title: Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study.
abstract: BACKGROUND
  Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD) have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature.
  
  
  OBJECTIVE
  The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation.
  
  
  METHODS
  In the study, Airway Trainer (Laerdal) manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA) and LMA Classic™ (CLMA) in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups.
  
  
  RESULTS
  The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds) as compared to CLMA (17.07 ± 3.5 seconds) and PLMA (25 + 4.78 seconds). Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%). The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA.
  
  
  CONCLUSIONS
  All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA.
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India.
authors.forename: Surender
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India.
authors.forename: Bijaya
authors.initials: B
authors.lastname: Hijam
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Critical Care (JPNATC), AIIMS, New Delhi, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Shende
authors.affiliation: Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.
authors.forename: Vimi
authors.initials: V
authors.lastname: Rewari
keywords: Patient position; prone; supraglottic airway device; tracheal extubation