The I-Gel (Intersurgical) and LMA-Supreme (Teleflex) supraglottic airway devices demonstrate comparable value in the intubation of paralysed patients undergoing general anaesthesia, according to results of a study presented here at the 2014 Annual Meeting of the Canadian Anesthesiologists’ Society (CAS).
Presentation title: Randomized Prospective Trial Comparing Two Supraglottic Airway Devices: I-Gel™ and LMA-Supreme™ in Paralyzed Patients. Abstract 33101
François Donati, MD, PhD, Université de Montréal, Montréal, Québec, presented the prospective study on June 14. She and colleagues randomised 100 paralysed adults (ASA I-III) who were scheduled for elective surgery performed under general anaesthesia to either the I-Gel (n = 50) or the LMA-Supreme (n = 50).
The resident clinician was blinded to the device to be used until just before insertion. If ventilation was inadequate, the particular device was removed and reinserted. If the problem was not alleviated, the other device was substituted. Leak pressure was measured manometrically.
The primary objective was comparison of ventilation pressures.
In both groups, insertion was successful in 46 patients (92%). Leak pressure was similar between patients intubated with the I-Gel (23 ± 7 cm H2O) and those intubated with the LMS-Supreme (21 ± 8 cm H2O) (P =.14). Peak inspiratory pressure was also similar between the devices.
The leak pressure was low for these second-generation devices (improvements over the first devices that were designed by each manufacturer), and the pressures were consistent with the passage of time.
The insertion time was shorter for the I-Gel (19 ± 7 s) than for the LMA-Supreme (27 ± 17 s) (P = .003), and fibre-optic visualisation of the vocal cords was more successful with the I-Gel (37/46 [70%]) than with the LMS-Supreme (22/44 [50%]) (P = .007).
In most cases, the drain tube was correctly placed for the oesophageal opening. Perioperative and postoperative complications (repositioning during surgery, blood on device on removal, sore throat, cough, dysphagia, and dysphonia) were similar for both devices, with postoperative discomfort typically being similar (23/41 for the I-Gel, 26/44 for the LMA-Supreme; P = .82) and comparably mild.
Baseline demographic data were similar in both patient groups.
The faster insertion time of the I-Gel requires further study, the researchers noted, although Dr. Donati stressed that this study involved residents who had little prior experience with intubation. Whether the insertion times of the devices will become more comparable with the absence of a learning curve is an open question, she said.
The team concluded that the choice of a supraglottic airway device is multifactorial and involves ease of insertion, adequate ventilation pressure, and an absence of device-related adverse effects.