Purpose of reviewBecause of the many advantages of supraglottic airways (SGA) compared to mask ventilation and endotracheal intubation, their areas of application are constantly expanding. The development of second-generation SGAs in particular has led to a widening of the indications for use thanks

Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways.

Background Laryngeal mask airway (LMA) Supreme is a newly introduced single-use supraglottic device, which shares common features of both the LMA Pro-Seal and the intubating LMA (ILMA). Clinical studies have compared the safety and efficacy of the LMA Supreme over the 'gold standard' LMA Pro-Seal in different patient populations. However, the clinical relevance of the potential advantage which one device may offer over the other remains unclear. Objective To quantify the potential advantage that the LMA Supreme may offer over the LMA Pro-Seal on oropharyngeal leak pressures in adult patients. Design A systematic review and meta-analysis of randomised controlled trials. Data source Three authors independently searched PubMed, PubMed Central, Scopus, Central Register of Clinical Trials of the Cochrane Collaboration, Google Scholar and Directory of open access journals. Eligibility criteria Randomised trials comparing the LMA Supreme and the LMA Pro-Seal in adults in supine position, reporting on safety outcomes and published in English. Results Seven randomised controlled trials met the eligibility criteria and were included in the meta-analysis. Pooled data from 666 patients showed that the LMA Supreme provided lower oropharyngeal leak pressures than the LMA Pro-Seal [mean difference -2.48 cmH2O, 95% confidence interval (CI) -4.45 to -0.52]. First insertion success rate was higher for the LMA Supreme than for the LMA Pro-Seal when a muscle relaxant was not used [relative risk 1.17, 95% CI 1.03 to 1.35; number needed to treat (NNT) 6, 95% CI 4 to 12]. Time taken to insert the LMA was similar for the two devices. Complications associated with the use of either of the devices are infrequent and similar. Conclusion Although the single-use LMA Supreme provides lower oropharyngeal leak pressures in comparison with the LMA Pro-Seal for controlled ventilation in supine adult patients, the clinical relevance of this small difference may be debatable and should be weighed against the potential risks of transmission of communicable diseases with the LMA Pro-Seal.

Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients: Systematic review with meta-analysis

Summary
We systematically reviewed 31 adult randomised clinical trials of the i-gel® vs laryngeal mask airway. The mean (95% CI) leak pressure difference and relative risk (95% CI) of insertion on the first attempt were similar: 0.40 (−1.23 to 2.02) cmH2O and 0.98 (0.95–1.01), respectively. The mean (95% CI) insertion time and the relative risk (95% CI) of sore throat were less with the i-gel: by 1.46 (0.33–2.60) s, p = 0.01, and 0.59 (0.38–0.90), p = 0.02, respectively. The relative risk of poor fibreoptic view through the i-gel was 0.29 (0.16–0.54), p < 0.0001. All outcomes displayed substantial heterogeneity, I2 ≥ 75%. Subgroup analyses did not decrease heterogeneity, but suggested that insertion of the i-gel was faster than for first-generation laryngeal mask airways and that the i-gel leak pressure was higher than first generation, but lower than second-generation, laryngeal mask airways. A less frequent sore throat was the main clinical advantage of the i-gel.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/anae.12772

A systematic review and meta-analysis of the i-gel(®) vs laryngeal mask airway in adults.

We systematically reviewed randomised controlled trials of the i-gel® vs different types of laryngeal mask airway in children We included nine studies There was no evidence for differences in: rate of insertion at first attempt; insertion time; ease of insertion; or gastric tube insertion The mean (95% CI) oropharyngeal leak pressure was 329 (225-434) cmH2 O higher with the i-gel, p < 000001 The relative rate (95% CI) of a good fibreoptic view through the i-gel was 110 (101-119), p = 002 There were no significant differences in the rates of complications, except for blood on the airway, relative rate with the i-gel 046 (023-091), p = 002 We concluded that the clinical performance of the i-gel and LMA was similar, except for three outcomes that favoured the i-gel

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.1111/anae.12746

A systematic review and meta-analysis of the i-gel® vs laryngeal mask airway in children.

Background I-gel(™) is a relatively newer addition in the pediatric anesthesia practice. Its comparison with the other laryngeal mask airway repor-ted a wide range of results. Randomized controlled trials where i-gel(™) has been compared with other laryngeal masks (laryngeal mask airway ProSeal(™) and laryngeal mask airway Classic(™) ) in children for airway management device during general anesthesia has been included in this meta-analysis. Methods PubMed and Central Register of Clinical Trials of the Cochrane Collaboration for eligible controlled trials using following search words: 'i-gel', 'i-gel laryngeal mask airway', 'i-gel children', 'i-gel paediatric' until February 15, 2014. A total nine prospective randomized controlled trials have been included in this meta-analysis. Results Pooled analyses have found that i-gel(™) provided significantly higher oropharyngeal leak pressure than laryngeal mask airway ProSeal(™) [496 participants, mean difference 2.07 cm H2 O, 95% CI 0.52-3.62; P = 0.009] and a similar leak in comparison with laryngeal mask airway Classic(™) [355 participants, mean difference 1.73 cm H2 O, 95% CI -0.04, 3.51 cm H2 O; P =0.06]. No difference was found in first insertion success rate and ease of insertion between i-gel(™) , laryngeal mask airway ProSeal(™) , and laryngeal mask airway Classic(™) . Ease of gastric tube insertion is similar between i-gel(™) and laryngeal mask airway ProSeal(™) . Reported complications are infrequent and similar in all three devices. Conclusion We conclude that i-gel(™) is an effective alternative of the commonly used laryngeal mask airway ProSeal(™) and laryngeal mask airway Classic(™) in children for airway management during general anesthesia.

Evaluation of i-gel(™) airway in children: a meta-analysis.

CONTEXT A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. OBJECTIVES To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. DESIGN Prospective, single-blind, randomised, controlled study. SETTING The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. PATIENTS Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. INTERVENTIONS Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. MAIN OUTCOME MEASURES Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. RESULTS Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ± 6.2 versus 26.8 ± 4.1 cmH2O;P < 0.01). This was consistent with a higher maximum tidal volume achieved with the LMAP compared to the LMAS (511 ± 68 versus 475 ± 55 ml; P = 0.04). The success rate of the first attempt insertion was higher for the LMAS group than the LMAP group (96.7 and 71.2%, respectively; P < 0.01). The time taken for insertion, ease of insertion of the drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. CONCLUSION The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.

Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial.

Background and Aims: To compare the use of remifentanil and alfentanil to suppress intraoperative adrenergic response of pain and the influence of these drugs on the recovery profile in patients undergoing laparoscopic cholecystectomy using a total intravenous anesthesia (TIVA) technique. Material and Methods: One hundred patients undergoing elective laparoscopic cholecystectomy were randomized to be managed with either remifentanil (group R) or alfentanil (group A). During general anesthesia, we evaluated adrenergic responses to intubation to first surgical incision and over the surgical procedure. We also recorded time to first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation. Results: The R group reported a significantly lower number of responses to intubation and responses to first surgical incision (14% vs. 30%; P = 0.013 and 8% vs. 18%; P = 0,037, respectively). The event of one or more responses during the surgical procedure was also lower in the R group (56% vs. 70%; P = 0.017). Hypertensive response to surgical stimuli during the procedure was lower in the R group as well as a lower frequency of tachycardia episodes in this group (34% vs. 56%; P = 0.033 and 28% vs. 44%; P = 0.041, respectively). No differences were found between groups relating to the percentage of hypotensive episodes and no episodes of bradycardia were appreciated. Both groups were similar relating to recovery times: time to the first spontaneous breathing, time to successful ventilation, time to respond to verbal orders, and time to extubation. Conclusion: Remifentanil showed a more stable hemodynamic response during the surgery compared with the use of alfentanil in anesthetized patients undergoing laparoscopic cholecystectomy using TIVA. Both opioids, alfentanil and remifentanil, have a similar recovery profile, and they do not delay time to awakening.

Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparoscopic cholecystectomy using total intravenous anesthesia

Diego Anta

Papers

Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial.

Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparoscopic cholecystectomy using total intravenous anesthesia

Effects of pneumoperitoneum on severe hypernatremia in an adult patient who underwent laparoscopic surgery of hydatid cysts