A Multicenter Study Comparing the ProSeal TMand Classic TMLaryngeal Mask Airway in Anesthetized, Nonparalyzed Patients (original) (raw)
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Egyptian Journal of Anaesthesia, 2013
Background: To overcome the problem of gastric content regurgitation, a device with drain tube and better airway sealing has been made: the ProSeal laryngeal mask airway (PLMA). We aimed to compare the clinical performance of the classic LMA with the PLMA. Several studies comparing these two devices have been done. Our study was designed to compare ease of insertion, airway sealing pressure, and fiber-optic assessment of positioning in adult patients, and we hopes to prove that PLMA is better to LMA in all these aspects. We hypothesized that PLMA would have a better leak pressure than the CLMA and minimum difference in leak pressure of 20% between them was considered clinically significant. Material and methods: One hundred adult patients of either sex between age group of 18-65 years scheduled for elective surgery were included in the study. Patients were randomly allocated to two groups of 50 patients each. In group I CLMA and in group II PLMA were used. The number of attempts, ease of insertion, time of insertion, and failure if occurred were noted down. Hemodynamic changes, airway sealing pressure, and the fiber-optic were also recorded. Results: Data thus compiled showed that insertion was successful in first attempt in 94% cases with LMA as well as PLMA. The time taken for successful placement of LMA and-PLMA was 15 and 17 s, respectively. Sealing pressure was higher for group II at all cuff volumes. More number of
Introduction: The Laryngeal Tube with suction and ProSeal LMA are newer airway management devices that are gaining acceptance for airway management in anaesthetized patients because of gastric drainage facility in both. We decided to compare their insertion, ventilation, haemodynamic and complication profiles. Material and methods: Sixty adult patients were randomly allotted to a Laryngeal Tube or ProSeal LMA group. The number of attempts required for successful placement, time taken to establish effective airway, haemodynamic and ventilatory parameters and incidence of postoperative complications was compared. Results: The LTS produced higher seal pressures (median value 29.60 cm of H2O), as compared to PLMA (23.67 cm of H2O), which was statistically significant (P<0.01). First attempt insertion success rate with PLMA was 24 as compared with 27 with the LTS which was statistically not significant (P>0.05). LTS produced a greater haemodynamic response than PLMA at insertion and at extubation. EtCO2 showed a statistically significant rise at 20, 25 and 30 minutes after insertion of LTS and at extubation. There was no statistical significance in the difference between the incidence of dysphagia and hoarseness in both groups. Conclusion: ProSeal LMA is a reliable and better airway management option as compared to Laryngeal Tube with suction , for patients undergoing short surgical procedures under general anaesthesia with controlled ventilation.
European Journal of Anaesthesiology, 2010
Background and objective The Supreme laryngeal mask airway (LMA) is a new single-use polyvinyl chloride supraglottic device that combines the functionality of the ProSeal and Fastrach airways. High oropharyngeal leak pressures are important as they indicate airway protection, feasibility of positive pressure ventilation and likelihood of successful LMA placement. The oropharyngeal leak pressure of the LMA Supreme is not well established versus the LMA ProSeal. This study was designed to compare the safety and efficacy of the LMA Supreme versus the LMA ProSeal in elective ambulatory procedures. Method Hospital ethics board approval was obtained. One hundred and five patients were consented and randomly allocated to LMA Supreme or ProSeal groups. Anaesthesia was induced with intravenous propofol 2-3 mg kg À1 and fentanyl 1-2 mg kg À1 and maintained with desflurane in an air-oxygen mixture. Anaesthesiologists with more than 5 years of experience performed all of the LMA insertions. Manometry was used to standardize intracuff pressure at 60 cmH 2 O. The primary outcome was the oropharyngeal leak pressure. Secondary outcomes were the time and number of attempts for insertion, ease of insertion and the anaesthesiologist's satisfaction score of the airway device. The success on first attempt insertion was measured. Patients were interviewed postoperatively for any pharyngolaryngeal adverse events. Results A total of 99 patients were analysed for the primary outcome. The baseline demographic data for both groups were comparable. The mean oropharyngeal leak pressure with the LMA Supreme was 21 AE 5 cmH 2 O (95% confidence interval 20-22). This was significantly lower than that of the LMA ProSeal, 25 AE 6 cmH 2 O (95% confidence interval 23-27; P < 0.001). The success rate of the first attempt insertion was higher for the LMA Supreme than for the LMA ProSeal (98 and 88%, respectively; P ¼ 0.04). There was no difference in the median time taken for insertion with the LMA Supreme versus the LMA ProSeal: 26 s (interquartile range 23-45) versus 30 s (interquartile range 20-38), respectively (P ¼ 0.16). The ease of insertion, postoperative pharyngolaryngeal adverse events, patient satisfaction scores and anaesthesiologist's satisfaction scores were comparable in both groups. There were no complications of aspiration or nerve injuries. Conclusion The LMA Supreme has lower oropharyngeal leak pressures than the LMA ProSeal. The success of the first attempt insertion was higher for the LMA Supreme. The LMA Supreme is a safe, efficacious and easy-to-use disposable supraglottic airway device in elective ambulatory procedures. The higher rate of success on first attempt insertion may make it more suitable as an airway rescue device.
A comparison of the laryngeal mask airway and PA Xpress TM for short surgical procedures
Anaesthesia, 2003
Sixty adult patients undergoing minor peripheral surgery under general anaesthesia were randomly allocated to receive either the laryngeal mask airway (laryngeal mask airway; size 4 for females and size 5 for males) or the PA Xpress TM (adult size), inserted by a single operator with experience of > 50 insertions of each device. The laryngeal mask airway was correctly placed on the first attempt in 27 patients (90%) compared with 20 patients (67%) when using the PA Xpress (p < 0.01). No patient required more than two attempts at insertion and there were no failures with the laryngeal mask airway, compared with four (13%) who needed three attempts and two failures (7%) with the PA Xpress (p < 0.001 and p < 0.01, respectively). Mean (SD) total placement time was shorter with the laryngeal mask airway [24.6 (3.1) s] than with the PA Xpress [35.4 (2.5) s; p < 0.01]. The most common complication was sore throat, which occurred less frequently with the laryngeal mask airway (8 patients; 26%) than with the PA Xpress (15 patients; 53.5%; p < 0.001).
British Journal of Anaesthesia, 2003
Background. Only a prototype laryngeal tube has been compared with the classic LMA ² for brief periods of anaesthesia. We compared the new laryngeal tube (which had several improvements in design) with the classic LMA. Methods. We randomly allocated 72 patients to receive either the laryngeal tube or an LMA, and compared adequacy of controlled ventilation during anaesthesia (good: clear airway without complications; fair; clear airway with complications or suboptimal airway; or failed), leak pressure and the incidence of postoperative complications. Results. Insertion was successful within 2 attempts in all 36 patients for the classic LMA and in 35 patients for the laryngeal tube. The mean leak pressure for the laryngeal tube (28 cm H 2 O) was signi®cantly greater than that for the classic LMA (21 cm H 2 O) (P<0.001; 95% CI 3.6±10.0 cm H 2 O). Ventilation was good in 25 cases, fair in 11, and failed in no patients with the classic laryngeal mask airway; and good in 23, fair in 11 and failed in two for the laryngeal tube. There was no signi®cant difference in adequacy of ventilation between the groups. The median peak airway pressure for the laryngeal tube (17.5 cm H 2 O) was greater than that for the classic LMA (16 cm H 2 O) (difference: 2 cm H 2 O; 95% CI 0±5 cm H 2 O). There was no signi®cant difference in the incidence and severity of the postoperative complications between the two groups. Conclusion. The laryngeal tube was as effective as the classic LMA during anaesthesia with controlled ventilation. There were similar operative and postoperative complications.
Context: ProSeal Laryngeal Mask Airway (PLMA) is extensively being used in pediatric anesthesia. Aims: To evaluate the efficacy of PLMA as compared to Classic Laryngeal Mask Airway (CLMA) for airway maintenance in pediatric patients. Settings and Design: A prospective, randomized, Single-blinded study was conducted in a tertiary care teaching hospital. Materials and Methods: Sixty ASA I and II children were included. Patients were randomized to either size 2 PLMA or size 2 CLMA groups. Parameters noted were time for insertion, number of attempts, airway sealing pressure, blood pressures (systolic, diastolic, and mean), pulse rate, end-tidal carbon dioxide (EtCO 2 ), peripheral oxygen saturation (SpO 2 ), and postoperative change in abdominal circumference, and airway trauma. Statistical analysis used: Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the chi-square (c 2 ) test. Unless otherwise stated, data are presented as mean (SD). Significance was taken as P < 0.05. Results: There was no statistical difference between the two groups for the success rates at the first attempt of insertion, airway sealing pressure, hemodynamic responses, SpO 2, EtCO 2 and postoperative changes in abdominal circumference. Patients in the PLMA group had longer time of insertion and higher incidence of airway trauma. Conclusions: The PLMA and the CLMA were comparable for hemodynamic and ventilatory parameters and change in abdominal circumference; however, the time taken for insertion and airway trauma was more with PLMA.
IP Innovative Publication Pvt. Ltd., 2018
Supraglottic airway devices have a special niche for themselves with regards to airway management in modern anaesthesia practice. They have become a very good alternative to mask ventilation and tracheal intubation in elective surgeries and have an important place in the emergency settings. The single-use supraglottic airway devices I-gel™ and LMA-Supreme™ have been developed with the aim to overcome the limitations and improve the efficacy of currently available supraglottic airway devices like there airway sealing pressure, ease of placement but with discordant results with regards to airway sealing pressure, ease and success of placement and airway morbidity. The aim of this prospective, randomized trial was to evaluate these two airway devices in routine clinical practice. Materials and Methods: 80 patients (ASA grade1-2) were randomly allocated to two groups; Group I (I-gel TM ; n=40) and Group S (LMA-Supreme TM ; n=40). A size 3 or 4 (I-gel TM and LMA-Supreme TM) was used in patients and inserted by experienced anaesthesiologists who had 3 years' experience and had performed 20 successful insertions with each device. First attempt success rate, time for insertion and airway sealing pressure of each device was measured. Airway sealing pressure with LMA-Supreme TM was measured at an intracuff pressure of 60cmH2O. Patients were enquired after surgery for the presence of any dysphagia, sore-throat or hoarseness of voice. Data were analyzed statistically using unpaired 't' test and Chi-square test. A p value of < 0.05 was considered to be statistically significant. Results: The first attempt success rate for I-gel TM was 92.5% and for LMA-Supreme TM was 87.5%. Ventilation was established in 19.7 seconds (range 14-24 seconds) in the I-gel TM group and in 24.2 seconds (range 19-29seconds) in LMA-Supreme TM group (p<0.001). There was no failure in either of the groups. Mean airway sealing pressure was comparable between both the devices (I-gel TM 23.2 cmH2O; LMA-Supreme TM 22.4 cmH2O; p>0.001). Conclusion: Both I-gel TM and LMA Supreme TM are disposable, latex-free devices which do not need any digital or introducer tool for insertion. They have good airway sealing pressures, ease of insertion and low airway morbidity especially with I-gel, so they can be a good choice in patients undergoing elective surgeries. Keywords: I-gel, LMA supreme, Airway sealing pressure.
Airway Management Using LMA‐Evaluation of Two Insertional Techniques: A Prospective Randomised Study
Texila International Journal of Public Health, 2024
The laryngeal mask airway (LMA), originally conceived as a component of anesthesiologists' airway armamentarium, has now become an indispensable airway adjunct for a broad spectrum of healthcare providers, extending to paramedics managing out-of-hospital cardiac arrest scenarios. his randomized trial compares the success rates of the traditional digital technique versus the 180-degree rotational technique for LMA insertion in patients undergoing superficial surgeries under general anesthesia. After ethical approval and informed consent, 120 healthy adults (ASA grade I-II, ages 18-65) scheduled for superficial surgeries were enrolled. Based on a pilot study, 52 cases per group were needed, with an additional 15% to account for dropouts, resulting in 60 participants per group. Exclusion criteria included emergency surgery, obesity, reflux disease, and procedures requiring prone positioning or lasting over an hour. No significant demographic or clinical differences were found between Group A (standard technique) and Group B (180-degree technique). The success rates were similar between the two techniques. However, the 180-degree technique may provide better oropharyngeal leak pressure, improving airway sealing and ventilation.