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Comparing leak pressure of LMA® ProSeal™ versus i-gel® at head rotation: a randomized controlled trial

Comparaison de la pression de fuite du dispositif LMA® ProSeal™ par rapport au i-gel® lors de rotation de la tête : une étude randomisée contrôlée

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Abstract

Purpose

The effect of head rotation on supraglottic airway (SGA) oropharyngeal leak pressure (OPLP) has not been well elucidated. The aim of this study was to help clarify which SGA device provides higher OPLP at head-rotated position.

Methods

Patients who underwent elective surgery under general anesthesia were enrolled and randomly divided into laryngeal mask airway (LMA®) ProSeal™ and i-gel® groups. The allocated SGA device was inserted under anesthesia. The primary outcome was OPLP, and secondary outcomes were ventilation score, expiratory tidal volume, and maximum pressure under volume-controlled ventilation (VCV) with an inspiratory tidal volume of 10 mL·kg−1 ideal body weight and fibreoptic view of the vocal cords at 0°, 30°, and 60° head rotation.

Results

Data from 78 and 76 patients were analyzed in the LMA ProSeal and i-gel groups, respectively. The mean (standard deviation) OPLP of the LMA ProSeal was significantly higher than that of the i-gel at the 60° head-rotated position (LMA ProSeal, 20.4 [6.5] vs i-gel, 16.9 [7.8] cm H2O; difference in means, 3.6; adjusted 95% confidence interval, 0.5 to 6.6; adjusted P = 0.02, adjusted for six comparisons). The maximum pressure under VCV at 60° head rotation was significantly higher in the LMA ProSeal group than in the i-gel group. The expiratory tidal volume of the LMA ProSeal did not significantly change with head rotation and was significantly higher than that of the i-gel at 60° head rotation. Ventilation score, fibreoptic view of the vocal cords, and complications were not significantly different between the ProSeal and i-gel groups.

Conclusions

The LMA ProSeal provides higher OPLP than the i-gel at a 60° head-rotated position under general anesthesia.

Trial registration

Japan Registry of Clinical Trials (https://jrct.niph.go.jp) (JRCT1012210043); registered 18 October 2021.

Résumé

Objectif

L’effet de la rotation de la tête sur la pression de fuite oropharyngée (OPLP en anglais) des dispositifs supraglottiques (DSG) n’est pas encore bien élucidé. L’objectif de cette étude était d’aider à déterminer quel DSG procurait une pression de fuite oropharyngée plus élevée lorsque la tête est en rotation.

Méthode

Les patient·es qui ont bénéficié d’une intervention chirurgicale non urgente sous anesthésie générale ont été recruté·es et aléatoirement réparti·es en deux groupes, soit masque laryngé (LMA®) ProSeal™ ou i-gel®. Le DSG alloué a été inséré sous anesthésie. Le critère d’évaluation principal était la pression de fuite oropharyngée, et les critères d’évaluation secondaires étaient le score de ventilation, le volume courant expiratoire et la pression maximale sous ventilation à volume contrôlé (VVC) avec un volume courant inspiratoire de 10 mL·kg−1 du poids corporel idéal et une visualisation fibroscopique des cordes vocales à une rotation de la tête de 0°, 30° et 60°.

Résultats

Les données de 78 et 76 patient·es ont été analysées dans les groupes LMA ProSeal et i-gel, respectivement. La pression de fuite oropharyngée moyenne (écart type) du LMA ProSeal était significativement plus élevée que celle de l’i-gel en position de rotation de la tête à 60° (LMA ProSeal, 20,4 [6,5] vs i-gel, 16,9 [7,8] cm H2O; différence de moyennes, 3,6; intervalle de confiance ajusté à 95 %, de 0,5 à 6,6; P = 0,02 ajusté, ajusté pour six comparaisons). La pression maximale sous VVC à une rotation de la tête de 60° était significativement plus élevée dans le groupe LMA ProSeal que dans le groupe i-gel. Le volume courant expiratoire du LMA ProSeal n’a pas changé de manière significative avec la rotation de la tête et était significativement plus élevé que celui de l’i-gel à une rotation de la tête de 60°. Le score de ventilation, la visualisation fibroscopique des cordes vocales et les complications n’étaient pas significativement différents entre les groupes ProSeal et i-gel.

Conclusion

Le LMA ProSeal procure une pression de fuite oropharyngée plus élevée que l’i-gel dans une position de rotation de la tête à 60° sous anesthésie générale.

Enregistrement de l’étude

Registre japonais des essais cliniques (https://jrct.niph.go.jp) (JRCT1012210043); enregistré le 18 octobre 2021.

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References

  1. Dingley J, Stephenson J, Allender V, Dawson S, Williams D. Changes in hardness and resilience of i-gelTM cuffs with temperature: a benchtop study. Anaesthesia 2018; 73: 856–62. https://doi.org/10.1111/anae.14300

    Article  CAS  PubMed  Google Scholar 

  2. Hoda MQ, Samad K, Ullah H. ProSeal versus classic laryngeal mask airway (LMA) for positive pressure ventilation in adults undergoing elective surgery. Cochrane Database Syst Rev 2017; 7: CD009026. https://doi.org/10.1002/14651858.cd009026.pub2

    Article  Google Scholar 

  3. Lai CJ, Yeh YC, Tu YK, Cheng YJ, Liu CM, Fan SZ. Comparison of the efficacy of supraglottic airway devices in low-risk adult patients: a network meta-analysis and systematic review. Sci Rep 2021; 11: 15074. https://doi.org/10.1038/s41598-021-94114-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Zhang X, Chen M, Li Q. The ProSeal laryngeal mask airway is more effective than the LMA-Classic in pediatric anesthesia: a meta-analysis. J Clin Anesth 2012; 24: 639–46. https://doi.org/10.1016/j.jclinane.2012.04.012

    Article  PubMed  Google Scholar 

  5. Rustagi P, Patkar GA, Ourasang AK, Tendolkar BA. Effect of pneumoperitoneum and lateral position on oropharyngeal seal pressures of Proseal LMA in laparoscopic urological procedures. J Clin Diagn Res 2017; 11: UC05–9. https://doi.org/10.7860/jcdr/2017/22168.9422

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kang F, Li J, Chai XQ, Yu JG, Zhang HM, Tang CL. Comparison of the i-gel laryngeal mask airway with the LMA-supreme for airway management in patients undergoing elective vertebral surgery. J Neurosurg Anesthesiol 2015; 27: 37–41. https://doi.org/10.1097/ana.0000000000000088

    Article  PubMed  Google Scholar 

  7. Kim MS, Park JH, Lee KY, et al. Influence of head and neck position on the performance of supraglottic airway devices: a systematic review and meta-analysis. PLoS One 2019; 14: e0216673. https://doi.org/10.1371/journal.pone.0216673

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kayama T. The guidelines for awake craniotomy. Neurol Med Chir (Tokyo) 2012; 52: 119–41. https://doi.org/10.2176/nmc.52.119

    Article  PubMed  Google Scholar 

  9. Grabert J, Klaschik S, Güresir Á, et al. Supraglottic devices for airway management in awake craniotomy. Medicine (Baltimore) 2019; 98: e17473. https://doi.org/10.1097/md.0000000000017473

    Article  PubMed  Google Scholar 

  10. Chaki T, Tachibana S, Kumita S, et al. Head rotation reduces oropharyngeal leak pressure of the i-gel and LMA® SupremeTM in paralyzed, anesthetized patients: a randomized trial. Anesth Analg 2021; 132: 818–26. https://doi.org/10.1213/ane.0000000000005150

    Article  CAS  PubMed  Google Scholar 

  11. Mishra SK, Nawaz M, Satyapraksh MV, et al. Influence of head and neck position on oropharyngeal leak pressure and cuff position with the Proseal laryngeal mask airway and the i-gel: a randomized clinical trial. Anesthesiol Res Pract 2015; 2015: 705869. https://doi.org/10.1155/2015/705869

    Article  PubMed  PubMed Central  Google Scholar 

  12. Maitra S, Khanna P, Baidya DK. 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. Eur J Anaesthesiol 2014; 31: 266–73. https://doi.org/10.1097/01.eja.0000435015.89651.3d

    Article  CAS  PubMed  Google Scholar 

  13. Maitra S, Baidya DK, Arora MK, Bhattacharjee S, Khanna P. Laryngeal mask airway ProSeal provides higher oropharyngeal leak pressure than i-gel in adult patients under general anesthesia: a meta-analysis. J Clin Anesth 2016; 33: 298–305. https://doi.org/10.1016/j.jclinane.2016.04.020

    Article  PubMed  Google Scholar 

  14. Shin HW, Yoo HN, Bae GE, et al. Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSealTM and i-gel® in adults: meta-analysis and systematic review. J Int Med Res 2016; 44: 405–18. https://doi.org/10.1177/0300060515607386

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Nakayama E, Kagaya H, Saitoh E, et al. Changes in pyriform sinus morphology in the head rotated position as assessed by 320-row area detector CT. Dysphagia 2013; 28: 199–204. https://doi.org/10.1007/s00455-012-9430-0

    Article  PubMed  Google Scholar 

  16. Komasawa N, Nishihara I, Tatsumi S, Minami T. Does prewarming the i-gel supraglottic airway device fit the larynx better compared to keeping it at room temperature for non-paralysed, sedated patients: a randomised controlled trial. BMJ Open 2015; 5: e006653. https://doi.org/10.1136/bmjopen-2014-006653

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sanuki T, Uda R, Sugioka S, et al. The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients. Eur J Anaesthesiol 2011; 28: 597–9. https://doi.org/10.1097/eja.0b013e32834698f4

    Article  PubMed  Google Scholar 

  18. Park SH, Han SH, Do SH, Kim JW, Kim JH. The influence of head and neck position on the oropharyngeal leak pressure and cuff position of three supraglottic airway devices. Anesth Analg 2009; 108: 112–7. https://doi.org/10.1213/ane.0b013e318192376f

    Article  PubMed  Google Scholar 

  19. Kim MH, Lee JH, Choi YS, Park S, Shin S. Comparison of the laryngeal mask airway supreme and the i-gel in paralysed elderly patients: a randomised controlled trial. Eur J Anaesthesiol 2018; 35: 598–604. https://doi.org/10.1097/eja.0000000000000700

    Article  PubMed  Google Scholar 

  20. Kim JT, Jeon SY, Kim CS, Kim SD, Kim HS. Alternative method for predicting optimal insertion depth of the laryngeal tube in children. Br J Anaesth 2007; 99: 704–7. https://doi.org/10.1093/bja/aem241

    Article  CAS  PubMed  Google Scholar 

  21. Jain D, Gandhi K, Sabharwal P, Banerjee G. Mild to moderate degree of neck flexion improves sealing pressures without compromising ventilation with i-gel in anaesthetised adults: a prospective observational study. Eur J Anaesthesiol 2019; 36: 544–6. https://doi.org/10.1097/eja.0000000000000997

    Article  PubMed  Google Scholar 

  22. Brimacombe J, Berry A. A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg 1993; 76: 457.

    CAS  PubMed  Google Scholar 

  23. Luthra A, Chauhan R, Jain A, Bhukal I, Mahajan S, Bala I. Comparison of two supraglottic airway devices: i-gel airway and Proseal laryngeal mask airway following digital insertion in nonparalyzed anesthetized patients. Anesth Essays Res 2019; 13: 669-75.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jain D, Ghai B, Bala I, Gandhi K, Banerjee G. Evaluation of i-gelTM airway in different head and neck positions in anesthetized paralyzed children. Paediatr Anaesth 2015; 25: 1248–53. https://doi.org/10.1111/pan.12748

    Article  PubMed  Google Scholar 

  25. Jain D, Ghai B, Gandhi K, Banerjee G, Bala I, Samujh R. Evaluation of i-gelTM size 2 airway in different degrees of neck flexion in anesthetized children—a prospective, self-controlled trial. Paediatr Anaesth 2016; 26: 1136–41. https://doi.org/10.1111/pan.13001

    Article  PubMed  Google Scholar 

  26. Shin WJ, Cheong YS, Yang HS, Nishiyama T. The supraglottic airway i-gel in comparison with ProSeal laryngeal mask airway and classic laryngeal mask airway in anaesthetized patients. Eur J Anaesthesiol 2010; 27: 598–601. https://doi.org/10.1097/eja.0b013e3283340a81

    Article  PubMed  Google Scholar 

  27. Park SK, Choi GJ, Choi YS, Ahn EJ, Kang H. Comparison of the i-gel and the laryngeal mask airway ProSeal during general anesthesia: a systematic review and meta-analysis. PLoS One 2015; 10: e0119469. https://doi.org/10.1371/journal.pone.0119469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Joly N, Poulin LP, Tanoubi I, Drolet P, Donati F, St-Pierre P. Randomized prospective trial comparing two supraglottic airway devices: i-gelTM and LMA-SupremeTM in paralyzed patients. Can J Anesth 2014; 61: 794–800. https://doi.org/10.1007/s12630-014-0198-6

    Article  PubMed  Google Scholar 

  29. Prabha R, Raman R, Khan MP, Kaushal D, Siddiqui AK, Abbas H. Comparison of i-gel for general anesthesia in obese and nonobese patients. Saudi J Anaesth 2018; 12: 535–9. https://doi.org/10.4103/sja.sja_79_18

    Article  PubMed  PubMed Central  Google Scholar 

  30. Oji M, Koyama Y, Oshika H, et al. Effect of endotracheal tube lubrication on cuff pressure increase during nitrous oxide exposure: a laboratory and prospective randomized controlled trial. BMC Anesthesiol 2019; 19: 169. https://doi.org/10.1186/s12871-019-0837-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Fujimoto M, Kubota J, Yamamoto T. The effect of rocuronium on ventilatory leak and sealing pressure using a supraglottic airway device: a randomized clinical trial. Acta Anaesthesiol Scand 2020; 64: 1120–7. https://doi.org/10.1111/aas.13608

    Article  CAS  PubMed  Google Scholar 

  32. Maitra S, Baidya DK, Bhattacharjee S, Khanna P. Evaluation of i-gelTM airway in children: a meta-analysis. Paediatr Anaesth 2014; 24: 1072–9. https://doi.org/10.1111/pan.12483

    Article  PubMed  Google Scholar 

  33. Kimijima T, Edanaga M, Yamakage M. Superior sealing effect of a three-dimensional printed modified supraglottic airway compared with the i-gel in a three-dimensional printed airway model. J Anesth 2018; 32: 655–62. https://doi.org/10.1007/s00540-018-2531-7

    Article  PubMed  Google Scholar 

  34. Komasawa N, Nishihara I, Tatsumi S, Minami T. Prewarming of the i-gel facilitates successful insertion and ventilation efficacy with muscle relaxation: a randomized study. J Clin Anesth 2014; 26: 663–7. https://doi.org/10.1016/j.jclinane.2014.08.009

    Article  PubMed  Google Scholar 

  35. Zheng J, Du L, Wang J, Zhang L, Chen G. Prewarming i-gel laryngeal mask for mechanical ventilation: a meta-analysis of randomised control trials and trial sequential analysis. BMJ Open 2021; 11: e045461. https://doi.org/10.1136/bmjopen-2020-045461

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wang J, Zeng J, Zhang C, et al. Optimized ventilation strategy for surgery on patients with obesity from the perspective of lung protection: a network meta-analysis. Front Immunol 2022; 13: 1032783. https://doi.org/10.3389/fimmu.2022.1032783

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Peng Z, Xia J, Yin N, Xue H. The effects of volume-controlled ventilation versus pressure-controlled ventilation on hemodynamic and respiratory parameters in patients undergoing lumbar spine fusion surgery: a randomized controlled trial. Ann Palliat Med 2021; 10: 9553–63. https://doi.org/10.21037/apm-21-1932

    Article  PubMed  Google Scholar 

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Author contributions

Tomohiro Chaki, Masatsugu Koizumi, and Shunsuke Tachibana contributed all aspects of this manuscript including study conception and design, analysis and interpretation of data, and drafting the article. Tomomi Matsumoto, Tomoe Kumagai, and Yuki Hashimoto contributed to acquisition of data and revising the article critically for important intellectual content. Michiaki Yamakage contributed to study conception and design, interpretation of data, and revising the article critically for important intellectual content.

Acknowledgement

The authors thank Tomoko Sonoda, DDS, PhD (Department of Basic Medical Sciences, Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan) for advice regarding statistical analyses. We would like to thank Editage (www.editage.com) for English language editing.

Disclosures

None.

Funding statement

Department of Anesthesiology, Sapporo Medical University School of Medicine, Japan.

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan

    Tomohiro Chaki MD, PhD, Masatsugu Koizumi MD, Shunsuke Tachibana MD, PhD, Tomomi Matsumoto MD, Tomoe Kumagai MD, Yuki Hashimoto MD & Michiaki Yamakage MD, PhD

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  1. Tomohiro Chaki MD, PhD
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Chaki, T., Koizumi, M., Tachibana, S. et al. Comparing leak pressure of LMA® ProSeal™ versus i-gel® at head rotation: a randomized controlled trial. Can J Anesth/J Can Anesth 71, 66–76 (2024). https://doi.org/10.1007/s12630-023-02648-3

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