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      A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial

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          Abstract

          Background and Aims:

          Second-generation supraglottic airway devices are widely used in current anaesthesia practice. This randomised study was undertaken to evaluate and compare laryngeal mask airway: ProSeal laryngeal mask airway (PLMA), Supreme laryngeal mask airway (SLMA) and I-gel.

          Methods:

          Eighty-four adult patients undergoing elective surgery were randomly allocated to three groups: group P (PLMA), group I (I-gel) and group S (SLMA) of 28 patients each. Insertion times, number of insertion attempts, haemodynamic response to insertion, ease of insertion of airway device and gastric tube, oropharyngeal leak pressure (OLP) and pharyngolaryngeal morbidity were assessed. The primary outcome measure was the OLP after successful device insertion. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0 software using Chi-squared/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests. P < 0.05 was considered statistically significant.

          Results:

          The demographic profile of patients was comparable. OLP measured after insertion, 30 minutes later and at the end of surgery differed significantly between the three groups ( P < 0.001). The mean OLP was 32.64 ± 4.14 cm·H 2O in group P and 29.79 ± 3.70 cm·H 2O in group S. In group I, the mean OLP after insertion was 26.71 ± 3.45 cm H 2O, which increased to 27.36 ± 3.22 cm H 2O at 30 minutes and to 27.50 ± 3.24 cm H 2O towards the end of surgery. However, these increases were not statistically significant ( P = 0.641). Device insertion time was longest for group P ( P = 0.001) and gastric tube insertion time was longest for group I ( P = 0.001). Haemodynamic response to insertion and pharyngolaryngeal morbidity were similar with all three devices.

          Conclusion:

          PLMA provides better sealing pressure but takes longer to insert. I-gel and SLMA have similar sealing pressures. I-gel insertion time is quicker.

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          Most cited references17

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          Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.

          The catecholamine and cardiovascular responses to laryngoscopy alone have been compared with those following laryngoscopy and intubation in 24 patients allocated randomly to each group. Following induction with fentanyl and thiopentone, atracurium was administered and artificial ventilation undertaken via a face mask for 2 min with 67% nitrous oxide in oxygen. Following laryngoscopy, the vocal cords were visualized for 10 s. In one group of patients, ventilation was then re-instituted via a face mask, while in the second group the trachea was intubated during the 10-s period and ventilation of the lungs maintained. Arterial pressure, heart rate and plasma noradrenaline and adrenaline concentrations were measured before and after induction and at 1, 3 and 5 min after laryngoscopy. There were significant and similar increases in arterial pressure and circulating catecholamine concentrations following laryngoscopy with or without intubation. Intubation, however, was associated with significant increases in heart rate which did not occur in the laryngoscopy-only group.
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            Postoperative sore throat after ambulatory surgery.

            Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery. We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat. In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery. Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.
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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
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                0019-5049
                0976-2817
                November 2018
                : 62
                : 11
                : 858-864
                Affiliations
                [1]Department of Anesthesia, Maulana Azad Medical College, New Delhi, India
                Author notes
                Address for correspondence: Dr. Anisha Singh, Department of Anesthesia, Maulana Azad Medical College, New Delhi, India. E-mail: anisha_sngh@ 123456yahoo.co.in
                Article
                IJA-62-858
                10.4103/ija.IJA_153_18
                6236799
                30532321
                fedb4f93-d154-4845-881d-eb5766fcf91a
                Copyright: © 2018 Indian Journal of Anaesthesia

                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.

                History
                Categories
                Original Article

                Anesthesiology & Pain management
                anaesthesia,laryngeal mask,time,ventilation
                Anesthesiology & Pain management
                anaesthesia, laryngeal mask, time, ventilation

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