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      Comparison of Clinical Performance of I-Gel™ with LMA—Proseal™ in Elective Surgeries

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          Abstract

          Summary

          Sixty ASA grade I & II adult patients of either sex were randomly assigned into two groups. Group I (n=30) for I-gel and Group P (n=30) for LMA – ProSeal. We assessed the airway sealing pressure, ease of insertion, success rate of insertion, ease of gastric tube placement, airway trauma by post operative blood staining of the device, tongue, lip and dental trauma, hoarseness, regurgitation / aspiration and cost effectiveness. Although the airway sealing pressure was higher with Group P (29.6 cm H 2O) than with Group I (25.27 cm H 20) (p < 0.05), but the airway sealing pressure of Group I was very well within the normal limit to prevent aspiration. The ease of insertion was more with Group I (29/30) than with Group P (25/30) (p < 0.05). The success rate of first attempt of insertion and ease of gastric tube placement was more with Group I (p > 0.05). Blood staining of the device & tongue, lip and dental trauma was more with Group P (p >0.05). There was no evidence of bronchospasm, laryngospasm, regurgitation, aspiration or hoarseness in either group.

          To conclude I-gel is a novel supraglottic device with an acceptable airway sealing pressure (25.27 cm H 2O). It is easier to insert, requires less attempts of insertion, has easier gastric tube placement and is less traumatic as compared to LMA-ProSeal.

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          Most cited references7

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          Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients.

          We have compared four tests for assessing airway sealing pressure with the laryngeal mask airway (LMA) to test the hypothesis that airway sealing pressure and inter-observer reliability differ between tests. We studied 80 paralysed, anaesthetized adult patients. Four different airway sealing pressure tests were performed in random order on each patient by two observers blinded to each other's measurements: test 1 involved detection of an audible noise; test 2 was detection of end-tidal carbon dioxide in the oral cavity; test 3 was observation of the aneroid manometer dial as the pressure increased to note the airway pressure at which the dial reached stability; and test 4 was detection of an audible noise by neck auscultation. Mean airway sealing pressure ranged from 19.5 to 21.3 cm H2O and intra-class correlation coefficient was 0.95-0.99. Inter-observer reliability of all tests was classed as excellent. The manometric stability test had a higher mean airway sealing pressure (P < 0.0001) and better inter-observer reliability (P < 0.0001) compared with the three other tests. We conclude that for clinical purposes all four tests are excellent, but that the manometric stability test may be more appropriate for researchers comparing airway sealing pressures.
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            Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff.

            The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.
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              The LMA 'ProSeal'--a laryngeal mask with an oesophageal vent.

              We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H2O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (P < 0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study.
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                Author and article information

                Journal
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Medknow Publications (India )
                0019-5049
                0976-2817
                June 2009
                : 53
                : 3
                : 302-305
                Affiliations
                [1 ]Chairperson, Department of Anesthesiology, Jaipur Golden Hospital, New Delhi, (INDIA)
                [2 ]Consultant, Department of Anesthesiology, Jaipur Golden Hospital, New Delhi, (INDIA)
                [3 ]P.G.Student, Department of Anesthesiology, Jaipur Golden Hospital, New Delhi, (INDIA)
                Author notes
                Correspondence to: Monika Gupta, 70 Loknayak Apartments, Sector 9, Rohini, New Delhi Email: mansi5511@ 123456yahoo.co.in
                Article
                IJA-53-302
                2900120
                20640137
                dc9a8071-18fa-470e-8b0a-ed7dc19bfdbf
                © Indian Journal of Anaesthesia

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 March 2009
                Categories
                Clinical Investigation

                Anesthesiology & Pain management
                airway sealing pressure,lma – proseal,i-gel
                Anesthesiology & Pain management
                airway sealing pressure, lma – proseal, i-gel

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