A Randomised Control Trial Comparing the Efficacy of LMA-Supreme and I-Gel as Rescue Ventilatory Device in Patients with Simulated Difficult Airway Undergoing Anaesthesia with Controlled Ventilation

Introduction: In an unanticipated difficult airway or in an emergency situation of cannot-intubate-cannot-ventilate scenario, Supraglottic Airway Devices (SGD) are recommended as rescue devices for establishing airway quickly to prevent hypoxia. Aim: To compare efficacy of i-gel airway and Laryngeal Mask Airway supreme (LMA supreme) as ventilatory devices and the time taken for their insertion in anaesthetised and paralysed patients with simulated difficult airway. Materials and Methods: One hundred and eighty adult patients with simulated difficult airway were randomly allocated to two groups of 90 patients each. In group I: i-gel and in group S: LMA supreme was inserted. Primary outcome studied was time taken for insertion of SGD. Secondary outcomes were the number of attempts taken for insertion of device, oropharyngeal leak pressure, ease of gastric catheter insertion, fibreoptic bronchoscopic view of anatomical alignment of device with glottic opening. Quantitative variables were compared using unpaired t-test/Mann-Whitney Test, between the two groups. Qualitative variable were compared using Chi-Square test/Fisher’s-exact test. Results: Total time taken for successful insertion was significantly shorter with group i-gel as compared to group LMA supreme {median (IQR) {19 (18.25-21)} versus {24 (23-24)} with p-value ≤0.0001. Overall success rate of insertion (96.67% vs 97.78%, p=1.000) and oropharyngeal leak pressure (p-value=0.555) of i-gel and LMA-S were comparable. i-gel has better anatomic alignment with glottic opening as compared to LMA-S (p-value ≤0.0001). Gastric tube insertion was easy in all patients in both the groups. Conclusion: Shorter time for the insertion of i-gel was observed due to absence of inflatable cuff, although both LMA-S and i-gel are equally efficacious as ventilatory devices in patients with simulated difficult airway under general anaesthesia with controlled ventilation.

Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway

ABSTRACT Introduction This prospective randomized study aimed to compare the effectiveness of the intubating laryngeal mask airway (ILMA) with the King Vision Video laryngoscope in aiding endotracheal intubation in Asian patients with normal airway. King Vision Video laryngoscope is a two-piece design. It has a reusable monitor that attaches to disposable blades. The ILMA is a device specifically designed to be an effective ventilatory device and blind intubating guide in patients with normal and abnormal airways. Materials and methods After ethics committee approval and obtaining patient's written informed consent, 60 American Society of Anesthesiologists grade I and II adult patients undergoing elective surgery requiring intubation were randomly allocated into either the ILMA group (Group L) or the King Vision Video laryngoscope group (Group V). • Thorough preanesthetic checkup was done. Patient was premedicated. Induction was done with propofol 2.5 mg/kg and succinylcholine 1.5 mg/kg. In Group L, ILMA was inserted using a single-handed rotational technique. In the King Vision Video laryngoscope group, intubation was done with videolaryngoscope. Placement was confirmed with auscultation and capnography. • An independent observer recorded the following: – Time taken for successful intubation – Success or failure of the tracheal intubation – Number of attempts needed for successful tracheal intubation – Complication associated with tracheal intubation: bleeding or postoperative sore throat – Hemodynamic response to intubation Results and conclusion King Vision Video laryngoscope is the more effective technique in aiding endotracheal intubation in patients with normal airways. How to cite this article Hanjura S, Agrawal AP, Agrawal M, Singh V, Vinay V, Ahmed R. Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway. Int J Adv Integ Med Sci 2017;2(1):1-7.