From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Anesth Analg. 2020 Feb;130(2):480-487. doi: 10.1213/ANE.0000000000003849.
Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia.
We recruited 100 patients, 65-90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible, <50% visual obstruction of epiglottis to vocal cords; vocal cords and posterior epiglottis visible; and vocal cords visible. We also investigated success rate and ease of insertion, insertion time, and manipulations during insertion as insertion variables, complications during maintenance and emergence periods, and postoperative pharyngolaryngeal complications including sore throat, dysphagia, and dysphonia.
After assessing for eligibility, 48 patients were allocated to each group. Oropharyngeal leak pressures were significantly higher in the i-gel group than in the self-pressurized air-Q group (P < .001) at the 2 measurement points. The raw mean difference at initial assessment and the median difference after 10 minutes were 5.5 cm H2O (95% confidence interval, 3.3-7.6 cm H2O) and 5.0 (95% confidence interval, 2.0-7.0 cm H2O), respectively. The initial scores of fiberoptic view were similar in the 2 groups. However, the self-pressurized air-Q supraglottic airway provided a significantly improved fiberoptic view at 10 minutes after initial assessment (P = .030). We found no statistically significant differences in insertion variables and complications between the 2 groups.
The i-gel provided better sealing function than the self-pressurized air-Q supraglottic airway according to the high oropharyngeal leak pressures in elderly patients during general anesthesia. The self-pressurized air-Q supraglottic airway had improved fiberoptic views in elderly patients during general anesthesia.
上呼吸道解剖结构的年龄相关性变化可能会显著影响声门上气道的整体性能。与儿童不同，对于老年人群，非充气套囊的 i-gel 和自充式 air-Q 插管型喉罩气道的临床性能尚不清楚。因此，我们对这两种声门上气道在接受全身麻醉的老年患者中的应用进行了前瞻性、随机比较。
我们招募了 100 名年龄在 65-90 岁之间、接受全身麻醉并肌松的择期手术患者。入组患者被分配到 i-gel 或自充式 air-Q 组。我们将气道放置和固定后的声门上漏气压以及初始评估后 10 分钟的纤维光学视野作为主要结局进行评估。纤维光学视野评分采用 5 分制：声带不可见；声带和前会厌可见，会厌遮挡声带>50%；声带和前会厌可见，会厌遮挡声带<50%；后会厌可见；声带可见。我们还研究了插入成功率和难易程度、插入时间以及插入过程中的操作作为插入变量、维护和苏醒期间的并发症以及包括咽痛、吞咽困难和声音嘶哑在内的术后咽喉并发症。
在评估合格性后，48 名患者被分配到每个组。在 2 个测量点，i-gel 组的声门上漏气压显著高于自充式 air-Q 组（P<0.001）。初始评估时的原始平均差异和 10 分钟后的中位数差异分别为 5.5cmH2O（95%置信区间，3.3-7.6cmH2O）和 5.0（95%置信区间，2.0-7.0cmH2O）。两组初始纤维光学视野评分相似。然而，自充式 air-Q 声门上气道在初始评估后 10 分钟时提供了显著改善的纤维光学视野（P=0.030）。两组在插入变量和并发症方面无统计学差异。
在全身麻醉期间，i-gel 为老年患者提供了比自充式 air-Q 声门上气道更好的密封功能，根据高声门上漏压。在全身麻醉期间，自充式 air-Q 声门上气道为老年患者提供了改善的纤维光学视野。
