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      Comparison and evaluation of single-use LMA supreme versus the reusable proseal LMA in paralyzed patients undergoing surgery with controlled ventilation

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          Abstract

          Background and Aims:

          The objective of this prospective randomized blinded study was to assess the safety and efficacy of the laryngeal mask airway (LMA) Supreme as compared with the LMA Proseal.

          Material and Methods:

          A total of 60 patients were randomised into two groups to either receive a Proseal LMA (PLMA) or Supreme LMA (SLMA) for airway management. The primary outcome was to measure oropharyngeal leak pressure (OLP) in both groups. The secondary outcomes were the measurement of insertion time, insertion success rate, fibreoptic grading, intracuff pressure, ease of ventilation, and airway pressure on standard ventilatory settings and postoperative complications.

          Results:

          Intracuff pressure increase after 60 minutes of induction was significantly higher in the PLMA group (PLMA 97.43 ± 11.03 cm of H 2O and SLMA 75.17 ± 8.95 cm of H 2O). OLP was recorded after device insertion, after 30 min and after 60 min in each group and was found to be 28.71 ± 2.97, 30.93 ± 2.87, and 31.93 ± 2.72 cm of H 2O in PLMA and 24.84 ± 2.08, 26.73 ± 2.26, and 27.95 ± 2.55 cm of H 2O in SLMA group, respectively. The mean OLP with the SLMA was significantly (p=<.001) lower than PLMA. All the other parameters were comparable in both groups.

          Conclusion:

          PLMA is better than SLMA as airway device to ventilate at higher airway pressure in paralyzed adult patients. On the basis of our study, we recommend Proseal over Supreme LMA.

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          Most cited references 15

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          The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients.

          The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a modified cuff to improve seal and a drainage tube to provide a channel for regurgitated fluid and gastric tube placement. In the present randomized, crossover study, the authors tested the hypothesis that ease of insertion, airway sealing pressure, and fiberoptic position differ between the PLMA and the standard laryngeal mask airway (LMA). For the PLMA, we also assess ease of gastric tube placement and the efficacy of an introducer tool. Sixty paralyzed, anesthetized adult patients were studied. Both devices (only size 4) were inserted into each patient in random order. Airway sealing pressure and fiberoptic position were determined during cuff inflation from 0 to 40 ml in 10-ml increments. Gastric tube insertion was attempted with the PLMA if there was no gas leak from the drainage tube. In 60 additional patients, ease of insertion for the PLMA was compared with and without an introducer. First-time success rates were higher (60 of 60 vs. 52 of 60; P = 0.003) and the effective airway time shorter (9 +/- 3 s vs20 +/- 18 s; P < 0.0001) for the LMA. There were no failed uses of either device within three attempts. Airway sealing pressure was 8-11 cm H2O higher for the PLMA at all cuff volumes (P < 0.00001) and was higher in females for both devices. Fiberoptic position was better with the LMA at all cuff volumes (P < 0.00001), but vocal cord visibility was similar (LMA, 59 of 60; PLMA, 56 of 60). For the PLMA, gastric tube placement was successful in 58 of 58 patients and took 9 +/- 5 s. First-time success rates were higher (59 of 60 vs53/60; P = 0.03) and the effective airway time shorter (15 +/- 13 s vs 23 +/- 18 s; P = 0.008) with the introducer. The PLMA is capable of achieving a more effective seal than the LMA and facilitates gastric tube placement, but it is more difficult to insert unless an introducer tool is used. When correctly positioned, the PLMA isolates the glottis from the upper esophagus with possible implications for airway protection.
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            Safety and efficacy of laryngeal mask airway Supreme versus laryngeal mask airway ProSeal: a randomized controlled trial.

            The Supreme laryngeal mask airway (LMA) is a new single-use polyvinyl chloride supraglottic device that combines the functionality of the ProSeal and Fastrach airways. High oropharyngeal leak pressures are important as they indicate airway protection, feasibility of positive pressure ventilation and likelihood of successful LMA placement. The oropharyngeal leak pressure of the LMA Supreme is not well established versus the LMA ProSeal. This study was designed to compare the safety and efficacy of the LMA Supreme versus the LMA ProSeal in elective ambulatory procedures.
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              LMA-Supreme--a new single-use LMA with gastric access: a report on its clinical efficacy.

              LMA-Supreme (SLMA) is a new, single-use, latex-free, laryngeal mask airway with gastric access. The anatomically shaped airway tube permits easy insertion without placing fingers in the patient's mouth. The cuff is designed to provide higher seal pressures than the LMA-Classic or Unique. A prospective, randomized, cross-over study of LMA-Proseal (PLMA) and SLMA in 36 fasted, adult, female patients with general anaesthesia, neuromuscular block (NMB) and positive pressure ventilation (PPV) is presented. First attempt insertion in 35/36 patients in each group (two attempts in one PLMA and three in one SLMA patient) with successful PPV in all. Median insertion time (15 s) and glottic seal pressure (28 cm H(2)O) were similar in both groups. Median volume of air for cuff inflation to 60 cm H(2)O was 22.4 ml (PLMA) and 21.9 ml (SLMA). Median age and BMI: 50 yr (range 25-74), 51 yr (23-72) and 29 kg m(-2) (range 21-46), 30 kg m(-2) (20-42) in PLMA and SLMA groups, respectively. Mallampati score mean arterial pressures after induction, and 1 min after induction and insertion of the first device were similar. A lubricated gastric tube (16Fr) was passed at the first attempt in both devices: median gastric content 15 ml (5-75), 17.5 (5-124) and a median pH of 3 (1-6), 1.5 (1-6) in the PLMA and SLMA groups, respectively. Fibreoptic laryngoscopic scores of 1-2 were recorded in 29/36 in both groups. Insertion success, glottic seal pressure and gastric access were similar in SLMA and PLMA.
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                Author and article information

                Journal
                J Anaesthesiol Clin Pharmacol
                J Anaesthesiol Clin Pharmacol
                JOACP
                Journal of Anaesthesiology, Clinical Pharmacology
                Wolters Kluwer - Medknow (India )
                0970-9185
                2231-2730
                Oct-Dec 2020
                18 January 2021
                : 36
                : 4
                : 494-499
                Affiliations
                Department of Anesthesiology, ESI-PGIMSR, Basaidarapur, New Delhi, India
                [1 ]Department of Anesthesiology, Narayana Nethralaya, Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. Shikha Chahar, House Number 211, Second Floor, Raja Garden, New Delhi - 110015, India. E-mail: shikhachahar123@ 123456gmail.com
                Article
                JOACP-36-494
                10.4103/joacp.JOACP_298_18
                8022041
                Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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