Self-pressurized air-Q® intubating laryngeal airway versus the LMA® Classic™: a randomized clinical trial

  • Sang Hee Ha
  • Min-Soo Kim
  • Jiwoo Suh
  • Jong Seok Lee
Reports of Original Investigations

Abstract

Purpose

The self-pressurized air-Q® (air-Q SP) intubating laryngeal airway is a relatively new supraglottic airway (SGA) device. The intracuff pressure of air-Q dynamically equilibrates with the airway pressure and adjusts to the patient’s pharyngeal and periglottic anatomy, potentially providing improved airway fit and seal. The aim of this prospective randomized study was to compare the clinical performance of air-Q to the LMA® Classic™ SGA.

Methods

Adult patients requiring general anesthesia for elective surgery were prospectively enrolled and randomly assigned to either air-Q SP or the LMA Classic SGA. Oropharyngeal leak pressure (primary endpoint), success rate, insertion features (insertion time, ease of insertion, requirement for device manipulation), sealing function, gastric insufflation, bronchoscopic view, and oropharyngeal complications at device insertion and following its removal (sore throat, dysphagia, dysphonia) were compared.

Results

The mean (standard deviation [SD]) oropharyngeal leak pressure just after insertion was similar in the air-Q SP and LMA [16.8 (4.9) vs 18.6 (5.5) cm H2O, respectively; mean difference, 1.8 cm H2O; 95% CI, −0.5 to 4.2; P = 0.13] and did not differ at ten minutes following device insertion. Median [interquartile range (IQR)] peak inspiratory pressure just after insertion was lower in the air-Q SP (11.0 [10.0-13.0] vs 13.0 [11.0-14.0] cmH2O, median difference, 1.0 cm H2O; 95% CI, 0.0 to 2.0; P = 0.03) but no difference was observed at ten minutes. The median [IQR] insertion time was faster with the air-Q SP (15.9 [13.6-20.3] sec vs 24 [21.2-27.1] sec; median difference, 8.1 sec; 95% CI, 5.6 to 9.9; P < 0.001) and improved bronchoscopic viewing grade were seen with the air-Q SP immediately after insertion (P < 0.001). No differences between the groups were observed with respect to the rate of successful insertion at first attempt, overall insertion success rate, ease of insertion, and complications.

Conclusions

The air-Q SP had similar leak pressures but a faster insertion time and superior bronchoscopic viewing grade when compared with the LMA Classic. The air-Q SP is a suitable alternative to the LMA Classic in adult patients and may be a superior conduit for tracheal intubation.

Trial registration

www.clinicaltrials.gov (NCT02206438). Registered 1 August 2014.

Étude clinique randomisée du masque laryngé d’intubation Self-pressurized air-Q® versus le LMA® Classic MD

Résumé

Objectif

Le masque laryngé d’intubation Self-pressurized air-Q® (air-Q SP) est un dispositif pour voie respiratoire supraglottique (VRS) relativement nouveau. La pression à l’intérieur du coussinet de l’air-Q s’équilibre de façon dynamique avec la pression des voies respiratoires et s’adapte à l’anatomie pharyngée et périglottique du patient, procurant une meilleure étanchéité et un meilleur moulage aux voies aériennes. L’objectif de cette étude prospective randomisée était de comparer les performances cliniques de l’air-Q et du dispositif supraglottique LMA® ClassicMD.

Méthodes

Des adultes nécessitant une anesthésie générale pour chirurgie élective ont été recrutés de façon prospective et randomisés dans le groupe de dispositif pour VRS air-Q SP ou dans le groupe LMA Classic. La pression de fuite oropharyngée (critère d’évaluation principal), le taux de succès, les caractéristiques de l’insertion (temps d’insertion, facilité d’insertion, nécessité de manipulation du dispositif, insufflation gastrique, vue en bronchoscopie et complications oropharyngées à l’insertion et après le retrait [mal de gorge, dysphagie, dysphonie]) ont été comparés.

Résultats

La pression de fuite oropharyngée moyenne (écart-type [ET]) juste avant l’insertion a été semblable pour l’air-Q SP et le LMA (respectivement 16,8 [4,9] contre 18,6 [5,5] cmH2O; différence des moyennes, 1,8 cmH2O; IC à 95 %, -0,5 à 4,2; P = 0,13] et n’était pas différente 10 minutes après l’insertion du dispositif. La pression inspiratoire maximum médiane (écart interquartile [IQR]) immédiatement après l’insertion était inférieure dans le groupe air-Q SP (11,0 [10,0-13,0] contre 13,0 [11,0-14,0] cmH2O, différence médiane, 1,0 cmH2O; IC à 95 %, 0,0 à 2,0; P = 0,03) mais aucune différence n’a été observée à dix minutes. Le temps d’insertion médian [IQR] a été plus court avec l’air-Q SP (15,9 [13,6-20,3] secondes contre 24 [21,2-27,1] s; différence des médianes, 8,1 s; IC à 95 %, 5,6 à 9,9; P < 0,001) et un meilleur niveau de vision bronchoscopique a été constaté avec l’air-Q SP immédiatement après l’insertion (P < 0,001). Aucune différence n’a été observée entre les groupes concernant les taux de succès des insertions à la première tentative, le taux global de succès des insertions, la facilité d’insertion et les complications.

Conclusions

L’air-Q SP avait des pressions de fuite similaires, mais un temps d’insertion plus rapide et une meilleure visualisation bronchoscopique comparativement au LMA Classic. L’air-Q SP est une option acceptable pour remplacer le LMA Classic chez les patients adultes et peut s’avérer supérieur pour une intubation trachéale.

Enregistrement de l’essai clinique

www.ClinicalTrials.gov (NCT02206438). Enregistré le 1er août 2014.

Notes

Conflicts of interest and source of funding

The authors have no funding or conflicts of interest to disclose.

Editorial responsibility

This submission was handled by Dr. Steven Backman, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Sang Hee Ha and Jong Seok Lee contributed substantially to all aspects of this manuscript, including conception and design, acquisition, analysis, and interpretation of data and drafting the article. Min-Soo Kim contributed substantially to the conception and design, acquisition, and analysis. Jiwoo Suh contributed substantially to the acquisition of data.

References

  1. 1.
    Brimacombe J. The laryngeal mask airway for outpatient anesthesia. J Clin Anesth 1994; 6: 452-4.CrossRefPubMedGoogle Scholar
  2. 2.
    Combes X, Jabre P, Margenet A, et al. Unanticipated difficult airway management in the prehospital emergency setting: prospective validation of an algorithm. Anesthesiology 2011; 114: 105-10.CrossRefPubMedGoogle Scholar
  3. 3.
    Brain AI. The laryngeal mask-a new concept in airway management. Br J Anaesth 1983; 55: 801-5.CrossRefPubMedGoogle Scholar
  4. 4.
    Lin BC, Wu RS, Chen KB, Yang MH, Lo YC, Chiang YY. A comparison of the classic and a modified laryngeal mask airway (OPLAC™) in adult patients. Anesth Analg 2011; 112: 539-44.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim MS, Oh JT, Min JY, Lee KH, Lee JR. A randomised comparison of the i-gel and the Laryngeal Mask Airway Classic™ in infants. Anaesthesia 2014; 69: 362-7.CrossRefPubMedGoogle Scholar
  6. 6.
    Jagannathan N, Sohn LE, Sawardekar A, et al. A randomised comparison of the self-pressurised air-QTM intubating laryngeal airway with the LMA Unique™ in children. Anaesthesia 2012; 67: 973-9.CrossRefPubMedGoogle Scholar
  7. 7.
    Lardner DR, Cox RG, Ewen A, Dickinson D. Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade. Can J Anesth 2008; 55: 29-35.CrossRefPubMedGoogle Scholar
  8. 8.
    Andrews DT, Williams DL, Alexander KD, Lie Y. Randomised comparison of the Classic Laryngeal Mask Airway™ with the Cobra Perilaryngeal Airway™ during anaesthesia in spontaneously breathing adult patients. Anaesth Intensive Care 2009; 37: 85-92.PubMedGoogle Scholar
  9. 9.
    Ali A, Canturk S, Turkmen A, Turgut N, Altan A. Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. Eur J Anaesthesiol 2009; 26: 1010-4.CrossRefPubMedGoogle Scholar
  10. 10.
    Reza Hashemian SM, Nouraei N, Razavi SS, et al. Comparison of i-gel™ and laryngeal mask airway in anesthetized paralyzed patients. Int J Crit Illn Inj Sci 2014; 4: 288-92.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Jagannathan N, Sohn LE, Mankoo R, Langen KE, Roth AG, Hall SC. Prospective evaluation of the self-pressurized air-Q intubating laryngeal airway in children. Paediatr Anaesth 2011; 21: 673-80.CrossRefPubMedGoogle Scholar
  12. 12.
    Jagannathan N, Sohn LE, Mankoo R, Langen KE, Mandler T. A randomized crossover comparison between the Laryngeal Mask Airway-Unique™ and the air-Q intubating laryngeal airway in children. Paediatr Anaesth 2012; 22: 161-7.CrossRefPubMedGoogle Scholar
  13. 13.
    Jagannathan N, Kozlowski RJ, Sohn LE, et al. A clinical evaluation of the intubating laryngeal airway as a conduit for tracheal intubation in children. Anesth Analg 2011; 112: 176-82.CrossRefPubMedGoogle Scholar
  14. 14.
    Karim YM, Swanson DE. Comparison of blind tracheal intubation through the intubating laryngeal mask airway (LMA Fastrach™) and the Air-Q™. Anaesthesia 2011; 66: 185-90.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim MS, Lee JH, Han SW, Im YJ, Kang HJ, Lee JR. A randomized comparison of the i-gel with the self-pressurized air-Q intubating laryngeal airway in children. Paediatr Anaesth 2015; 25: 405-12.CrossRefPubMedGoogle Scholar
  16. 16.
    Galgon RE, Schroeder K, Joffe AM. The self-pressurising air-Q® Intubating Laryngeal Airway for airway maintenance during anaesthesia in adults: a report of the first 100 uses. Anaesth Intensive Care 2012; 40: 1023-7.PubMedGoogle Scholar
  17. 17.
    Drage MP, Nunez J, Vaughan RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anaesthesia 1996; 51: 1167-70.CrossRefPubMedGoogle Scholar
  18. 18.
    LMATM instruction manual, San Diego, LMA North America Inc, 2005. Available from URL: http://www.lmaco-ifu.com/sites/default/files/node/166/ifu/revision/4367/ifu-lma-classic-paa2100000buk.pdf (accessed January 2018).
  19. 19.
    Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT, Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology 2010; 112: 652-7.CrossRefPubMedGoogle Scholar
  20. 20.
    Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth 1999; 82: 286-7.CrossRefPubMedGoogle Scholar
  21. 21.
    Lopez-Gil M, Brimacombe J, Keller C. A comparison of four methods for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA) in paediatric patients. Paediatr Anaesth 2001; 11: 319-21.CrossRefPubMedGoogle Scholar
  22. 22.
    Lee JR, Kim MS, Kim JT, et al. A randomised trial comparing the i-gel™ with the LMA Classic™ in children. Anaesthesia 2012; 67: 606-11.CrossRefPubMedGoogle Scholar
  23. 23.
    Park C, Bahk JH, Ahn WS, Do SH, Lee KH. The laryngeal mask airway in infants and children. Can J Anesth 2001; 48: 413-7.CrossRefPubMedGoogle Scholar
  24. 24.
    Francksen H, Renner J, Hanss R, Scholz J, Doerges V, Bein B. A comparison of the i-gel™ with the LMA-Unique™ in non-paralysed anaesthetised adult patients. Anaesthesia 2009; 64: 1118-24.CrossRefPubMedGoogle Scholar
  25. 25.
    Inagawa G, Okuda K, Miwa T, Hiroki K. Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients. Paediatr Anaesth 2002; 12: 322-6.CrossRefPubMedGoogle Scholar
  26. 26.
    Nishimoto K, Kariya N, Iwasaki Y, et al. Air-Q® intubating laryngeal airway as a conduit for tracheal intubation in a patient with Apert syndrome: a case report (Japanese). Masui 2014; 63: 1125-7.PubMedGoogle Scholar
  27. 27.
    Schebesta K, Karanovic G, Krafft P, Rossler B, Kimberger O. Distance from the glottis to the grille: the LMA Unique, Air-Q and CobraPLA as intubation conduits: a randomised trial. Eur J Anaesthesiol 2014; 31: 159-65.CrossRefPubMedGoogle Scholar
  28. 28.
    McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999; 54: 444-53.CrossRefPubMedGoogle Scholar
  29. 29.
    Endo K, Okabe Y, Maruyama Y, Tsukatani T, Furukawa M. Bilateral vocal cord paralysis caused by laryngeal mask airway. Am J Otolaryngol 2007; 28: 126-9.CrossRefPubMedGoogle Scholar
  30. 30.
    McKinney B, Grigg R. Epiglottitis after anaesthesia with a laryngeal mask. Anaesth Intensive Care 1995; 23: 618-9.PubMedGoogle Scholar
  31. 31.
    Inomata S, Nishikawa T, Suga A, Yamashita S. Transient bilateral vocal cord paralysis after insertion of a laryngeal mask airway. Anesthesiology 1995; 82: 787-8.CrossRefPubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Sang Hee Ha
    • 1
    • 2
  • Min-Soo Kim
    • 1
  • Jiwoo Suh
    • 1
  • Jong Seok Lee
    • 1
    • 2
  1. 1.Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
  2. 2.Department of Anesthesiology and Pain Medicine, Yonsei University College of MedicineGangnam Severance HospitalSeoulKorea

Personalised recommendations