title: Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery.
abstract: BACKGROUND
  The LMA Supreme™, i-gel® and LMA ProSeal™ are second-generation supraglottic airway devices. We tested the hypothesis that these devices differ in performance when used for spontaneous ventilation during anaesthesia.
  
  
  METHODS
  150 patients who underwent general anaesthesia for elective surgery were randomly allocated into three groups. Data was collected on oropharyngeal leak pressures, ease and duration of device insertion, ease of gastric tube insertion, and airway safety.
  
  
  RESULTS
  Leak pressure, our primary outcome measure, was found to be higher for the i-gel than the Supreme and ProSeal (mean ± standard error of the mean: 27.31 ± 0.92 cmH2O, 23.60 ± 0.70 cmH2O and 24.44 ± 0.70 cmH2O, respectively; p = 0.003). Devices were inserted on the first attempt for 90%, 82% and 72% of patients in the i-gel, Supreme and ProSeal groups, respectively (p = 0.105); mean device placement times were 23.58 seconds, 25.10 seconds and 26.34 seconds, respectively (p = 0.477). Gastric tubes were inserted on the first attempt in 100% of patients in the Supreme group, and 94% of patients in the i-gel and ProSeal groups (p = 0.100). There was blood staining on removal in 9 (18%) patients in each of the Supreme and ProSeal groups, with none in the i-gel group (p = 0.007). The incidence of postoperative sore throat, dysphagia and hoarseness was lowest for the i-gel.
  
  
  CONCLUSIONS
  The three devices were comparable in terms of ease and duration of placement, but the i-gel had higher initial oropharyngeal leak pressure and lower airway morbidity compared with the ProSeal and Supreme.
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Singapore.
authors.forename: Geoffrey Haw Chieh
authors.initials: GH
authors.lastname: Liew
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Esther Dawen
authors.initials: ED
authors.lastname: Yu
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Singapore.|National Heart Centre, Singapore.
authors.forename: Shitalkumar Sharad
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Singapore.|National Heart Centre, Singapore.
authors.forename: Harikrishnan
authors.initials: H
authors.lastname: Kothandan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D000768:Anesthesia, General; D003680:Deglutition Disorders / Q000150:complications; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009960:Oropharynx; D010612:Pharyngitis; D011184:Postoperative Period; D011312:Pressure; D012121:Respiration, Artificial; D055815:Young Adult
keywords: LMA; ProSeal; Supreme; airway; i-gel