Institutional members access full text with Ovid®

Share this article on:

Comparison of the laryngeal mask airway supreme and the i-gel in paralysed elderly patients: A randomised controlled trial

Kim, Myoung H.; Lee, Jae H.; Choi, Yong S.; Park, Sujung; Shin, Seokyung

European Journal of Anaesthesiology (EJA): August 2018 - Volume 35 - Issue 8 - p 598–604
doi: 10.1097/EJA.0000000000000700
Airway management

BACKGROUND The laryngeal mask airway supreme (LMA-S) and i-gel are both popular second-generation supraglottic airway devices that have been widely studied in surgical patients, but their differences in clinical performance in the elderly are not clear.

OBJECTIVE We compared the efficacy and safety of the LMA-S and i-gel in anaesthetised and paralysed elderly patients.

DESIGN A randomised study.

SETTING Single-centre trial, study period January 2014 from to October 2016.

PATIENTS One hundred and six elderly patients who underwent urological or orthopaedic surgery with an expected duration less than 2 h.

INTERVENTION Patients were allocated to either the LMA-S (n = 53) or i-gel (n = 53) group. All insertions were performed in a standardised manner according to the manufacturers’ instructions.

MAIN OUTCOME MEASURES Our primary endpoint was the rate of successful insertion at the first attempt. The adequacy of positive pressure ventilation and airway sealing, fibreoptic laryngoscopy grades and stability of airway maintenance during anaesthesia were also assessed.

RESULTS Although the rate of successful insertion at the first attempt was similar between the two groups (94.3 vs. 82.7%, P = 0.072), more patients required device manipulation during insertion with the LMA-S than the i-gel (42.3 vs. 18.9%, P = 0.011). Good fibreoptic laryngoscopy grades were significantly more common with the i-gel than the LMA-S (79.3 vs. 55.8%, P = 0.042), and peak inspiratory pressures were lower in the i-gel group both immediately after insertion and at the end of surgery. Leak pressures were significantly higher in the i-gel group than the LMA-S group, both immediately after insertion and at the end of surgery (25.8 vs. 23.0, P = 0.036; and 28.1 vs. 23.7, P < 0.001, respectively).

CONCLUSION Both the LMA-S and i-gel were used successfully and safely in elderly patients. However, the i-gel demonstrated better airway sealing than the LMA-S at insertion and during maintenance of anaesthesia.

TRIAL REGISTRATION NCT02026791 at clinicaltrial.gov.

From the Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea (MHK, JHL, YSC, SP, SS)

Correspondence to Seokyung Shin, Department of Anaesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea Tel: +82 2 2227 4624; fax: +82 2 2227 7897; e-mail: skshin@yuhs.ac

Published online 28 August 2017

© 2018 European Society of Anaesthesiology