title: The LMA-Supreme versus the I-gel in simulated difficult airway in children: a randomised study.
abstract: BACKGROUND
  Supraglottic airway devices such as the LMA-Supreme (LMA-S) and I-gel, which have an additional lumen for the insertion of a gastric tube, can be useful in the management of the difficult airway.
  
  
  OBJECTIVE
  To test the performance of these two devices in the difficult paediatric airway.
  
  
  METHODS
  Randomised double-blind study.
  
  
  METHODS
  Anaesthesia department, university hospital.
  
  
  METHODS
  Sixty American Society of Anesthesiologists (ASA) I-II children undergoing elective surgery.
  
  
  METHODS
  After obtaining ethical approval and written informed consent from the parents, we compared the size 2 LMA-S with the I-gel in a simulated airway scenario made more difficult by using a cervical collar to limit mouth opening and neck movement.
  
  
  METHODS
  The primary aim was to compare the oropharyngeal leak pressure of the LMA-S and the I-gel. The secondary aims were to compare success rate, insertion time, time to pass a gastric tube and fibreoptic view of the larynx.
  
  
  RESULTS
  Oropharyngeal leak pressure (mean ± SD) for the LMA-S was significantly higher than with the I-gel (20.9 ± 3.2 versus 18.9 ± 3.2 cmH2O, P = 0.019). First attempt success rate for the LMA-S was 100 and 90% for the I-gel (P > 0.05). Insertion time of the LMA-S was shorter than I-gel (11.2 ± 1.8 versus 13.5 ± 2.4 s, P = 0.001). Gastric tube placement was possible in all patients. The mean insertion time of the gastric tube was shorter with the LMA-S than with the I-gel (10.3 ± 3.6 versus 12.7 ± 3.2 s, P = 0.009). Fibreoptic laryngeal views were similar in both groups.
  
  
  CONCLUSIONS
  In the simulated difficult airway in children, both airway devices provided effective ventilation. Paediatric size 2 LMA-S sustained a higher airway pressure before leaking and was quicker to insert than the I-gel equivalent. These differences may not be clinically significant.
authors.affiliation: From the Medical Faculty of Kocaeli University, Department of Anesthesiology and Reanimation, Umuttepe/Kocaeli, Turkey.
authors.forename: Alparslan
authors.initials: A
authors.lastname: Kus
authors.forename: Cigdem N
authors.initials: CN
authors.lastname: Gok
authors.forename: Tulay
authors.initials: T
authors.lastname: Hosten
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Gurkan
authors.forename: Mine
authors.initials: M
authors.lastname: Solak
authors.forename: Kamil
authors.initials: K
authors.lastname: Toker
mesh_terms: D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D009960:Oropharynx / Q000502:physiology; D011312:Pressure; D013997:Time Factors