title: Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients.
abstract: BACKGROUND
  The single-use supraglottic airway devices LMA-Supreme (LMA-S; Laryngeal Mask Company, Henley-on-Thames, United Kingdom) and i-gel (Intersurgical Ltd, Wokingham, Berkshire, United Kingdom) have a second tube for gastric tube insertion. Only the LMA-S has an inflatable cuff. They have the same clinical indications and might be useful for difficult airway management. This prospective, crossover, randomized controlled trial was performed in a simulated difficult airway scenario using an extrication collar limiting mouth opening and neck movement.
  
  
  METHODS
  Sixty patients were included. Both devices were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, and adverse events.
  
  
  RESULTS
  Success rate for the LMA-S was 95% versus 93% for the i-gel (P = 1.000). LMA-S needed shorter insertion time (34 +/- 12 s vs. 42 +/- 23 s, P = 0.024). Tidal volumes and airway leak pressure were similar (LMA-S 26 +/- 8 cm H20; i-gel 27 +/- 9 cm H20; P = 0.441). Fiberoptic view through the i-gel showed less epiglottic downfolding. Overall agreement in insertion outcome was 54 (successes) and 1 (failure) or 55 (92%) of 60 patients. The difference in success rate was 1.7% (95% CI -11.3% to 7.6%).
  
  
  CONCLUSIONS
  Both airway devices had similar insertion success and clinical performance in the simulated difficult airway situation. The authors found less epiglottic downfolding and better fiberoptic view but longer insertion time with the i-gel. Our study shows that both devices are feasible for emergency airway management in patients with reduced neck movement and limited mouth opening.
authors.affiliation: Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland.
authors.forename: Lorenz G
authors.initials: LG
authors.lastname: Theiler
authors.forename: Maren
authors.initials: M
authors.lastname: Kleine-Brueggeney
authors.forename: Dagmar
authors.initials: D
authors.lastname: Kaiser
authors.forename: Natalie
authors.initials: N
authors.lastname: Urwyler
authors.forename: Cedric
authors.initials: C
authors.lastname: Luyet
authors.forename: Andreas
authors.initials: A
authors.lastname: Vogt
authors.forename: Robert
authors.initials: R
authors.lastname: Greif
authors.forename: M M E
authors.initials: MM
authors.lastname: Unibe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000503:physiopathology; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013990:Tidal Volume / Q000502:physiology; D055815:Young Adult