title: LMA Supreme™ vs i-gel™--a comparison of insertion success in novices.
abstract: Two new supraglottic airway devices, the LMA Supreme™ (LMA) and the i-gel™, offer potential benefits when inserted by inexperienced operators. This study compared the insertion success rate and ventilation profile between the LMA Supreme and the i-gel when inserted by operators without previous airway management expertise. Following a short lecture and manikin training, airway novices were randomly allocated to insert either the LMA Supreme or the i-gel into 80 patients undergoing breast surgery. The primary outcome was first-time success rate, and secondary outcomes were overall success rate, insertion time, airway leak pressure, tidal volume during pressure controlled ventilation at 17 cmH(2)O, and adverse events. First-time insertion success rate was significantly higher for the LMA Supreme than the i-gel (30/39 (77%) vs 22/41 (54%); p = 0.029). Significantly more placement failures occurred with the i-gel (6 vs 0, p = 0.025). Mean (SD) leak pressure (29 (8) vs 23 (11) cmH(2)O, p = 0.007) and expired tidal volume (PCV 17 cmH(2)O) (785 (198) vs 654 (91), p = 0.001) were significantly greater with the LMA Supreme than with the i-gel, respectively. More patients complained of pharyngolaryngeal pain with the LMA Supreme than with the i-gel (17/39 (44%) vs 8/41 (20%); p = 0.053). We found better first time success rate, fewer failures, and a better seal with the LMA Supreme compared with the i-gel, indicating that the LMA Supreme may be preferable for emergency airway use by novices.
authors.affiliation: Section of Anaesthesia and Intensive Care, S. Anna Hospital, University of Ferrara, Ferrara, Italy. rgc@unife.it
authors.forename: R
authors.initials: R
authors.lastname: Ragazzi
authors.forename: L
authors.initials: L
authors.lastname: Finessi
authors.forename: I
authors.initials: I
authors.lastname: Farinelli
authors.forename: R
authors.initials: R
authors.lastname: Alvisi
authors.forename: C A
authors.initials: CA
authors.lastname: Volta
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001940:Breast / Q000601:surgery; D002983:Clinical Competence; D004209:Disposable Equipment; D004867:Equipment Design; D005260:Female; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000295:instrumentation*; D017214:Laryngeal Masks / Q000009:adverse effects / Q000706:statistics & numerical data*; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D013990:Tidal Volume