with the Laryngeal Tube Suction™ in patients undergoing minor surgery
  • Optimal device positioning was more often achieved with the LMA Supreme™ than with the i-gel™ or the Laryngeal Tube Suction™
  • Rates of post-operative morbidity were significantly lower in recipients of the LMA Supreme™ compared with the i-gel™ and the Laryngeal Tube Suction™

Objectives:

  • To compare the performances of the LMA Supreme™, i-gel™ and Laryngeal Tube Suction™ supraglottic airway devices in patients undergoing minor surgery

Method:

  • This was a prospective, randomised study conducted at a single centre
  • Patients who were American Society of Anesthesiologists physical status 1-3 and who were undergoing minor urological, gynaecological or orthopaedic surgery were eligible for inclusion
  • Patients were randomised to receive the LMA Supreme™, i-gel™ or Laryngeal Tube Suction™ devices Outcomes of interest included
    • Oesophageal sealing (assessed by the presence of methylenblue dye administered via the drain tube during both positive pressure and spontaneous ventilation)
    • Device positioning
    • Oropharyngeal leak pressure
    • Post-operative airway morbidity

Results:

  • Overall, 42 male and 83 female patients were randomised to receive the LMA Supreme™ (n=43), i-gel™ (n=40) and Laryngeal Tube Suction™ (n=42)
    • The mean age and body mass index of included patients was 49 years and 26.4 kg/m2, respectively
  • Adequate ventilation was achieved in all patients randomised to receive the LMA Supreme™ and i-gel™
    • Adequate ventilation was not achieved after two attempts in 13 patients randomised to receive the Laryngeal Tube Suction™ (who were excluded from the analysis)
  • The performance of the three devices is shown in Table 1
Figure 1. Fibre-optic assessment of the position of the LMA Supreme™, i-gel™ and Laryngeal Tube Suction™ devices

  • Fibre-optic assessment showed that ‘optimal’ device positioning was most often achieved with the LMA Supreme™ (Figure 1)
  • Fibre-optic assessment showed the presence of methylenblue dye in the mask bowl and around the arytenoids in two patients who received the i-gel™ (indicating incomplete oesophageal sealing)
    • No dye was visible in any of the patients who received the LMA Supreme™ or the Laryngeal Tube Suction™
  • There were no instances of regurgitation in any patients
  • Airway morbidity in the post-operative period was significantly (p<0.05) lower in recipients of the LMA Supreme™ versus the i-gel™ and the Laryngeal Tube Suction™

Conclusions:

  • The LMA Supreme™ and the i-gel™ were associated with a greater rate of insertion success than the Laryngeal Tube Suction™ in patients undergoing minor surgery
  • Oropharyngeal leak pressures with the three devices were comparable