title: Effect of pneumoperitoneum and Trendelenberg position on oropharyngeal sealing pressure of I-gel™ and ProSeal LMA™ in laparoscopic gynecological surgery: A randomized controlled trial.
abstract: BACKGROUND
  A sustained and effective oropharyngeal sealing with supraglottic airway (SGA) is required to maintain the ventilation during laparoscopic gynecological surgery in the Trendelenburg position. This study was conducted with I-gel™ and ProSeal LMA™, two prototype SGA devices with a gastric access.
  
  
  METHODS
  We enrolled 60 American Society of Anesthesiologists physical status I and II patients and randomized to either I-gel or ProSeal LMA (PLMA) group. After induction of anesthesia using a standardized protocol, one of the SGA devices was inserted. The primary objective of this study was to compare the oropharyngeal leak (sealing) pressure of I-gel™ and ProSeal LMA™ after pneumoperitoneum and Trendelenberg position. The secondary objectives were to compare ease of insertion, cuff position as assessed by the fiberoptic view of the glottis, adequacy of ventilation and incidence of complication.
  
  
  RESULTS
  The baseline (before pneumoperitoneum) oropharyngeal leak pressure of I-gel was less than the PLMA (mean (standard deviation [SD]) 24 (4) vs. 29 (4) cmH2O, respectively; P < 0.001). After pneumoperitoneum, the leak airway pressure in I-gel group was significantly less than that of PLMA group (mean [SD] 27 (3) vs. 34.0 (4) cmH2O, respectively; P < 0.001). Peak airway pressure was increased after pneumoperitoneum compared to baseline in both the groups. However, end-tidal carbon dioxide was maintained within normal limits. The insertion parameters, fiberoptic view of the glottis, fiberoptic view of the drain tube, and complications were comparable between the groups.
  
  
  CONCLUSIONS
  Both I-gel and PLMA are effective for ventilation in gynecological laparoscopic surgeries. However, PLMA provides better sealing as compared to I-gel.
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Sandeep Kumar
authors.initials: SK
authors.lastname: Mishra
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: B
authors.initials: B
authors.lastname: Sivaraman
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Hemavathy
authors.initials: H
authors.lastname: Balachander
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Naggappa
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Satyen
authors.initials: S
authors.lastname: Parida
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Ravindra R
authors.initials: RR
authors.lastname: Bhat
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Pondicherry, India.
authors.forename: Kotteeswaran
authors.initials: K
authors.lastname: Yuvaraj
keywords: Fiberoptic; I-gel; ProSeal LMA™; gynecological laparoscopic surgery; leak airway pressures; pneumoperitonium