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Airway Management

A comparison of the i-gel with the LMA Supreme in nonparalysed anaesthetized children: 19AP2-8

Francksen, H.; Duetschke, P.; Renner, J.; Berthold, B.

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European Journal of Anaesthesiology: June 2012 - Volume 29 - Issue - p 231
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Background and Goal of Study: The aim of our prospective, randomised, controlled trial was to assess the applicability of the I-gelTM (Intersurgical Ltd, Wokingham, Berkshire, United Kingdom) (1) and LMA-STM (LMA-STM, Laryngeal Mask Company, Henley-on-Thames, United Kingdom) (2) and I-gelTM in small children in routine clinical practice.

Materials and Methods: 40 children (ASA 1-3) were randomly allocated to controlled ventilation with the I-gelTM (n=20) or LMA-STM (n=20). A size 1 and 2 was used in children. Time of insertion, SpO2, etCO2, VTex and Paw and airway leak pressure (ALP) of each device was measured. After insertion, the position of the devices was controlled using a fiberoptic bronchoscope (FOS) (4=only vocal cords visible; 3=vocal cords plus posterior epiglottis; 2=vocal cords plus anterior epiglottis; 1=vocal cords not visible but functions adaequately; 0=vocal cords not visible and functions inadaequately). We evaluated ease of inserting of the gastric tube, occurrence of gastric inflation was assessed with a stethoscope placed on the epigastrium.

Results: Insertion of the I-gelTM was possible in 18 children in first attempt (90%) and in 1 children in second attempt (5%). In the LMA-STM group, first attempt in 12 patients (60%) and second attempt in 2 patients (10%). Time of insertion was significantly shorter in the I-GelTM group (median: 10 vs. 12 sec; range: 8-12 vs. 10-30 sec; P=0,002). Failure rate: I-GelTM 1/20 vs. LMASTM 6/20 (5/10 size 1 and 1/10 size 2). Ventilation variables revealed sufficient ventilation and oxygenation with either device. Paw (I-GelTM, 15±4 cm H2O; LMA-STM, 15±3 cm H2O) and ALP (I-GelTM 26±5 cm H2O; LMA-STM 23±5 cm H2O) were comparable. Gastric inflation occurred in 2 children in LMA-STM group and in 1 child in I-gelTM group. Gastric tube insertion was achieved in all cases. Fiberoptic scores of the position of the devices were comparable in both groups.

Conclusion(s): Both devices appeared to be simple and save alternatives to secure the airway. Use of the nasogastric tube should be recommended because aspiration is possible although the ALP is adaequate. Significantly shorter insertions time and ease of insertion suggest that the I-gelTM may be the first choice for small children under 5 kg.

References:

1. Anesth Analg 2002; 95:1094-7
2. Anaesthesiology 2009 Feb; 110(2):262-5
© 2012 European Society of Anaesthesiology