Comparison of oropharyngeal leak pressure of I-gel <sup>TM</sup> and Blockbuster <sup>TM</sup> laryngeal mask airway in anaesthetized pediatric patients

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Abstract

Background

Supraglottic airways (SGA) are increasingly used in pediatric anesthesia. Among SGA, I-gel ^TM is a commonly used device in pediatric patients. The Blockbuster ^TM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This study was conducted to compare the clinical performance of I-gel ^TM and Blockbuster ^TM LMA in pediatric patients.

Methods

A total of 140 children aged 1–5 years, who were undergoing elective surgery, were randomized into two groups either I-gel ^TM (Group I) or Blockbuster ^TM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under general anesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), and secondary objectives were number of attempts of device insertion, success rate, ease of LMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities.

Results

The mean OPLP was significantly higher for I-gel ^TM compared to Blockbuster ^TM LMA (27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on the first attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time, ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups.

Conclusions

The I-gel ^TM was more efficacious device in term of OPLP than Blockbuster ^TM LMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

Related collections

Most cited references 17

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National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists.

N Woodall, Gregory Cook (2011)

The first stage of the Royal College of Anaesthetists Fourth National Audit Project (NAP4) (to determine the incidence of major complications of airway management in the UK) required a national census of airway management techniques currently in use. A network of local reporters (LRs) was established, with a link to each of the 309 National Health Service hospitals believed to undertake surgery. LRs were requested to report the primary airway management technique used for all general anaesthetics performed in their hospital during a specified 2 week period. Individual unit's data for the survey period were extrapolated using a multiplier of 25 to provide an estimated annual usage. Data were received from all 309 hospitals. The number of general anaesthetics reported in the 2 weeks was 114,904 giving an estimate of 2.9 million annually. Eighty-nine per cent of returns were reported by the LR to be 'accurate' or 'a close estimate' (an error of <10%). The primary airway management device for general anaesthesia was a supraglottic airway in 64,623 (56.2%), a tracheal tube in 44,114 (38.4%), and a facemask in 6167 (5.3%). The second stage of NAP4 is designed to register and collect details of each major airway complication from the same hospitals over a 12 month period. The individual case reports will produce the numerator to calculate the incidence of airway complications associated with general anaesthesia in the UK. The results of the census presented here will provide the denominator.

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Performance of the pediatric-sized i-gel compared with the Ambu AuraOnce laryngeal mask in anesthetized and ventilated children.

Robert Greif, Natalie Urwyler, Maren Kleine … (2011)

This prospective, randomized, controlled trial compares the performance of the pediatric i-gel (Intersurgical Ltd., Wokingham, United Kingdom) with the Ambu AuraOnce laryngeal mask (Ambu A/S, Ballerup, Denmark) in anesthetized and ventilated children. With ethics committee approval and written informed consent, the authors included 208 children, aged 0-17 yr, scheduled for elective day-surgery under general anesthesia. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were first-attempt and overall success, time to sufficient ventilation, and adverse events. Demographic data did not differ between groups. The leak pressure of the i-gel was significantly higher than the leak pressure of the Ambu (mean ± SD: 22 ± 5 cm H₂O vs. 19 ± 3, P < 0.01). First-attempt success was 91% for the i-gel and 93% for the Ambu (P = 0.50). Overall success was 93% for the i-gel versus 98% for the Ambu (P = 0.10). Successfully inserted i-gels needed to be secured by taping in place to ensure the seal in 44% (0% with the Ambu, P < 0.01). Insertion was faster with the Ambu (24 ± 8 s vs. 27 ± 11, P = 0.02). There were no major side effects with either device. The leak pressure of the i-gel was statistically but not clinically significantly higher than the leak pressure of the Ambu. Time to insertion was longer with the i-gel. Both airway devices are suitable for positive pressure ventilation with high success rates in infants and children. Because the i-gel is prone to sliding out, it must be taped in place to avoid loss of the airway.

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A comparison of four methods for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA) in paediatric patients.

J Brimacombe, Y Molina, Matthew Keller (2001)

This study compares four tests for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA). We tested the hypothesis that the oropharyngeal leak pressure and interobserver reliability differs between tests. Eighty paralysed anaesthetized paediatric patients (weight 10-30 kg) were studied with the intracuff pressure set at 60 cmH2O. Four different oropharyngeal leak 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 involved detection of endtidal CO2 in the oral cavity. Test 3 involved observation of the aneroid manometer dial as the pressure increased and noting the airway pressure at which the dial reaches stability. Test 4 involved detection of an audible noise by neck stethoscopy. The mean oropharyngeal leak pressure was 12.5 cmH2O and was similar between tests. The intraclass correlation coefficient was 0.99 for all tests and was classed as excellent. We conclude that all four tests provide accurate and reliable information about oropharyngeal leak pressure in children.

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Author and article information

Journal

Journal ID (nlm-ta): Anesth Pain Med (Seoul)

Journal ID (iso-abbrev): Anesth Pain Med (Seoul)

Journal ID (publisher-id): APM

Title: Anesthesia and Pain Medicine

Publisher: Korean Society of Anesthesiologists

ISSN (Print): 1975-5171

ISSN (Electronic): 2383-7977

Publication date (Print): 31 January 2023

Publication date (Electronic): 30 January 2023

Volume: 18

Issue: 1

Pages: 51-56

Affiliations

[1 ]Department of Anesthesiology and Critical Care, Dr S N Medical College Jodhpur, Jodhpur, India

[2 ]Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, India

Author notes

Corresponding Author Manoj Kamal, M.D. Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences Jodhpur, 123, Vaishali Avenue, Jhanwar Road, Jodhpur 342008, Rajasthan, India Tel: 91-291-2705705, Fax: 91-291-2434376 Email: geetamanojoo7@ 123456yahoo.co.in

Author information

Caren Candace Selvin http://orcid.org/0000-0001-6740-0242

Geeta Singariya http://orcid.org/0000-0002-1887-0851

Pooja Bihani http://orcid.org/0000-0001-8790-1466

Manoj Kamal http://orcid.org/0000-0001-8314-0348

Naveen Paliwal http://orcid.org/0000-0002-3773-4708

Shobha Ujwal http://orcid.org/0000-0002-4190-6381

Article

Publisher ID: apm-22209

DOI: 10.17085/apm.22209

PMC ID: 9902638

PubMed ID: 36746902

SO-VID: ece7de49-a757-4363-aade-a6ab9fafe882

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 7 July 2022

Date revision received : 22 August 2022

Date accepted : 9 September 2022