I-Gel and LMA classic in the hands of novice: A comparative study

Background: Supraglottic airway devices (SADs) such as LMA classic (cLMA), I-Gel, etc. are indispensable tool for the anaesthesiologists experienced in airway management. But studies evaluating the performance of these devices in the hands of unskilled personnel are scarce. Aims and Objective: To determine the procedure time and the proportion of patients having successful placement of I-gel and LMA classic by first-year Post Graduate Trainees (PGTs) of Anaesthesiology who tried insertion of those devices after a short training in mannequins without any hands-on training regarding placement of the devices in human. Materials and Methods: After getting Institute’s Ethics Committee’s approval for this interventional study, forty adult patients, posted for short surgical or gynaecological surgery, were randomly allocated in to two groups to have placement of either I-Gel (group ‘I’, n=20) or cLMA (group ‘C’, n=20) by first-year PGTs. The procedure time (Primary outcome) i.e. the time taken for successful placement of either device was determined and compared. A standard technique of anaesthesia was followed in every patient. Any adverse event such as sore throat, odynophagia, blood stain on the device, etc. was also recorded. Results: All patients were comparable with respect to demographic data and Mallampati scores. The mean procedure time (seconds) was considerably lower in I-Gel group compared with cLMA (63.3 ± 57.2 versus 163.0 ± 158.3, respectively, P value <0.001). The incidence of successful placement at first attempt was significantly higher for I-Gel group. The incidence of adverse events was comparable. Conclusion: Procedure time for I-Gel insertion is significantly shorter than with LMA Classic along with a higher success rate with first attempt for the former. I-Gel may be a better alternative as airway device for the unskilled anaesthesiologist.

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Comparison of Safety and Efficacy of Endotracheal Tube, Laryngeal Mask Airway Supreme and I Gel in Laparoscopic Surgeries

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/122 ◽

2021 ◽

Vol 8 (11) ◽

pp. 623-628

Author(s):

Heena Saini ◽

Rajesh Angral ◽

Neelam Gupta

Keyword(s):

Laryngeal Mask Airway ◽

Endotracheal Tube ◽

Gastric Tube ◽

Airway Device ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Group I ◽

Supraglottic Airway Devices ◽

Lma Supreme ◽

Airway Devices

BACKGROUND Present study was undertaken to assess the feasibility of laryngeal mask airway (LMA) supreme and I gel, the second generation supraglottic airway devices in laparoscopic surgeries. METHODS 120 patients with American Society of Anaesthesiologists (ASA) I and II (20 - 50 years) of either sex who underwent laparoscopic surgery under general anaesthesia were randomly divided into three groups. Airway was secured with endotracheal tube (ETT) in group E (N = 40), with LMA supreme in Group S (N = 40) and with I-gel in group I (N = 40). Insertion characteristics of airway device, ease of gastric tube insertion, haemodynamic response and perioperative laryngopharyngeal morbidities were assessed. RESULTS I-gel was easier to insert with higher first attempt success rate (95 %) than LMA Supreme (85 %) and ETT (90 %) but it was statistically insignificant. Heart rate (HR) and mean arterial pressure (MAP) was significantly higher in ETT group at the time of intubation, continued till 5 minutes and also at the time of extubation but statistically significant increase in HR and MAP were noted in group S and I only at the time of device insertion. Gastric tube was easier to insert in group S with shortest insertion time which was statistically significant. Incidence of coughing, dysphonia, dysphagia and sore throat was significantly more in group E. CONCLUSIONS I-gel and LMA Supreme can be used as an alternative to ETT for airway management in adult patients undergoing elective laparoscopic surgeries. KEYWORDS Endotracheal Tube, I-gel, LMA Supreme, Supraglottic Airway Device

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Comparative evaluation of sevoflurane and propofol to facilitate insertion of supra glottic airway device

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.113 ◽

2021 ◽

Vol 8 (4) ◽

pp. 521-526

Author(s):

Neha Amey Panse ◽

Jyoti Kale ◽

Priyanka Praphulchandra Khondalay

Keyword(s):

Side Effects ◽

Pressor Response ◽

Early Discharge ◽

Airway Device ◽

Supraglottic Airway ◽

P Value ◽

Induction Agent ◽

The Awakening ◽

Supraglottic Airway Devices ◽

Airway Devices

: Propofol has been used since ages as induction agent to aid in insertion of Supraglottic airway devices however its side effects like hypotension, apnea and pain on injection do coexist. To avoid these side effects sevoflurane has been studied and well recognized because of its sweet smelling property. We conducted this study with primary aim to compare the insertion conditions such as no. of attempts for insertion, hemodynamic variations and awakening after surgery. The secondary aim was to note the adverse effects associated with Sevoflurane and propofol. We included sixty female patients of age 18-65 years graded as ASA I and II undergoing short gynecological procedures. Patients were induced with Sevoflurane 8% or IV Propofol 2mg/kg. Attempts for I-gel insertion, jaw relaxation, biting, coughing, gagging, laryngospasm and hemodynamic pressor response and awakening after surgery were noted.Induction time with Propofol is less compared to Sevoflurane. I-Gel insertion time with Sevoflurane and Propofol is insignificant (p value= 0.93). 25 patients in Group S and 27 patients in group P had very easy insertion of I-gel. 23 patients in Group S and 27 patients in Group P had relaxed jaw. None of the patients in both groups experienced laryngospasm. Propofol provided better conditions for I-gel insertion with manageable hypotension while the patients induced with Sevoflurane were hemodynamically more stable but the jaw relaxation was less as compared to that provided by propofol. Induction with 8% Sevoflurane by Vital Capacity Breath (VCB) technique can be an alternative for induction in high risk patients. Also the awakening from anaesthesia is faster with sevoflurane and is more suitable for patients demanding early discharge after day care surgeries.

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Comparison of Clinical Performance of Supraglottic Airway Devices in Elderly Patients: A Prospective Randomized Trial

Journal of Anesthesiology and Reanimation Specialists’ Society ◽

10.5222/jarss.2021.27147 ◽

2021 ◽

Author(s):

Reyhan Polat ◽

Sibel Çatalca ◽

Julide Ergil ◽

İlkay Baran ◽

Aylin Tamam ◽

...

Keyword(s):

Elderly Patients ◽

Clinical Performance ◽

The Elderly ◽

Supraglottic Airway ◽

Positive Pressure ◽

Success Rates ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Airway Devices

INTRODUCTION: Airway management in the elderly may be challenging. Supraglottic airway devices (SADs) may be used to provide airway security. The aim of study was to compare the efficacy and safety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised and non-paralysed elderly patients. METHODS: The study was approved by a local ethics committee. Eighty patients, aged older than 65 years, who were scheduled to undergo elective urological or orthopaedic surgery participated in the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n = 26), Group P: p-LMA (n = 27) or Group I: i-gel (n = 27). The primary outcome was oropharyngeal sealing pressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, ease of insertion, success rates, time to insertion, haemodynamic response and complications such as sore throat and dysphagia. RESULTS: There were no significant differences among the groups with respect to OSP (p=0.852), whereas there was a statistically significant difference between Group I and Group C in terms of leak volume and leak fraction ( p= 0.042 and p = 0.020, respectively ). Adverse events were similar among the groups (p > 0.05). DISCUSSION AND CONCLUSION: In this study, although the leak volume and leak fraction were lower in i-gel inserted patients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patients who were not applied muscle relaxants and will be operated under general anesthesia.

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A Randomised Clinical Trial to Compare the Effectiveness of Baska Mask Versus i-gel in Patients Undergoing Laparoscopic Surgeries in a Tertiary Centre

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/383 ◽

2021 ◽

Vol 8 (24) ◽

pp. 2040-2044

Author(s):

Anil Kumar Mysore Ramakrishna ◽

Sarika Manjunath Shetty ◽

Anup Natha Ramachandragowda ◽

Vyshnavi Sriram ◽

Shali Sohail ◽

...

Keyword(s):

Randomised Trial ◽

Randomised Clinical Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Secondary Outcome ◽

Tertiary Centre ◽

Group I ◽

Supraglottic Airway Devices ◽

Sealing Pressure ◽

The Impact

BACKGROUND A wide array of supraglottic airway devices (SAD) are available for the present day anaesthetic practice, each having its own unique features. Laparoscopic surgeries demand meticulous airway maintenance due to the impact of pneumoperitoneum on cardiorespiratory physiology. It thus becomes imperative to have knowledge about the most optimal SAD that can be used for laparoscopic surgeries to provide good quality anaesthesia. The objective of this randomised trial was to compare the airway sealing pressure (ASP) of Baska mask and i-gel and overall success rate in patients undergoing laparoscopic surgeries under general anaesthesia and controlled ventilation. METHODS One hundred and forty patients undergoing laparoscopic surgeries were randomly assigned to either Baska group (Group B) or i-gel group (Group I). Anaesthesia was induced with propofol 2 - 2.5 milligram per kilogram (mg / kg) and relaxation achieved with vecuronium 0.1 mg / kg and SAD was inserted. The primary outcome was airway sealing pressure (ASP) noted after insertion of the device. The secondary outcome measures included the number of attempts and time taken for successful insertion, ASP after gas insufflation of abdomen, Brimacombe grading, hemodynamic changes, airway morbidity (blood on the SAD upon removal, post-operative sore throat, dysphagia and dysphonia) and any other adverse events associated with the use of the devices. RESULTS There were no significant differences in demographic and hemodynamic data. ASP after insertion of the device was significantly higher (p < 0.0001) with Baska than i-gel (41.45 + 4.72 versus 30.29 + 5.76 cm H2O respectively). Brimacombe scoring of grade four was seen in 75.3 % of Baska compared to 18 % in i-gel group. Time taken to insert Baska was significantly more than with i-gel (14.84 versus 11.25 seconds respectively, P < 0.001). However, first time success was more with Baska than with i-gel (147 versus 140 respectively). CONCLUSIONS Both Baska and i-gel can be used safely and effectively in laparoscopic surgeries. Baska provides a better ASP and Brimacombe view than i-gel. However, i-gel offers the advantage of easier insertion in shorter time. KEYWORDS Supraglottic Airway Device, Baska Mask, i-gel, Airway Sealing Pressure

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Impact of a semi-structured briefing on the management of adverse events in anesthesiology: A randomized pilot study.

10.21203/rs.2.13966/v2 ◽

2019 ◽

Author(s):

Christopher Neuhaus ◽

Johannes Schäfer ◽

Markus A. Weigand ◽

Christoph Lichtenstern

Keyword(s):

Rapid Sequence Induction ◽

Airway Device ◽

Supraglottic Airway ◽

Anesthesia Induction ◽

Team Members ◽

Rapid Sequence ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Alternative Means ◽

Airway Devices

Abstract Background : Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. Methods : 37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine. Results : We observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p=0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p=0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm. Conclusions : Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2016/6406391 ◽

2016 ◽

Vol 2016 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Eun Jin Ahn ◽

Geun Joo Choi ◽

Hyun Kang ◽

Chong Wha Baek ◽

Yong Hun Jung ◽

...

Keyword(s):

Systematic Review ◽

General Anesthesia ◽

Pediatric Patients ◽

Meta Analysis ◽

Final Analysis ◽

Airway Device ◽

Supraglottic Airway ◽

Comparative Efficacy ◽

Supraglottic Airway Devices ◽

Airway Devices

Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view.

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Comparison of the efficacy of supraglottic airway devices in low-risk adult patients: a network meta-analysis and systematic review

Scientific Reports ◽

10.1038/s41598-021-94114-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chih-Jun Lai ◽

Yi-Chun Yeh ◽

Yu-Kang Tu ◽

Ya-Jung Cheng ◽

Chih-Min Liu ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Laryngeal Tube ◽

Airway Device ◽

Supraglottic Airway ◽

Randomized Controlled ◽

Oropharyngeal Leak Pressure ◽

Supraglottic Airway Devices ◽

Tube Suction ◽

Airway Devices

AbstractNumerous supraglottic airway device (SADs) have been designed for adults; however, their relative efficacy, indicated by parameters such as adequacy of sealing, ease of application, and postinsertion complications, remains unclear. We conducted a systematic review and network meta-analysis to evaluate the efficacy of various SADs. We searched electronic databases for randomized controlled trials comparing at least two types of SADs published before December 2019. The primary outcomes were oropharyngeal leak pressure (OLP), risk of first-attempt insertion failure, and postoperative sore throat rate (POST). We included 108 studies (n = 10,645) comparing 17 types of SAD. The Proseal laryngeal mask airway (LMA), the I-gel supraglottic airway, the Supreme LMA, the Streamlined Liner of the Pharynx Airway, the SoftSeal, the Cobra Perilaryngeal Airway, the Air-Q, the Laryngeal Tube, the Laryngeal Tube Suction II, the Laryngeal Tube Suction Disposable, AuraGain, and Protector had significantly higher OLP (mean difference ranging from 3.98 to 9.18 cmH2O) compared with that of a classic LMA (C-LMA). The Protector exhibited the highest OLP and was ranked first. All SADs had a similar likelihood of first-attempt insertion failure and POST compared with the C-LMA. Our findings indicate that the Protector may be the best SAD because it has the highest OLP.Systematic review registration PROSPERO: CRD42017065273.

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A Randomised comparison and evaluation of I-gel, Supreme laryngeal mask airway and Ambu Auragain in Laparoscopic surgeries under general anaesthesia with controlled ventilation

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i4.32931 ◽

2021 ◽

Vol 12 (4) ◽

pp. 68-75

Author(s):

Meenakshi Sumadevi Pradeep ◽

Niteen Khanderao Nandanwankar ◽

Priya Vishwanath Lahane ◽

Nazima Yusuf Memon ◽

Shridhar Devidas Yennawar ◽

...

Keyword(s):

General Anaesthesia ◽

Primary Outcome ◽

Supraglottic Airway ◽

Randomised Study ◽

Controlled Ventilation ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Group A ◽

Airway Devices

Background: Supraglottic airway devices (SAD) are becoming increasingly popular for use in patients undergoing laparoscopic surgeries. In this prospective randomised study, we compared three supraglottic airway devices namely, I-gel, Supreme LMA and Ambu Auragain. Aims and Objectives: The study was undertaken to compare three supraglottic airway devices I-gel, Supreme LMA and Ambu Auragain in laparoscopic surgeries under general anaesthesia with controlled ventilation. Materials and Methods: This was a randomized comparative study in which 90 patients undergoing laparoscopic surgeries under general anesthesia were included. In group A Ambu AuraGain was used whereas in group I and Group S I-gel and Supreme LMA was used respectively. Primary outcome measures which were compared amongst the studied groups included time taken for insertion, ease of insertion, attempts required for insertion, ease of insertion of Ryles tube, fiberoptic bronchoscopic grading and Oropharyngeal leak pressure. Results: There was highly significant difference in the time taken for insertion of SAD in Group-A when compared to Group- I (p<0.0001) and Group-S (p<0.0001). Group-A had significantly increased grades of ease of insertion of SAD when compared to Group-I (p=0.04) and Group-S (p=0.004). 16.66% of patients in Group-A required 3 attempts for successful insertion of the SAD, while no patients in Group- I or Group A required more than two attempts for insertion(p<0.05). Conclusion: Ambu AuraGain provides better oropharyngeal seal and has higher leak pressures as compared to I-gel and Supreme LMA with similar hemodynamic stability and post-operative outcome makingit a preferable SAD over I-gel and Supreme LMA.

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Impact of a semi-structured briefing on the management of adverse events in anesthesiology: a randomized pilot study

BMC Anesthesiology ◽

10.1186/s12871-019-0913-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Christopher Neuhaus ◽

Johannes Schäfer ◽

Markus A. Weigand ◽

Christoph Lichtenstern

Keyword(s):

Rapid Sequence Induction ◽

Airway Device ◽

Supraglottic Airway ◽

Anesthesia Induction ◽

Team Members ◽

Rapid Sequence ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Alternative Means ◽

Airway Devices

Abstract Background Human factors research has identified mental models as a key component for the effective sharing and organization of knowledge. The challenge lies in the development and application of tools that help team members to arrive at a shared understanding of a situation. The aim of this study was to assess the influence of a semi-structured briefing on the management of a simulated airway emergency. Methods 37 interprofessional teams were asked to perform a simulated rapid-sequence induction in the simulator. Teams were presented with a “cannot ventilate, cannot oxygenate” scenario that ultimately required a cricothyroidotomy. Study group (SG) teams were asked to perform a briefing prior to induction, while controls (CG) were asked to perform their usual routine. Results We observed no difference in the mean time until cricothyroidotomy (SG 8:31 CG 8:16, p = 0.36). There was a significant difference in groups’ choice of alternative means of oxygenation: While SG teams primarily chose supraglottic airway devices, controls initially reverted to mask ventilation (p = 0.005). SG teams spent significantly less time with this alternative airway device and were quicker to advance in the airway algorithm. Conclusions Our study addresses effects on team coordination through a shared mental model as effected by a briefing prior to anesthesia induction. We found measurable improvements in airway management during those stages of the difficult airway algorithm explicitly discussed in the briefing. For those, time spent was shorter and participants were quicker to advance in the airway algorithm.

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A comparative study of supraglottic airway devices Baska mask and ProSeal-laryngeal mask airway in short gynaecological procedures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195924 ◽

2019 ◽

Vol 8 (1) ◽

pp. 285

Author(s):

Ranjith Kumar Kachakayala ◽

Parmeet Bhatia ◽

Shalendra Singh ◽

Deepak Dwivedi

Keyword(s):

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Study Support ◽

Group 2 ◽

Low Incidence ◽

Airway Devices ◽

To Receive ◽

Group 1

Background: Baska Mask® (BM) a newer Supraglottic Airway Device (SAD) considered to cause low incidence of Postoperative Pharyngolaryngeal Complications (POPC). This study was designed to assess efficacy, safety and early and late POPC between BM and commonly use ProSeal LMA (PMLA).Methods: Patients between 18 to 60 years of age undergoing elective short gynecological procedures were randomized into two groups, to receive ventilation with either BM (group 1, n=50) or an PMLA (group 2, n=50).Results: There was no significant difference in the ease of insertion for both the devices (p<0.24). There was no significant difference in the number of attempts for both the devices (p<0.69). When compared to PLMA, the time (in seconds) required for insertion of BM was significantly less in duration (20.9 vs. 16) (p<0.0001). Between the two groups significant hemodynamic changes noticed after removal of SGA. The blood staining of device was similar in both groups. Failure to place device, postoperative complication like laryngospasm and bronchospasm did not occur in both BM and PLMA groups.Conclusions: In conclusion, findings of this study support that BM takes significantly shorter placement time and provides a better seal as compared to PLMA but without any reduction in laryngopharyngeal complications.

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