Beleña J M, Núñez M, Vidal A, Gasco C, Alcojor A, Lee P, Pérez J L
Department of Anesthesiology and Critical Care, Sureste University Hospital, 28500, C/Ronda del Sur, 10, Arganda del Rey, Madrid, Spain,
Anaesthesist. 2015 Apr;64(4):271-6. doi: 10.1007/s00101-015-0020-z. Epub 2015 Mar 24.
The LMA Supreme(TM) (LMA-S) and i-gel(TM) are two of the most commonly used supraglottic airway devices (SADs) with an inbuilt drain channel. These devices are particularly indicated for performing certain procedures accompanied by high peak airway pressure, such as laparoscopy. This study compared the devices regarding efficacy, safety, ease of use and incidence of adverse events, focusing on the postoperative rate of sore throat, dysphagia or dysphonia and development with time, in patients undergoing laparoscopic cholecystectomy procedures under general anesthesia.
This was a prospective, randomized, controlled clinical study including 140 patients randomized into 2 groups undergoing elective laparoscopic cholecystectomy to use either i-gel or LMA-S. After the general anesthesia procedure, the speed of insertion, success rates, ease of insertion of the drain tube, leak pressure and tidal volume achieved by the devices were evaluated. The postoperative oropharyngeal discomfort (POPD) during the period of stay of the patients in the recovery room was also recorded.
The mean leak pressure was comparable between the two groups (i-gel 28.18 ± 3.90 cmH2O and LMA-S 27.50 ± 4 cmH2O, p = 0.09), as well as maximum expiratory tidal volume provided (i-gel 559.60 ± 45.25 ml and LMA-S 548.95 ± 56.18 ml, p = 0.12). Insertion times were lower for the i-gel (10 ± 1.62 s) compared with the LMA-S (11.31 ± 2.85 s, p = 0.008). Insertion success rate at the first attempt was higher for the LMA-S (95 % compared with i-gel 79 %, p = 0.007). Drain tubes were easier to insert in the LMA-S group (p < 0.001). No differences were found between groups relating to intraoperative complications. Frequency of coughing and visible blood on removal of the device were low and comparable in both groups (p = 0.860 and p = 0.623, respectively). There were no differences relating to the incidence of sore throat, dysphagia or hoarseness at 10 min postoperatively between groups (p = 0.088). The i-gel group complained about a higher sore throat score at 2 h postoperatively (p = 0.009), specifically patients receiving i-gel suffered more from sore throats with 0.24 more points on the visual analog scale (VAS) than patients from the LMA-S group. The i-gel group also reported a lower POPD drop during the first 2 h (p < 0.001).
No differences were found between i-gel and LMA-S regarding leak pressure in the groups of anesthetized patients undergoing laparoscopic cholecystectomy. The LMA-S was easier to insert than the i-gel (based on its better first time success rate) and this device showed better ease of drain tube insertion, although the i-gel was quicker to insert than the LMA-S. The i-gel resulted in higher sore throat scores at 2 h postoperatively and lower POPD reduction during the 2 h period studied in the recovery room was reported.
LMA Supreme™（LMA-S）和i-gel™是两种最常用的带有内置引流通道的声门上气道装置（SADs）。这些装置特别适用于进行某些伴有较高气道峰压的手术，如腹腔镜手术。本研究比较了这两种装置在疗效、安全性、易用性和不良事件发生率方面的差异，重点关注全身麻醉下接受腹腔镜胆囊切除术患者术后的咽痛、吞咽困难或声音嘶哑发生率及其随时间的变化。
这是一项前瞻性、随机、对照临床研究，纳入140例患者，随机分为2组，分别接受择期腹腔镜胆囊切除术，使用i-gel或LMA-S。全身麻醉后，评估装置的插入速度、成功率、引流管插入的难易程度、漏气压力和潮气量。还记录了患者在恢复室停留期间的术后口咽不适（POPD）情况。
两组的平均漏气压力相当（i-gel为28.18±3.90 cmH₂O，LMA-S为27.50±4 cmH₂O，p = 0.09），提供的最大呼气潮气量也相当（i-gel为559.60±45.25 ml，LMA-S为548.95±56.18 ml，p = 0.12）。i-gel的插入时间（10±1.62秒）低于LMA-S（11.31±2.85秒，p = 0.008）。LMA-S首次尝试插入成功率更高（95%，而i-gel为79%，p = 0.007）。LMA-S组的引流管更容易插入（p < 0.001）。两组术中并发症无差异。两组在拔除装置时咳嗽频率和可见血性分泌物均较低且相当（分别为p = 0.860和p = 0.623）。两组术后10分钟时咽痛、吞咽困难或声音嘶哑的发生率无差异（p = 0.088）。i-gel组术后2小时咽痛评分更高（p = 0.009），具体而言，接受i-gel的患者在视觉模拟量表（VAS）上咽痛得分比LMA-S组患者高0.24分。i-gel组在最初2小时内POPD下降也更低（p < 0.001）。
在接受腹腔镜胆囊切除术的麻醉患者组中，i-gel和LMA-S在漏气压力方面无差异。LMA-S比i-gel更容易插入（基于其更高的首次成功率），且该装置的引流管插入更容易，尽管i-gel的插入速度比LMA-S快。i-gel导致术后2小时咽痛评分更高，且在恢复室研究的2小时内POPD下降更低。
