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The ProSeal is a wire-reinforced laryngeal mask airway with an additional drain tube that leads to the distal tip of the laryngeal cuff. The design should improve the seal with the larynx.
The ProSeal and classic laryngeal mask airways were compared in 180 patients in a randomized crossover study. Patients were anaesthetized without neuromuscular b...
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Background: There is increasing use of laryngeal mask airway in children because of ease of insertion and minimal disturbances in cardio respiratory system and lesser risk of airway injury during perioperative period as compared to endotracheal tube. It is also simple, well-tolerated, safe, reusable, cost effective method of airway management in pa...
OBJECTIVE:
The main goal of this study was to achieve a medico-economic comparison between four disposable laryngeal masks (LM) (LMA-Unique™, Ambu AuraOnce™, I-Gel™ and LMA-Suprême™).
STUDY DESIGN:
A prospective, randomized, monocentre study.
MATERIAL AND METHODS:
In a center, using routinely LMA-Unique masks, scheduled breast surgery patients we...
Background: Few studies have compared the efficacy of 2% lignocaine viscous gargling with intravenous lignocaine given prior to induction with propofol and fentanyl for laryngeal mask airway (LMA) insertion for minor-to-moderate elective surgeries.
Methods: Sixty patients were randomized into two groups: Group V (n = 30) and Group I (n = 30). Group...
Laparoscopic cholecystectomy (LC) is usually performed under general anaesthesia (GA). With the advancement of surgical and anaesthetic technique, there were many LC have been successfully performed under epidural anaesthesia in recent years. Surgeons in our hospital have performed gas-free trans-umbilical single port laparoscopic cholecystectomy s...
Citations
... Recently, several studies have evaluated sonographic confirmation of LMA location and compared it with other methods, and USG has been shown to be a suitable tool for confirming LMA location (1). In our study, in which we evaluated the arytenoid cartilages and the PLMA cuff ultrasonographically, we confirmed the optimal PLMA placement by visualising the PLMA cuff as a "reverse hanging drop" in the laryngopharynx, which was consistent with the literature (12). Studies have reported that the position of LMA cuff may vary depending on the patient's epiglottis or preepiglottic space size, and sometimes, a large epiglottis or a pre-epiglottic space filled with fat may also obstruct the view of laryngeal structures (13). ...
Objective: The study aims to evaluate the Proseal laryngeal mask airway (PLMA) position with ultrasonographic imaging. Methods: The study included American Society of Anesthesiologists I-III patients with Mallampati scores I-II and operated using PLMA as an airway device. Before PLMA insertion, the glottic aperture was assessed by ultrasonography (USG). After PLMA placement, the USG evaluation was repeated. The symmetry of the arytenoid cartilages was examined. Asymmetry of an arytenoid to the glottic midline and the other arytenoid was graded 0 to 3 (USG arytenoid grade). After PLMA was placed, fiber optic bronchoscopy (FOB) was done to evaluate the PLMA position (FOB LMA grade). The relationship between USG arytenoid grade and FOB LMA grade was examined. Results: Forty-eight patients were included in the study. The mean age was 49 ± 15.8 (19-82), and 25 were female. It was determined that PLMA was in the correct position in 81.3% of the evaluation with USG and 68.8% of the assessment with FOB. USG arytenoid grade correlated with FOB LMA grade (r= -.582, p<.001). To detect a rotated LMA, USG had a sensitivity of 100% (%95 CI, 39.8 – 100.0) and a specificity of %80 (%95 CI, 22.8 – 99.8). The positive and negative predictive values were %97.7 (%95 CI, 88.0 – 99.9) and %100 (%95 CI, 91.8 – 100.0), respectively. The accuracy was %97.9 (%95 CI, 86.3 – 99.3). Conclusion: Ultrasonografi can be a simple, noninvasive, and reliable method to confirm PLMA placement in anesthesia practice. Keywords: Laryngeal mask airway, ultrasonography, airway management
... The OLP is an important index for evaluating the effectiveness and safety of laryngeal mask ventilation and is of great significance in maintaining airway tightness, ensuring ventilation, and reducing the entry of oropharyngeal and gastric contents into the respiratory tract. [10][11][12][13] OLP results from a tight surface-to-surface fit between the laryngeal mask and soft tissue surrounding the glottis. The study of Ambu AuraFlex laryngeal mask by Liu et al [2] showed that when the intracapsular pressure reached 30 cm H 2 O, the OLP could reach 19 to 20 cm H 2 O, which could meet the ventilation needs of pediatric ophthalmic surgery anesthesia. ...
This study aimed to compare the clinical effects of the Medis flexible laryngeal mask airway (FLMA) with those of the Ambu AuraFlex FLMA in pediatric ophthalmic surgery. A total of 80 patients, aged 1 to 5 years, in American Society of Anesthesiologists I-II, weighing ≥10 kg, and without any existing airway difficulties, were enrolled in this study. The patients were randomly divided into Group M (Medis FLMA) and Group A (Ambu AuraFlex FLMA). The time of insertion, number of attempts, finger assistance required, manipulation, oropharyngeal leak pressure (OLP), fiberoptic grade of view, and complications such as bloodstaining, hoarseness, and sore throat were recorded. Group M showed a significantly higher OLP than did Group A (P = .002); however, Group M required more finger assistance than did Group A (P = .009). There were no statistically significant differences between the 2 groups in terms of insertion time, number of attempts, manipulation, fiberoptic view grade, or complications. Both the Medis and Ambu AuraFlex FLMA can provide smooth ventilation during pediatric ophthalmic surgeries. The Medis FLMA showed a higher OLP than did the Ambu AuraFlex FLMA but required more finger assistance during insertion.
... LMAs could not be inserted in 3 patients per group so, the perioperative airway and other parameters were analyzed in the 29 patients per group. LMA Baska mask insertion took less time than that of the LMA Protector [14 (11-20) vs 20 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 13 seconds, p=0.035] ( Table 3). Nasogastric tube insertion time was shorter in the Baska mask group when compared to the LMA Protector [14 (12-15) seconds versus 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) seconds; p=0.003]. ...
... LMA Baska mask insertion took less time than that of the LMA Protector [14 (11-20) vs 20 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) 13 seconds, p=0.035] ( Table 3). Nasogastric tube insertion time was shorter in the Baska mask group when compared to the LMA Protector [14 (12-15) seconds versus 17 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) seconds; p=0.003]. Fiberoptic views were comparable among the groups (Table 3). ...
... 12 This was lower than other supraglottic airway devices (SADs) insertion times mentioned previously. [13][14][15][16] Consistent with our results, the LMA Protector was inserted in 19-29 seconds in the previous studies. 3,17 We found the insertion time to be 20 s for the LMA Protector in our study. ...
... The difference was clinically as well as statistically signicant [ Table 2]. There are many studies comparing LMA-Proseal with Classic LMA, in which they have observed lower rst attempt 6,7 insertion success with LMA Proseal. The common reason which was stated was that when deated, the semi -rigid distal end of the drain tube formed the leading edge of the LMA-Proseal, which was more rigid as compared to the softer I-gel. ...
Comparison Of I-gel With Proseal Lma In Adult Patients Undergoing Elective Surgical Procedures Under General Anaesthesia Without Paralysis Objective: Supraglottic airway devices (SADs) have been widely used as an alternative to tracheal intubation during general anaesthesia. They are easily inserted, better tolerated, with fewer hemodynamic changes. This study compares the efcacy of two supraglottic devices (LMA Proseal and I-gel) in elective surgical procedure under general anaesthesia without paralysis. Material and Method: A prospective randomized study was conducted on 40 patients who were posted for elective short surgical procedures under general anaesthesia. They were randomly divided into two groups of 20 patients each, Group I (I-gel) and Group P (PLMA). All the patients were induced with general anaesthesia and the planned SAD was inserted with head in neutral position. Ease of insertion, number of insertion attempts, oropharyngeal seal pressure and incidence of adverse effects were assessed. Results: I-gel was signicantly easier to insert than Proseal (P < 0.05). The mean time for insertion was more with Group P (40.8±09.61 secs) than with Group I (29.63±08.13 secs). Although the airway sealing pressure was signicantly higher with Group P (26.63±1.31 cm of H2O), the airway sealing pressure of Group I (20.97 ± 2.14 cm of H2O) was within normal limit. The success rate of rst attempt insertion was more with Group I. There was no evidence of airway trauma, regurgitation, and aspiration. Sore throat was signicantly more evident in Group P. Conclusion: I-Gel is better supraglottic device with acceptable airway sealing pressure, easier to insert, less traumatic with lower incidence of sore throat. Hence, I-gel is better alternative than Proseal LMA.
... This difference in airway anatomy may affect the correct placement of SADs [3]. Although fiberoptic laryngeal (FOL) view is considered the preferred verification tool for direct visualization of the glottis, it has also been reported to be a superior technique for detecting the malposition of SADs [4][5][6]. Some studies of SAD position using FOB have reported that a proportion of children need repositioning of smaller SADs (12.8%-49%) despite adequate ventilation [2,7,8]. ...
Background:
This study was designed to observe and compare the performance of fiberoptic laryngeal (FOL) view, leakage test (LT) and ultrasonography (USG) usage in detecting i-gel position in pediatric patients.
Methods:
One hundred ten consecutive children were included in this single-armed prospective observational study. After anesthetic induction, i-gel placement confirmed using FOL and LT was evaluated using USG in three planes. According to our scoring system, acceptable and unacceptable grades (FOL, LT and USG) were determined to describe placement. Sensitivity and specificity were determined by comparing USG performance with the other two tests.
Results:
Ultrasonography was found a sensitivity of 20% positive predictive value (PPV) for unacceptable i-gel placement according to FOL grade and a sensitivity of 37.04% with a 100% PPV according to LT grade. USG was found a specificity of 91.84% negative predictive value (NPV) of 91.84% for acceptable i-gel placement according to FOL grade and the NPV specificity of 100% with a 82.65% NPV according to LT grade.
Discussion:
Ultrasonography demonstrated a very good diagnostic performance in the detection of optimal i-gel placement according to both FOL and LT. However, both FOL and LT showed poor diagnostic performance compared to USG in demonstrating i-gel malposition.
... Newer methods are required to assess both the laryngeal size and visualize the EAD in situ [11]. The other described method of placement assessment is the fibreoptic evaluation of the glottis view through the airway lumen of PLMA [12][13][14][15]. Though it is an important assessment tool but may not be available routinely and does not provide real-time assessment of placement of PLMA. ...
... We used Brimacombe's grading system for grading laryngeal view and quantified the rotation of a supraglottic airway device to the laryngeal inlet, providing a comprehensive assessment of the supraglottic airway device position [9]. The fibreoptic technique is reported to be a superior technique to identify the malposition of LMA [9,13,14]. ...
Extraglottic airway devices (EAD) have revolutionized the perioperative airway management. The accuracy of clinical tests to identify malposition has been questioned by recent studies where fibreoptic evaluation identified various malpositions that were undiagnosed by a clinical test. Ultrasound (USG) has evolved to guide various airway interventions. However, USG is under-evaluated in the assessment of the EADs position. Our study aimed to compare clinical versus USG assessment of optimal placement of ProSeal laryngeal mask airway (PLMA). This randomized control trial was done in 212 consenting patients undergoing onco-surgery with PLMA as an airway device. Patients were randomized in Group CL (n-107) and US (n-105). Following primary assessment—using clinical tests and USG evaluation using a scoring system, fibreoptic evaluation of the placement of PLMA was done and then assessed for optimal position. The accuracy of each technique for optimal placement was compared statistically. We found that the sensitivity and specificity of the clinical evaluation were 98.77% and 34.62% with a diagnostic accuracy of 83.18% when compared with fibreoptic evaluation. While USG evaluation using the scoring system has sensitivity and specificity of 95.45% and 29.41% with a diagnostic accuracy of 84.76%. It was noted that USG assessment has a higher positive predictive value (87.5%) as compared to clinical assessment (82.47%). The incidence of rotation was higher in the clinical group. There was no difference in airway related morbidity. USG is comparable to clinical tests for evaluation of the optimal placement of PLMA. However, USG has various advantages over clinical assessment as it is quick and identifies the unacceptable placement of PLMA where the tip of PLMA may not lie over the tip of the esophagus, thereby, avoiding unnecessary mucosal injury during forceful or repeated attempts for gastric drainage tube insertion.Trial registration: Clinical Trials Registry (CTRI/2017/11/010359) dated 3rd November 2017.
... During the advancement of the SGA device by means of the standard digit-based technique, impaction and friction at the back of the mouth are often encountered, which are the main causes of failed insertion [27]. Furthermore, some types of SGA device have soft bowl, large cuff, or flexible shaft [28,29]. These features may disturb the insertion of SGA device. ...
Background:
Prompt insertion and placement of the supraglottic airway (SGA) devices in the correct position are required to secure the airway. This meta-analysis was performed to validate the usefulness of the 90° rotation technique as compared with the standard digit-based technique for the insertion of SGA devices in anesthetized patients in terms of success rate, insertion time, and postoperative complications.
Methods:
A literature search of PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science was conducted. Randomized controlled trials, without limitations on publication period, language, journal, or region, until July 2021, that compared the 90° rotation and the standard digit-based techniques for insertion of SGA devices in anesthetized patients were included.
Results:
The first-attempt (risk ratio [RR] 1.16, 95% confidence interval [CI] 1.09 to 1.25, p < 0.001) and overall success rates (RR 1.06, 95% CI 1.03 to 1.09, p < 0.001) were significantly higher in the 90° rotation group. The insertion time was shorter in the 90° rotation group (mean difference -4.42 s, 95% CI -6.90 s to -2.15 s, p < 0.001). The incidences of postoperative sore throat (OR 0.63, 95% CI 0.49 to 0.83, p < 0.001) and blood staining (RR 0.28, 95% CI 0.20 to 0.39, p < 0.001) were lower in the 90° rotation group.
Conclusions:
The use of the 90° rotation technique increases the success rate of SGA device insertion and decreases pharyngeal mucosal trauma as compared with that of the standard digit-based technique in anesthetized patients.
... seconds) in Group P. The insertion of ProSeal laryngeal mask airway takes longer time than Classic laryngeal mask airway. Studies by Cook TM, Nolan JP, 9 Verghese C and coworkers corroborated with our study ndings. J. ...
The present study was designed to evaluate the performance details of the Classic laryngeal mask airway and ProSeal laryngeal mask airway in anesthetized, paralysed patients in terms of ease of insertion, oro-pharyngeal seal pressure, beroptic position of airway tube and complication rates. Seventy patients of ASA grade I and II of either sex, aged between 20-50 years undergoing minor peripheral surgeries in the supine position were selected. Patients were randomly allocated to receive either Classic LMA or Proseal LMA for airway management after induction with Fentanyl 2 µg/kg, Propofol 2.5 mg/kg and neuromuscular blockade with atracurium 0.5mg/kg. Anaesthesia was further maintained with sevourane 1-3% in 50% oxygen and air. The study showed that Classic LMA takes less time for insertion, achieves an unobstructed view of the glottis more frequently but achieves a poorer seal with the pharynx. The ProSeal LMA takes longer time for insertion but is capable of achieving a more effective seal and also facilitates gastric tube placement.
... The mean insertion time for PLMA and I-gel in the present study was 27.40 ± 11.51 s (range 14-54 s) as compared to [21] and Lu et al. [15] observed mean OPL pressure of 29 cm of H 2 O for PLMA. Bosely et al. [14] compared PLMA and I-gel in 100 European patients using standard insertion techniques. ...
... The difference was not clinically significant (P = 0.758). Insertion time reported in the present study was higher than that reported in the previous studies; [16,17,20,21] however, probably this absolute time difference is of negligible clinical importance in day-to-day anesthetic practice. Bosley et al. [14] reported lesser insertion time for both PLMA and I-gel (mean time LMA ProSeal ® 12 s, I-gel ® 17 s). ...
Aims:
The study is aimed to compare the efficacy of I-gel and ProSeal laryngeal mask airway (PLMA) in nonparalysed anesthetized individuals following manufacturer-recommended digital insertion.
Materials and methods:
In this prospective randomized observational study, 40 American Society of Anesthesiologists I and II patients, aged 18-65 years scheduled for elective surgical procedures were allocated either to PLMA group (Group P, n = 20) or the I-gel group (Group I, n = 20). Following digital insertion of PLMA or I-gel, the following parameters were compared: insertion time, ease of insertion, number of attempts, failed insertion, airway reaction during insertion, oropharyngeal leak (OPL) pressure, and gastric insufflation on auscultation. Fiberoptic view of both the channels of the airway devices and ease of insertion of 12 F Ryle's tube through gastric drain channel were graded. Postoperative complications were also noted.
Results:
First attempt and overall insertion success were similar (PLMA, 85% and 100%; I-gel 80% and 100%, respectively). Mean (standard deviation) insertion times were similar (PLMA, 27.40 [11.51] s; I-gel 25.45 [9.03] s). Mean OPL pressure was 3.5 cm H2O higher with PLMA (P < 0.012). The passage of Ryle's tube was easier through I-gel than PLMA. Grade I glottic view (full view of the vocal cords) was visible in 17 (85%) patients who were managed with I-gel whereas only 9 (45%) patients had Grade I view in the PLMA group.
Conclusion:
The time required for digital insertion of PLMA and I-gel in nonparalyzed anesthetized patients is similar but PLMA forms a better oropharyngeal seal. I-gel is better positioned over the laryngeal framework and esophagus. I-gel allows easier passage of Ryle's tube through its drain channel than PLMA. The incidence and severity of postoperative sore throat and hoarseness was higher with PLMA.
... [6][7][8] Mean OSP reported for cLMA in previous studies is 16-20 cm H 2 O. [6,7,9] Reported mean OSP for Air-Q is found to be higher than cLMA in various studies (22-28 cm H 2 O). [2,[9][10][11] Design features unique to Air-Q which might have contributed to an improved OSP are anterior curve of the airway tube, mask ridges, and higher posterior heal height. OSP differences may not have a clinical significance during spontaneous ventilation but may be an important consideration if positive pressure ventilation is being used. ...
... [6][7][8]11,12] In this study, overall fiberoptic grades of laryngeal view were more favorable (Grade I and II) through the Air-Q when compared with cLMA which is consistent with the findings of previous studies. [10][11][12] The design of Air-Q, with an area above the ventilating orifice for the epiglottis to rest on when properly positioned, may have contributed to the finding of better grades of laryngeal view. [12] This also explains the successful blind as well as fiberoptic guided intubation through Air-Q in previous studies. ...
... [12] This also explains the successful blind as well as fiberoptic guided intubation through Air-Q in previous studies. [10,11] The limitation of our study was that we compared a single-sized Air-Q with cLMA, both being a first generation supraglottic airway. As cLMA is a prototype airway and no trials were available on the comparison of cLMA with Air-Q, we planned to compare these two devices. ...
Objective: Classic laryngeal mask airway (cLMA) is a prototype supraglottic airway device, and Air-Q is a newly introduced device for use as a primary airway and as an aid for intubation. Due to paucity of literature comparing Air-Q with cLMA, this prospective, randomized, single-blinded study was performed, to evaluate their clinical performance as a primary airway conduit.
Methods: Sixty patients of either sex with the American society of anesthesiology Grade I or II, weighing between 50 and 70 kg, were randomly allocated to either the cLMA (n = 30) or Air-Q (n = 30) group. After induction of anesthesia, the assigned airway device was introduced. The ease of insertion, vital parameters, oropharyngeal seal pressure (OSP), airway morbidity, and fiberoptic grades of laryngeal view was recorded.
Results: There was no significant difference in ease of insertion, the time taken for successful device placement, number of attempts, or postoperative morbidities. Air-Q was found better with respect to hemodynamic stability during placement of the device. There was a significant difference in the OSP between the Air-Q (22.12 ± 1.740 cm H2O) and cLMA (16.28 ± 2.052 cm H2O), P < 0.001. Fiberoptic laryngeal view through Air-Q was also superior (P < 0.001).
Conclusion: Air-Q was found to be superior to cLMA for controlled ventilation in view of better OSP and a superior fiberoptic laryngeal view.
