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.

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.

The Laryngeal Mask Airway Supreme for positive pressure ventilation during laparoscopic cholecystectomy

Background: Laryngeal Mask Airway Supreme™ (LMA Supreme™) is a new single-use polyvinyl chloride supraglottic device that offers gastric access. To date, studies that have tested the LMA Supreme™) for use in laparoscopic surgery have been reported. We present the largest evaluative study that describes the use of this mask for anaesthesia in gynaecological laparoscopic surgery.Method: Hospital ethics board approval was obtained, and 140 fasted patients undergoing elective gynaecological laparoscopy were prospectively studied. We evaluated the ease of insertion of the device and the drain tube, the oropharyngeal leak pressure (OLP), incidence of postoperative sore throat, and other adverse events.Results: Insertion of the LMA Supreme™ was successful in all patients (first attempt, n = 123; second attempt, n = 16; and third attempt, n = 1). Gastric tube insertion was successful in all patients (easy, n = 135; difficult, n = 5). Initial mechanical ventilation was adequate in almost all cases. Mean OL...

/pdf/the-laryngeal-mask-airway-supreme-safety-and-efficacy-during-2ba4r5ewha.pdf

The Laryngeal Mask Airway Supreme™: safety and efficacy during gynaecological laparoscopic surgery

Background: LMA Proseal TM (LMA-P) and i-gel TM are two of the most used supraglottic airway devices (SADs) with an inbuilt drain channel. We compared these devices regarding efficacy, safety, ease of use and incidence of adverse events. Methodology: We randomized 140 patients undergoing elective laparoscopic cholecystectomy to have either i-gel or LMA-P. We evaluated speed of insertion, success rates, ease of insertion of the drain tube, leak pressure and tidal volume. We also recorded postoperative oropharyngeal discomfort based on sore throat, dysphagia and dysphonia. Results: I-gel had a lower leak pressure and achieves a lower tidal volume compared to the LMA-P (28.3 ± 3.3 cmH 2 O versus 30.9 ± 2.6 cmH 2 O; p = 0.027), as well as a lower tidal volume provided (562.6 ± 41 ml versus 584.8 ± 44 ml; p = 0.025). Insertion times were lower for i-gel compared with LMA-P (10 ± 1.7 versus 11.7 ± 2 s; p = 0.004). Insertion success rate on first attempt as well as drain tube insertion were comparable between groups. I-gel group complained about a slightly higher sore throat scoring at 2 h postoperatively (p = 0.025). Conclusions: We found that i-gel had a lower leak pressure and achieves a lower tidal volume compared to the LMA-P in anesthetised patients undergoing laparoscopic cholecystectomy. Although i-gel was quicker to insert than LMA-P, it reported higher sore throat scoring at 2 h postoperatively.

Comparison of the i-gel TM and the LMA Proseal TM in anesthetized patients undergoing laparoscopic cholecystectomy: a prospective, randomized clinical trial

Javier Yuste

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.

The Laryngeal Mask Airway Supreme for positive pressure ventilation during laparoscopic cholecystectomy

The Laryngeal Mask Airway Supreme™: safety and efficacy during gynaecological laparoscopic surgery

Comparison of the i-gel TM and the LMA Proseal TM in anesthetized patients undergoing laparoscopic cholecystectomy: a prospective, randomized clinical trial