A comparative analysis of the baska mask versus I-gel for general anesthesia in surgical patients undergoing laparoscopic cholecystectomy

Background and Aims: Baska mask is a newly introduced membranous cuffed supraglottic device whereas I-gel is made up of thermoplastic elastomer, both suitably designed from the anatomical perspective of the airway. Settings and Design: We conducted randomized controlled comparative trial of the Baska mask versus I-gel in a patient undergoing laparoscopic cholecystectomy. Subjects and Methods: A total of 100 adult patients in the age group of 20–70 years undergoing elective laparoscopic cholecystectomy were randomly divided into two groups as follows: (1) Baska mask group and (2) I-gel group. The primary outcome was to compare oropharyngeal leak pressure (OLP) of Baska mask and I-gel groups. The secondary outcome was the ease of insertion and removal, number of attempts, insertion time, leak fraction, and laryngopharyngeal morbidity. Statistical Analysis Used: Demographic details were compared using the Chi-square and t-tests. Student's t-test for independent variables was used to compare means of data obtained. Results: Mean OLP was significantly higher in Baska mask group than I-gel group at insertion (29.54 ± 1.41 cm H2O vs. 23.16 ± 3.07 cm H2O, P = 0.02) and 30 min after insertion (33.54 ± 1.16 cm H2O vs. 25.97 ± 2.25 cm H2O, P = 0.001). Insertion time was 12.33 ± 2.61 s with Baska mask and 11.31 ± 1.84 s with I-gel (P = 0.02). Insertion was very easy in 58% of patients in Baska mask and 76% of patients in I-gel (P = 0.03). The leak fraction of Baska mask was significantly less than I-gel (3.56 ± 3.6 vs. 7.16 ± 2.45, P = 0.01). Laryngopharyngeal morbidity was comparable in the two groups. Conclusion: Baska mask is more effective in providing greater OLP compared to I-gel without any increase in laryngopharyngeal morbidity.

Comparison of I-gel and ProSeal laryngeal mask airway during volume controlled ventilation

Introduction: I-gel and the ProSeal laryngeal mask airway (PLMA) are two supra-glottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of I-gel compared with PLMA for airway maintenance in patients under general anesthesia with controlled ventilation. The aim of the study: To compare the supra-glottic airway devices, I-Gel and ProSeal Laryngeal mask airway with respect to Ease of insertion, Time taken for insertion, Airway leak pressure, Hemodynamic response during intubation. Materials and methods: A total number of, 40 patients were randomized into two groups of 20 each. After induction of anesthesia using a standardized protocol for all the patients, one of the supra-glottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion, airway leak pressure, hemodynamic changes, were noted. Results: There was no significant difference in the incidence of adverse effects in both the groups. One incidence of airway trauma was noted in I-gel group. No gastric insufflations and laryngo or bronchospasm in both groups. Conclusion: Based on the result of our study we conclude that I-gel had an acceptable airway leak pressure of 23 cm H2O when compared to ProSeal whose airway leak pressure is significantly higher i-e 29 cm H2O.Both the devices provided optimal oxygenation and no fall in saturation was observed in both the groups.

A Comparison Of Ease Of Insertion AndWorking Performance Of Pro-seal And I Gel - The Supra Glottic Airway Devices In Elective Surgeries.

Background: PLMA has improved features of cuff design and incorporation of gastric drain channel led to better seal achievement around the glottis. I gel single-use, cuff less, utilizes a thermoplastic elastomer to create a more intimate interface for interaction with the supraglottic tissue. Supraglottic airway devices provide good seal during anaesthesia for spontaneously breathing and controlled ventilation with moderate airway pressures. Methodology: Hundred patients from routine elective surgical procedure were randomized to receive mechanical ventilation, through either I gel or PLMA. Insertion characteristics, working performance, ease of gastric tube insertion and hemodynamic characteristics was assessed. Results: The shorter insertion time (Group I was 20.98 ± 2.29 sec and Group P 30.04 ± 2.6 sec; P value <0.05) was found with I gel as compared to PLMA. There was no statistical difference in insertion attempts, ease of insertion, failure of insertion and airway manipulation. The success and ease of gastric tube placement was more with I gel than with PLMA. Expired tidal volume and leak pressures were better with group P as compared to group I and the leak volume was insignificant in both the groups. The incidence of sore throat and blood staining was similar in both the groups. Conclusion: In comparison to PLMA, I gel is a cheaper, easier to insert, requires less manipulation and cuff inflation is not needed. It has other potential advantages like easier gastric tube placement and fewer traumas to oropharyngeal structure.

The CobraPLA(TM) During Anesthesia with Controlled Ventilation: A Clinical Trial of Efficacy

The CobraPLA(TM) (CPLA) is a relatively new supraglottic airway device that has not been sufficiently investigated. Here, we performed a prospective observational study to evaluate the efficacy of the CPLA during controlled ventilation. In 50 anesthetized and paralyzed patients undergoing elective surgery a CPLA was inserted and inflated to an intracuff pressure of 60 cm H2O. The success rate of insertion upon the first attempt was 82% (41/50), with a mean insertion time of 16.3 +/- 4.5 seconds. The adequacy of ventilation was assessed by observing the end tidal CO2 waveform, movement of the chest wall, peak airway pressure (13.5 cm H2O), and leak fraction (4%). We documented the airway sealing pressure (22.5 cm H2O) and noted that the the site of gas leaks at that pressure were either at the neck (52%), the abdomen (46%), or both (2%). In 44 (88%) patients, the vocal cords were visible in the fiberoptic view through the CPLA. There was no gastric insufflation during the anesthesia. Respiratory and hemodynamic parameters remained stable during CPLA insertion. Postoperative blood staining of CPLA was minimal, occurring in 22% (11/50) of patients. Mild and moderate throat soreness was reported in 44% (22/50) and 4% (2/50) of patients, respectively. Lastly, mild dysphonia was observed in 6% (3/50) of patients and mild dysphagia in 10% (5/50) of patients. Our results indicated that the CPLA is both easy to place and allows adequate ventilation during controlled ventilation.

Changes in Position and Intraabdominal Pressure do not Influence Oropharyngeal Leak Pressure in Laparoscopic Surgery Maintained with a ProSeal Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: It is known that pneumoperitoneum and changes of body position during laparoscopic surgery influenced peak inspiratory pressure (PIP). We asked the question whether oropharyngeal leak pressure (OLP) is changed by changes in intraabdominal pressure and position during laparoscopic surgery with a ProSeal laryngeal mask airway (PLMA). Since gynecological laparoscopic surgery (Lap-Gy) and laparoscopic cholecystectomy (Lap-C) require different surgical positions, we included both surgeries in this study so that we could investigate the effects of various positions on OLP. METHODS: Lap-Gy (n = 15) was performed in the trendelenburg position combined with the lithotomy position, whereas Lap-C (n = 10) was performed in the reverse trendelenburg position. The measured variables were PIP and OLP. We also marked the fiberoptic score to determine the intraoral position (FP) of the PLMA. OLP was measured using a manometric stability test. The variables were measured in a regular sequence as follows: S-0o-0, L-0o-0, L-0o-15, L-(-15o)-15, L-(-30o)-15 in Lap-Gy and S-0o-0, S-0o-15, S-(+15o)-15, S-(+30o)-15 in Lap-C. At each measured point, the capital S means supine and L lithotomy. Intermediate numbers with a 'o' superscript are table angles to the horizontal plane (degrees) , '-' means the trendelenburg position and '+', the reverse trendelenburg position, and the last number represents intraabdominal pressure (mmHg). RESULTS: PIP was significantly increased when L-0o-0 changed to L-0o-15, L-0o-15 to L-(-15o)-15 and L-(-15o)-15 to L-(-30o)-15 in Lap-G, and when S-0o-0 was changed to S-0o-15 in Lap-C (P < 0.05). But, OLP and FP were not significantly altered by changes in postion or intraabdominal pressure in both Lap-Gy and Lap-C. CONCLUSIONS: PIP was affected by pneumoperitoneum and positional changes. But, increases in intraabdominal pressure by pneumoperitoneum and changes in position during laparoscopic surgery had no effect on OLP and FP of PLMA.

Efficacy of the Laryngeal Tube in General Anesthesia / 대한마취과학회지

BACKGROUND: A prototype airway management device, a laryngeal tube, has been recently introduced in Korea. This study was designed to assess the efficacy of the laryngeal tube for airway management under general anesthesia. METHODS: We studied thirty-six ASA physical status I and II patients undergoing general anesthesia. Anesthesia was induced with sleep dose propofol 2.0 mg/kg i.v., supplemented with fentanyl 1 microgram/kg, and maintained with 50% nitrous oxide and propofol. After inserting the laryngeal tube, its cuff was inflated using a balloon cuff gauge until the intracuff pressure reached approximately 65 cmH2O. Adequacy of ventilation was assessed by observing the end tidal carbon dioxide wave form, chest wall movement and by stethoscope auscultation. Oropharyngeal leak pressure was also measured. Changes in heart rate, blood pressure, end-tidal carbon dioxide, airway pressure and oxygen saturation before induction, before insertion, 2, 5 and 10 minutes after insertion and 5 minutes after incision were recorded. RESULTS: The first time success rate at achieving an effective airway was 30 in 36 (83%). The mean leak pressure was 22.9+/-4.6 mmHg. Heart rate, blood pressure, oxygen saturation, end-tidal carbon dioxide and airway pressure values remained stable during laryngeal tube insertion and during the surgical procedure. CONCLUSIONS: We conclude that the laryngeal tube is easy to place, allows adequate ventilation and has a lower incidence of complications. It may offer an alternative device for the oxygenation of non-intubated patients undergoing general anesthesia.