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October 19, 2008
9:00 AM - 11:00 AM
Room Hall E2-Area G,
A Comparison of the I-Gel with the Lma Unique in Non-Paralysed Anaesthetized Aduld Patients.
Helga Francksen, M.D., Jochen Renner, M.D., Martin Bauer, M.D., Jens Scholz, M.D., Berthold Bein, M.D.
Anaesthesiology and Intansive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
Purpose of the study: Reusable supraglottic airway devices have been established in clinical anesthesia and were previously shown to be safe and efficient (1). However, especially for emergency airway management, there was increasing demand for disposable devices. The purpose of the present prospective, randomised, controlled trial was to assess two disposable devices, the newly developed non-inflatable laryngeal mask I-Gelâ and the laryngeal mask UniqueTM (LMA-U) in routine clinical practice.

Materials and methods: After IRB approval and written informed consent was obtained, in 80 patients (ASA 1–3), undergoing minor routine gynaecologic surgery, standardised total intravenous anesthesia (remifentanil and propofol) was induced. Patients were randomly allocated to controlled ventilation (FiO2, 0.4; VT, 7 ml/kg; respiratory rate, 10 min-1) with the I-Gel (n=40) or LMA-U (n=40). Both devices were inserted by a single experienced anesthesiologist. Using the LMA-U, cuff inflation was performed with 20 ml of air as recommended by the manufacturer. SpO2 was recorded before induction of anaesthesia, and after administration of oxygen. After five and ten minutes of ventilation with the I-gel or LMA-U, SpO2, etCO2, tidal volume (VT) and peak airway pressure (Paw) were recorded. After insertion, the position of both devices was controlled using a fiberoptic bronchoscope. Capillary blood gas samples were taken before induction of anesthesia, and after 10 minutes of ventilation. Time of insertion and airway leak pressure of each device were measured (2). Occurrence of gastric inflation was assessed with a stethoscope placed on the epigastrium. Patients were asked about sore-throat, dysphonia, and dysphagia 24 hours after surgery.

Results: There were no differences with respect to demographic data between groups. Time of insertion was comparable with the I-Gel and LMA-U( median: 17 vs. 15 s.; range :11-27 vs.10-33 s.), failures 0/40 with I-Gel and 1/40 with LMA-U devices. Blood gas samples and ventilation variables revealed sufficient ventilation and oxygenation with either device. Mean Paw was comparable in both devices (I-Gel: 14.2±3.0 cmH2O, LMA-U: 12.2±2.1 cmH2O), whereas mean airway leak pressure was significantly higher (p<0.0001) in the I-Gel group (28 cmH2O, range 24-40) compared to the LMA-U group (21 cmH2O, range 8-31).[figure1]No gastric inflation occurred with I-Gel device, whereas we observed in the LMA-U group gastric insufflation in 3 patients. Fiberoptic control of the position of the devices revealed no differences. Post-operative sore-throat and dysphagia were comparable in both devices.

References: (1) Anesth Analg 2002;95:1094-7.

(2) Br J Anaesth 1999;82:286-7.

Anesthesiology 2008; 109 A523
Figure 1