Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial.

Background and Aims: Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. Material and Methods: The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. Results: All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Conclusions: Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.

Comparison of insertion characteristics of LMA ProSeal from the front and head-end of the patient: A randomized pilot study.

Background and Aims: LMA ProSeal (PLMA) is a commonly used airway maintenance device in elective procedures and is routinely inserted from the head-end of the patient. It is also used in pre-hospital emergencies where it may not always be possible to access the head-end. This study aims to compare the insertion characteristics of PLMA when inserted while standing, either at the head-end or from the front. Material and Methods: After institutional ethics committee approval, 60 consenting patients of either sex, between 18 and 60 years, ASA class I/II, and scheduled to undergo elective surgeries were randomly allocated to either group H (head-end insertion) or group F (front-end insertion). Patients with anticipated difficult airway, chronic respiratory disease, obesity, and who were pregnant were excluded. Insertion time, ease of insertion, fiber optic view, ease of drain tube insertion, number of attempts and success rate were noted. Normally distributed quantitative variables were compared using t-test, and qualitative variables were compared using Chi-squared test. A P < 0.05 was considered significant. Results: Insertion time in group H (23.76 ± 4.48 s) was lesser than in group F (30.53 ± 6.23s) (P = 0.027). Ease of insertion (P = 0.052), fiber optic view, ease of drain tube placement (P = 1.000), and number of attempts (P = 1.000) were comparable among the groups. Conclusion: Although the insertion time from the front is longer than from the head-end, the other insertion characteristics of PLMA including ease of its insertion, placement and success rate of placement are similar when it is inserted from the front or from the head-end. It is an appropriate airway device for securing the airway when the head-end is inaccessible.

How Much Is Too Much in a Reusable Laryngeal Mask Airway?

ProSealTM Laryngeal Mask Airway (PLMA) (Teleflex Medical, Westmeath, Ireland) is a versatile and popular reusable supraglottic airway device. The manufacturer advises maximum reuse of up to 40 times. However, excessive reuse of the device can cause rare complications. Here, we report a rather uncommon complication of intraoperative cuff rupture of a PLMA probably due to the combination of a forceful metal introducer tip insertion and nitrous oxide-based anaesthesia.

Suction Catheter-Guided Technique of ProSeal™ Laryngeal Mask Airway Insertion has a Lower Incidence of Trauma and Sore Throat Compared With a Standard Introducer Tool: A Randomized Controlled Trial.

ProSeal laryngeal mask airway (PLMA) insertion is often difficult. Suction catheter-guided PLMA insertion was compared with the standard introducer tool-assisted technique. One hundred sixty female patients undergoing laparoscopic gynecologic procedures under general anesthesia were randomized into two groups-the suction catheter group (Group SC) and the introducer tool group (Group IT). First-attempt success rate, insertion time, manipulation required, incidence of trauma, and incidence and severity of throat discomfort were compared. PLMA was inserted successfully in the first attempt in 72 of 80 patients in Group SC and in 67 of 80 patients in Group IT (P = .241). Time for successful insertion was 17.31 ± 6.50 seconds in Group SC and 22.65 ± 7.17 seconds in Group IT (P = .001). Manipulation to get a proper fit was required in 9 of 80 patients in Group SC compared with 19 of 80 patients in Group IT (P = .037). Minor airway trauma was noted in 11% of patients in Group SC and 28% of patients in Group IT (P = .001). The incidence and severity of sore throat was significantly lower with the suction catheter than with the introducer tool. Suction catheter-guided PLMA insertion requires less time, fewer manipulations, and results in lower incidence and severity of sore throat than with the introducer tool. Both techniques have a similar first-attempt success rate.

An Analysis of the Comparative Efficacy Between a Third-Generation and a Second-Generation Supraglottic Airway Device in Patients Undergoing Laparoscopic Cholecystectomy.

Background and objective Supraglottic airway devices are extensively used nowadays to secure the airway and minimize postoperative airway-related complications. This study aimed to evaluate whether the Baska® mask (BM) provides higher seal pressure and a better first-time insertion compared to the laryngeal mask airway (LMA) ProSeal™ (LMA-P) in adult laparoscopic cholecystectomy. Methodology This prospective, randomized, single-blinded interventional study was performed after obtaining ethical approval from the Institutional Ethics Committee at the Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Sixty adult patients of both genders scheduled for laparoscopic cholecystectomy under general anesthesia were divided into two groups, with 30 patients in each group. Our study observed the number of insertion attempts, time of insertion, oropharyngeal seal pressure (OSP), number of patients requiring manipulation for proper placement of supraglottic airway devices, and ease of insertion. Results There were no significant differences in terms of insertion attempts, ease of insertion, and laryngopharyngeal morbidity between the groups. The mean OSP at five minutes was 31.55 ±2.23 cm H2O, and that at 30 minutes was 35.86 ±3.70 cm H20 in the BM group, while in the LMA-P group, it was 24.17 ±3.74 cm H20 and 25.97 ±3.79 cm H20 respectively (p<0.001). In our study, the trend of OSP continued to increase in the BM group more than in the LMA-P group during surgery. Conclusion The BM provided better OSP than the LMA-P, which was observed throughout the surgery.

To compare clinical versus ultrasound assessment of correct placement of ProSeal Laryngeal mask airway (PLMA): a prospective randomized study.

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.

A Comparative Study of the ProSeal Laryngeal Mask Airway Versus Endotracheal Tube in Neonates With Anorectal Malformations.

BACKGROUND: Laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia. However, LMA use in neonatal age groups (younger than seven days) is limited because many anaesthesiologists prefer to use endotracheal tube in neonates. In this study, we compared the ProSeal LMA and endotracheal tube by measuring their performance, including ease of insertion via number of attempts for placement of device, total effective time for intubation and extubation, hemodynamic responses and perioperative complications. METHODS: In this prospective randomized study, 70 patients (neonates) weighing >2.5 kg, with American Society of Anaesthesiologists (ASA) classification grade 4 requiring emergency surgery for anorectal malformation were enrolled and divided into two groups. After induction, patients' airways were secured with either ProSeal LMA size 1 (Group I) or endotracheal tube (Group II). Anaesthesia was maintained on oxygen and sevoflurane with muscle relaxant atracurium. RESULTS: Demographic and surgical data were similar between the two groups. The ProSeal LMA insertion time was shorter than endotracheal intubation. Hemodynamic variations were less in the ProSeal LMA group as compared to the endotracheal tube group. The total time for removal of airway devices from the end of surgery for the ProSeal group was lower than that for the endotracheal intubation group. Postoperative complications were less in the ProSeal group as compared to the endotracheal group. CONCLUSIONS: The ProSeal LMA can be a better alternative to the endotracheal tube in neonates due to the ease of insertion, lesser changes in hemodynamic parameters and minimal postoperative complications.

Comparison of Proseal Laryngeal Mask Airway with the I-Gel Supraglottic Airway During the Bailey Manoeuvre in Adult Patients Undergoing Elective Surgery.

OBJECTIVE: Since the inception of Bailey manoeuvre, various authors have advocated for the substitution of endotracheal tube (ETT) with a supraglottic airway device (SAD) before the emergence from anaesthesia. There is scant information about the ideal supraglottic device in the literature. The present study compared the Proseal laryngeal mask airway (LMA) with the I-gel SAD during the Bailey manoeuvre. The primary objective was to compare these for ease of insertion and adequate placement of supraglottic airway, whereas the secondary objective was comparison of haemodynamics following the Bailey manoeuvre. METHODS: A total of 100 patients aged 18-60 years who were scheduled for elective surgery under general anaesthesia were randomised into 2 groups: group I (Bailey manoeuvre using Proseal LMA) and group II (Bailey manoeuvre using I-gel). The Bailey manoeuvre was performed 15 min before the end of surgery using the chosen supraglottic airway as per randomisation. We measured the ease of insertion (number of attempts required for insertion) and adequate placement (Brimacombe scoring) of SADs (fibre-optic bronchoscopy). Haemodynamic parameters were recorded until 10 min after the Bailey manoeuvre. RESULTS: The groups were comparable in terms of demographic parameters. Both the devices were comparable in terms of ease of insertion (p>0.05). Significantly higher (p<0.05) Brimacombe scores were seen with the I-gel. Significant (p<0.05) rise in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was observed at the insertion of SAD, removal of ETT, and at 1 min after the Bailey manoeuvre in Proseal LMA in contrast to the I-gel. CONCLUSION: This study showed that the I-gel provides a better glottic visualisation and haemodynamically superior profile compared with the Proseal LMA during the Bailey manoeuvre.

Comparison of laryngeal tube suction II and proseal LMA™ in pediatric patients, undergoing elective surgery.

BACKGROUND: Supraglottic airway devices now have an established place in pediatric anesthesia practice. The laryngeal tube suction (LTS) II, a recent revision of the LTS, has very few studies evaluating its use in pediatric patients. The aim of this study was to compare insertion and ventilation profiles of the LTS-II size 2 and the ProSeal™ Laryngeal Mask Airway (PLMA) size 2 in pediatric patients undergoing elective surgeries. MATERIALS AND METHODS: A randomized prospective study was conducted in 100 children aged 2-5 years between 12 and 25 kg weight, of the American Society of Anesthesiologists physical status I and II scheduled for routine elective surgeries of <90 min duration. They were randomly divided into two groups of 50 each, depending on the device inserted, and a standard protocol for anesthesia was followed. Outcome measures were studied in terms of ease and time of insertion, oxygen saturation (SpO2), oropharyngeal seal pressure (OSP), and ventilation failures. RESULTS: Both groups were well matched in terms of age, weight, and type of surgery. The success rate for the first attempt was 90% for both the LTS-II group and PLMA group. Insertion was found to be easy in the majority of cases in both groups, and there was no statistical difference in blood pressure, heart rate, or SpO2 on insertion. However, the OSP was significantly more in LTS-II and PLMA (P < 0.001). There were no clinically important complications in the postoperative period. CONCLUSIONS: Pediatric size 2 LTS-II is easy to insert and provides higher OSP compared with same size PLMA in anesthetized and paralyzed children undergoing elective surgery. It is a safe alternative to PLMA in short duration elective surgeries and may be a better device as it provides for higher OSPs.

A Prospective Randomised Clinical Trial for the Comparison of Two Techniques for the Insertion of Proseal Laryngeal Mask Airway in Adults-Index Finger Insertion Technique versus 90° Rotation Technique.

OBJECTIVE: The 90° rotation technique for inserting the Proseal laryngeal mask airway (PLMA) is reported to be better than the standard index finger insertion technique to improve the insertion success rate. The objective of this study was to evaluate and compare the ease of insertion through the 90° rotation and standard insertion techniques in terms of number of attempts, duration of insertion and occurrence of complications. METHODS: One hundred and twenty adult patients were allocated to either a standard technique group or rotation technique group with 60 patients in each. In the rotation technique group, the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90° counter-clockwise around the patient's tongue, advanced and rotated back until resistance was felt. RESULTS: The success rate of the rotation technique group at the first insertion attempt was greater than that of the standard index finger insertion technique (98% vs. 78%; p=0.001), and less time for insertion was required (11.88±3.62 s vs. 25.98±10.92 s; p<0.0001). The incidence of post-operative sore throat was lower (15% vs. 38.34%; p=0.0067), and blood staining on the PLMA was less (11.7% vs. 45%; p<0.0001). The increase in the mean arterial pressure was more in the standard technique group. CONCLUSION: The 90° rotation technique has a higher success rate at first insertion attempt for inserting the ProSeal LMA than the index finger insertion technique with less time for insertion and fewer side effects.