Similar oropharyngeal leak pressures during anaesthesia with i-gel, LMA-ProSeal and LMA-Supreme Laryngeal Masks.
BACKGROUND
We test the hypothesis that there are differences in performance among three extra-glottic airway devices during spontaneous breathing anaesthesia.


METHODS
One hundred and fifty consecutive patients (ASA Grade 1-2, aged 18-80 yr) were randomly allocated for airway management with the i-gel (Intersurgical Ltd, Wokingham, Berkshire UK), the LMA-ProSeal and the LMA-Supreme (The Laryngeal Mask Company Ltd, Wooburn Green, Bucks, UK). Anaesthesia was with fentanyl/propofol/sevoflurane mixture. A laryngoscope-guided, gastric tube-guided technique was used for insertion. The following primary variables were assessed: ease of insertion, effective airway time, anatomical position, oropharyngeal leak pressure among devices, and change in oropharyngeal leak pressure between 30 and 60 minutes for each device during the spontaneous breathing anaesthesia.


RESULTS
Differences detected were that the LMA-Supreme was easier to insert and had a shorter effective airway time than the LMA-Proseal and i-gel. Anatomical position was better for the LMA-Supreme than for the i-gel. Oropharyngeal leak pressures were similar among devices during apnoea and spontaneous ventilation, but much higher than in the first generation classic type of laryngeal masks. There were no changes in oropharyngeal leak pressure for any device during the spontaneous breathing phase. There were no differences in performance for any variable between the LMA-ProSeal and i-gel.


CONCLUSIONS
The LMA-Supreme is easier and quicker to insert than the LMA-ProSeal and i-gel using a laryngoscope-guided, gastric tube-guided technique and is associated with better anatomical positioning than the i-gel. Oropharyngeal leak pressures are similar among devices.
Department of Anaesthesia and Intensive Care, Cairns Hospital, James Cook University, Cairns, Queensland, Australia. t.van.zundert@mumc.nl
T C R V
TC
Van Zundert
J R
JR
Brimacombe
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D000077149:Sevoflurane; D013997:Time Factors; D055815:Young Adult
D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol