在瘫痪的老年患者中比较喉罩 Supreme 和 i-gel：一项随机对照试验。

Comparison of the laryngeal mask airway supreme and the i-gel in paralysed elderly patients: A randomised controlled trial.

机构信息

From the Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea (MHK, JHL, YSC, SP, SS).

出版信息

Eur J Anaesthesiol. 2018 Aug;35(8):598-604. doi: 10.1097/EJA.0000000000000700.

DOI:10.1097/EJA.0000000000000700

PMID:28857785

Abstract

BACKGROUND

The laryngeal mask airway supreme (LMA-S) and i-gel are both popular second-generation supraglottic airway devices that have been widely studied in surgical patients, but their differences in clinical performance in the elderly are not clear.

OBJECTIVE

We compared the efficacy and safety of the LMA-S and i-gel in anaesthetised and paralysed elderly patients.

DESIGN

A randomised study.

SETTING

Single-centre trial, study period January 2014 from to October 2016.

PATIENTS

One hundred and six elderly patients who underwent urological or orthopaedic surgery with an expected duration less than 2 h.

INTERVENTION

Patients were allocated to either the LMA-S (n = 53) or i-gel (n = 53) group. All insertions were performed in a standardised manner according to the manufacturers' instructions.

MAIN OUTCOME MEASURES

Our primary endpoint was the rate of successful insertion at the first attempt. The adequacy of positive pressure ventilation and airway sealing, fibreoptic laryngoscopy grades and stability of airway maintenance during anaesthesia were also assessed.

RESULTS

Although the rate of successful insertion at the first attempt was similar between the two groups (94.3 vs. 82.7%, P = 0.072), more patients required device manipulation during insertion with the LMA-S than the i-gel (42.3 vs. 18.9%, P = 0.011). Good fibreoptic laryngoscopy grades were significantly more common with the i-gel than the LMA-S (79.3 vs. 55.8%, P = 0.042), and peak inspiratory pressures were lower in the i-gel group both immediately after insertion and at the end of surgery. Leak pressures were significantly higher in the i-gel group than the LMA-S group, both immediately after insertion and at the end of surgery (25.8 vs. 23.0, P = 0.036; and 28.1 vs. 23.7, P < 0.001, respectively).

CONCLUSION

Both the LMA-S and i-gel were used successfully and safely in elderly patients. However, the i-gel demonstrated better airway sealing than the LMA-S at insertion and during maintenance of anaesthesia.

TRIAL REGISTRATION

NCT02026791 at clinicaltrial.gov.

摘要

背景

喉罩 Supreme（LMA-S）和 i-gel 都是第二代声门上气道装置，在外科患者中已得到广泛研究，但它们在老年患者中的临床性能差异尚不清楚。

目的

我们比较了麻醉和肌松状态下 LMA-S 和 i-gel 在老年患者中的效果和安全性。

设计

随机研究。

设置

单中心试验，研究时间为 2014 年 1 月至 2016 年 10 月。

患者

106 例接受泌尿外科或骨科手术、预计手术时间少于 2 小时的老年患者。

干预

患者被分配到 LMA-S（n=53）或 i-gel（n=53）组。所有插入均按照制造商的说明进行标准化操作。

主要观察指标

我们的主要终点是首次尝试时的成功率。还评估了正压通气和气道密封的充分性、纤维光学喉镜分级以及麻醉期间气道维持的稳定性。

结果

虽然两组首次尝试的成功率相似（94.3% vs. 82.7%，P=0.072），但 LMA-S 组在插入过程中需要设备操作的患者多于 i-gel 组（42.3% vs. 18.9%，P=0.011）。i-gel 组的纤维光学喉镜分级明显优于 LMA-S 组（79.3% vs. 55.8%，P=0.042），并且 i-gel 组的吸气峰压在插入后和手术结束时均低于 LMA-S 组。i-gel 组的泄漏压力在插入后和手术结束时均明显高于 LMA-S 组（25.8 比 23.0，P=0.036；28.1 比 23.7，P<0.001）。