title: Comparison of three disposable extraglottic airway devices in spontaneously breathing adults: the LMA-Unique, the Soft Seal laryngeal mask, and the Cobra perilaryngeal airway.
abstract: BACKGROUND
  The authors compared three disposable extraglottic airway devices in spontaneously breathing anesthetized adults: the LMA-Unique (LMA-U; The Laryngeal Mask Company, San Diego, CA), the Soft Seal laryngeal mask (SS-LM; Portex Ltd., Hythe, United Kingdom), and the Cobra perilaryngeal airway (Cobra-PLA; Engineered Medical Systems, Inc. Indianapolis, IN).
  
  
  METHODS
  Three hundred twenty consecutive adults (American Society of Anesthesiologists physical status I-III; aged 18-80 yr) were randomly allocated for airway management with one of the three devices. Anesthesia was with fentanyl-propofol for induction and a sevoflurane-nitrous oxide-oxygen-fentanyl mixture for maintenance. Intraoperative data were collected by an unblinded observer about ease of insertion, effective airway time, oropharyngeal leak pressure, anatomical position (determined with a rigid endoscope), intracuff pressure changes, and airway trauma. Data were collected by a blinded observer about sore throat, dysphagia, and dysphonia 2 h after surgery.
  
  
  RESULTS
  Insertion was easier with the LMA-U and SS-LM than with the Cobra-PLA (P < 0.02), but the overall failure rates were similar. Effective airway times were similar among groups. Oropharyngeal leak pressure was lower with the LMA-U than with the SS-LM and Cobra-PLA (P < 0.001). Intracuff pressure increased during surgery with all extraglottic airway devices. Anatomical position was better with the Cobra-PLA than with the SS-LMA (P < 0.001) and better with the SS-LM than with LMA-U (P < 0.001). Blood staining was detected more frequently with the Cobra-PLA than with the LMA-U and SS-LM (P < 0.001), but there were no differences in airway morbidity.
  
  
  CONCLUSIONS
  The LMA-U and SS-LM are easier to insert and cause less trauma than the Cobra-PLA, but the Cobra-PLA has a more effective seal than the LMA-U and better endoscopically determined anatomical position than the LMA-U and SS-LM.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, Catharina Hospital-Brabant Medical School, Eindhoven, The Netherlands. zundert@iae.nl
authors.forename: André
authors.initials: A
authors.lastname: van Zundert
authors.forename: Baha
authors.initials: B
authors.lastname: Al-Shaikh
authors.forename: Joseph
authors.initials: J
authors.lastname: Brimacombe
authors.forename: Jurgen
authors.initials: J
authors.lastname: Koster
authors.forename: Dick
authors.initials: D
authors.lastname: Koning
authors.forename: Eric P
authors.initials: EP
authors.lastname: Mortier
mesh_terms: D000328:Adult; D000368:Aged; D004209:Disposable Equipment; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged