title: A randomized comparison of the laryngeal mask airway supreme™ and laryngeal mask airway unique™ in infants and children: does cuff pressure influence leak pressure?
abstract: BACKGROUND
  The cuff pressure for optimal airway sealing with first-generation laryngeal mask airway has been shown to be 40 cm H(2)O in children. Currently, there are no data regarding the ideal intracuff pressure for the laryngeal mask airway Supreme (Supreme) in children.
  
  
  OBJECTIVE
  To compare the clinical performance of the laryngeal mask airway supreme with the laryngeal mask airway unique in infants and children.
  
  
  METHODS
  One hundred eighty children were assigned to receive either a Supreme or a laryngeal mask airway-U. We hypothesized higher airway leak pressure with the Supreme at both 40 cm H(2)O and 60 cm H(2)O, when compared with the laryngeal mask airway-U. Ease and time of insertion, insertion attempts, fiber optic examination, quality of airway, efficacy of mechanical ventilation, success of gastric tube placement (Supreme), incidence of gastric insufflation, and complications were also assessed.
  
  
  RESULTS
  Airway leak pressure at an intracuff pressure of 60 cm H(2)O for the Supreme was 17.4 (5.2) vs laryngeal mask airway-U at 18.4 (6.6) cm H(2)O and did not differ when compared to an intracuff pressure of 40 cm H(2)O for both devices; Supreme at 17.2 (5) vs laryngeal mask airway-U at 17.7 (6) cm H(2)O. The laryngeal mask airway-U was associated with higher first-attempt success rates. The Supreme was associated with less gastric insufflation than the laryngeal mask airway-U.
  
  
  CONCLUSIONS
  Intracuff pressures of 40 cm H(2)O may be sufficient for the Supreme in children, and there may be no added benefit of an intracuff pressure of 60 cm H(2)O, as leak pressures were similar. The Supreme may be preferred over the laryngeal mask airway-U for its lower rates of gastric insufflation and provision for gastric access when mechanical ventilation is utilized.
authors.affiliation: Department of Pediatric Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA. simjag2000@yahoo.com
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Jagannathan
authors.forename: Lisa
authors.initials: L
authors.lastname: Sohn
authors.forename: Katherine
authors.initials: K
authors.lastname: Sommers
authors.forename: Dawn
authors.initials: D
authors.lastname: Belvis
authors.forename: Ravi D
authors.initials: RD
authors.lastname: Shah
authors.forename: Amod
authors.initials: A
authors.lastname: Sawardekar
authors.forename: Jami
authors.initials: J
authors.lastname: Eidem
authors.forename: Justin
authors.initials: J
authors.lastname: Dagraca
authors.forename: Isabella
authors.initials: I
authors.lastname: Mukherji
mesh_terms: D000399:Air Pressure; D058109:Airway Management / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007327:Insufflation; D007441:Intubation, Gastrointestinal; D017214:Laryngeal Masks; D008297:Male; D010612:Pharyngitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial / Q000295:instrumentation; D016896:Treatment Outcome
keywords: airway; clinical trial; devices