A randomised comparison of the Ambu® AuraGain™ and the LMA® supreme in infants and children

We conducted a randomised trial in 100 children in order to compare the clinical performance of the Ambu^® AuraGain^? and the LMA^® Supreme^* for airway maintenance during mechanical ventilation. The primary outcomes were initial and 10‐min airway leak pressures. Ease, time and success rates for device and gastric tube insertion, fibreoptic grades of view, airway quality during anaesthetic maintenance, and complications were also assessed. There were no differences in the initial and ten min airway leak pressures between the Ambu AuraGain and LMA Supreme, median (IQR [range]) initial: 19 (16–22 [10–34]) vs 18 (14–24 [8–40]) cmH₂O, p = 0.4; and ten min: 22 (18–26 [11–40]) vs 20 (16–26 [12–40]) cmH₂O, p = 0.08, respectively. Ease, time and success rates for device placement, gastric tube insertion and complications were also not significantly different. Children receiving the LMA Supreme required more airway manouevers (7 vs 1 patient, p = 0.06) to maintain a patent airway. Our results suggest that the Ambu AuraGain may be a useful alternative to the LMA Supreme, as demonstrated by comparable overall clinical performance in children.     

A randomized crossover comparison between the Laryngeal Mask Airway-Unique™ and the air-Q intubating laryngeal airway in children

Objectives: The purpose of this randomized crossover study was to evaluate the feasibility of the air‐Q intubating laryngeal airway (ILA) in clinical practice when compared with the Laryngeal Mask Airway‐Unique^? (LMA‐U), the current standard of care for primary airway maintenance. Aim: We hypothesized that the ILA would have better airway seal pressures and laryngeal alignment than the LMA‐U in anesthetized nonparalyzed children. Background: The ILA is a newer supraglottic airway for children with design features that allow it to be used for primary airway maintenance and as a conduit for tracheal intubations. Methods: Fifty healthy children, 6–36 months of age, 10–15 kg, who were scheduled for elective surgery in which the use of a size two LMA‐U and size 1.5 ILA would be appropriate for airway maintenance, were enrolled into this randomized crossover study. Primary outcome measures were airway leak pressures and fiberoptic grades of view. Secondary outcome measures included ease and time for successful insertion, incidence of gastric insufflation, ventilation parameters, and complications. Results: There were no statistically significant differences in regard to the ease of device insertion, time to ventilation, gastric insufflation, and ventilation parameters between the ILA and the LMA‐U. All devices were successfully placed on the first attempt, and there were no instances of failure. There were statistically significant differences in the airway leak pressure between the ILA (19.0 ± 5.4 cmH₂O) and the LMA‐U (16.1 ± 4.9 cmH₂O), P = 0.001. There were also statistically significant differences in the fiberoptic grades of view between the ILA and LMA‐U, P = 0.004. Conclusions: The ILA had higher airway leak pressures and superior fiberoptic grades of view when compared with the LMA‐U and can be a suitable alternative to the LMA‐U in children weighing 10–15 kg.     

The Laryngeal Mask Airway SupremeTM– a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the Laryngeal Mask Airway ProSealTM in paralysed, anaesthetised patients

The LMA Supreme^TM is a new extraglottic airway device which brings together features of the LMA ProSeal^TM, Fastrach^TM and Unique^TM. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal^TM and the LMA Supreme^TM in paralysed anesthetised patients. Ninety‐three females aged 19–71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSeal^TM, 92% and 100%; LMA Supreme^TM 95% and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4–8 ml higher for the LMA ProSeal^TM over the inflation range (p < 0.001). Intracuff pressure was 16–35 cm higher for the LMA ProSeal^TM when the cuff volume was 20–40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30–40 ml. There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSeal^TM 91% and 100%; LMA Supreme^TM 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSeal^TM and LMA Supreme^TM in paralysed, anaesthetised females, but oropharyngeal leak pressure and intracuff pressure are higher for the LMA ProSeal^TM.     

Crossover comparison of airway sealing pressures of 1.5 and 2 size LMA-ProSeal™ and LMA-Classic™ in children, measured with the manometric stability test

Objectives: To compare airway sealing pressures, air leak, optimal positioning of the LMA‐ProSeal? and LMA‐Classic? in children. Methods: A crossover, randomized study was conducted in children aged 6 months–7 years weighing <20 kg scheduled for minor elective surgery under GA with sevoflurane. Either a 1.5 or 2‐size LMA‐ProSeal? or LMA‐Classic? was inserted first. Optimal position of the devices was evaluated by fiberoptic bronchoscopy (FOB). Airway sealing pressures were determined under standardized conditions by the manometric stability test at the proximal end of the LMA device. Gas leak observed by auscultation over the neck and epigastrium was noted at these pressures. Results: Twenty‐seven children of mean ages 29.48 ± 19.81 months and mean weight 11.23 ± 3.28 kg were included for evaluation. Airway sealing pressures were noted to be similar: 23.11 ± 8.28 cm H₂O with LMA‐ProSeal? and 23.26 ± 8.21 cm H₂O with LMA‐Classic?. At these sealing pressures, air leak in the neck was observed in 21/27 children with LMA‐ProSeal? compared with 24/27 with LMA‐Classic? (P = 0.467). Optimal device positioning as viewed by FOB was seen in 14/27(51.8%) children with LMA‐ProSeal? and 15/27(55.6%) with LMA‐Classic?. Airway sealing pressures with suboptimal position of LMA‐ProSeal? was 22.23 ± 10.23 cm H₂O and with optimal position 23.93 ± 6.25 cm H₂O (P = 0.612). Conclusion: The LMA‐ProSeal? and LMA‐Classic? size 1.5 and 2 provide similar mean airway sealing pressures as assessed by the manometric stability test under standardized conditions, with similar air leak and optimal positioning.     

A network meta‐analysis of the clinical properties of various types of supraglottic airway device in children

We conducted both conventional pairwise and Bayesian network meta‐analyses to compare the clinical properties of supraglottic airway devices in children. We searched six databases for randomised clinical trials. Our primary end‐points were oropharyngeal leak pressure, risk of insertion failure at first attempt, and blood staining risk. The risk of device failure, defined as the abandonment of the supraglottic airway device and replacement with a tracheal tube or another device, was also analysed. Sixty‐five randomised clinical trials with 5823 participants were identified, involving 16 types of supraglottic airway device. Network meta‐analysis showed that the i‐gel?, Cobra perilaryngeal airway? and Proseal laryngeal mask airway (LMA^®‐Proseal) showed statistically significant differences in oropharyngeal leak pressure compared with the LMA^®‐Classic, with mean differences (95% credible interval, CrI) of 3.6 (1.9–5.8), 4.6 (1.7–7.6) and 3.4 (2.0–4.8) cmH₂O, respectively. The i‐gel was the only device that significantly reduced the risk of blood staining of the device compared with the LMA‐Classic, with an odds ratio (95%CrI) of 0.46 (0.22–0.90). The risk (95%CI) of device failure with the LMA‐Classic, LMA^®‐Unique and LMA‐Proseal was 0.36% (0.14–0.92%), 0.49% (0.13–1.8%) and 0.50% (0.23–1.1%), respectively, whereas the risk (95%CI) of the i‐gel and PRO‐Breathe was higher, at 3.4% (2.5–4.7%) and 6.0% (2.8–12.5%), respectively. The risk, expressed as odds ratio (95%CrI), of insertion failure at first attempt, was higher in patients weighing < 10 kg at 5.1 (1.6–20.1). We conclude that the LMA‐Proseal may be the best supraglottic airway device for children as it has a high oropharyngeal leak pressure and a low risk of insertion. Although the i‐gel has a high oropharyngeal leak pressure and low risk of blood staining of the device, the risk of device failure should be evaluated before its routine use can be recommended.     

A cohort evaluation of the Laryngeal Mask Airway‐Supreme™ in children

Objectives: To assess the clinical performance of the laryngeal mask airway‐Supreme in children. Aim: The purpose of this prospective audit was to evaluate the feasibility of the laryngeal mask airway‐Supreme in clinical practice and generate data for future comparison trials. Background: The laryngeal mask airway‐Supreme is a new second‐generation supraglottic airway that was recently released in limited pediatric sizes (sizes 1, 2). Methods: One hundred children, ASA I‐III, newborn to 16 years of age, and undergoing various procedures requiring a size 1, 2, or 3 laryngeal mask airway‐Supreme were studied. Assessments included insertion success rates, airway leak pressures, success of gastric tube insertion, quality of airway, and perioperative complications. Results: The first‐time insertion success rate was 97%, with an overall insertion success rate of 100%. The mean initial airway leak pressure for all patients was 22.3 ± 6.6 cm H₂O. Gastric tube placement was possible in 98% of patients. Complications were noted in six patients: coughing or laryngospasm (n = 3), sore throat (n = 1), and dysphonia (n = 2). Conclusions: The laryngeal mask airway‐Supreme was inserted with a high degree of success on the first attempt by clinicians with limited prior experience with the device. It was effectively used for a variety of procedures in children undergoing spontaneous and mechanical ventilation with minimal complications. The leak pressures demonstrated in this study, along with access for gastric decompression, suggest that the laryngeal mask airway‐Supreme may be an effective device for positive pressure ventilation in children.     

Exposure to anaesthetic trace gases during general anaesthesia: CobraPLA vs. LMA classic

Background: To prospectively investigate the performance, sealing capacity and operating room (OR) staff exposure to waste anaesthetic gases during the use of the Cobra perilaryngeal airway (CobraPLA) compared with the laryngeal mask airway classic (LMA). Methods: Sixty patients were randomly assigned to the CobraPLA or the LMA group. Insertion time, number of insertion attempts and airway leak pressures were assessed after induction of anaesthesia. Occupational exposure to nitrous oxide (N₂O) and Sevoflurane (SEV) was measured at the anaesthetists' breathing zone and the patients' mouth using a photoacoustic infrared spectrometer. Results: N₂O waste gas concentrations differed significantly in the anaesthetist's breathing zone (11.7±7.2 p.p.m. in CobraPLA vs. 4.1±4.3 p.p.m. in LMA, P=0.03), whereas no difference could be shown in SEV concentrations. Correct CobraPLA positioning was possible in 28 out of 30 patients (more than one attempt necessary in five patients). Correct positioning of the LMA classic was possible in all 30 patients (more than one attempt in three patients). Peak airway pressure was higher in the CobraPLA group (16±3 vs. 14±2 cmH₂O, P=0.01). The average leak pressure of the CobraPLA was 24±4 cmH₂O, compared with 20±4 cmH₂O of the LMA classic (P<0.001; all values means±SD). Conclusion: Despite higher airway seal pressures, the CobraPLA caused higher intraoperative N₂O trace concentrations in the anaesthetists' breathing zone.     

A randomised comparison of the self-pressurised air-Q(TM) intubating laryngeal airway with the LMA Unique(TM) in children*

We conducted a randomised trial comparing the self‐pressurised air‐Q^TM intubating laryngeal airway (air‐Q SP) with the LMA‐Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air‐Q SP (12 (10–15 [5–18])) s than with the LMA‐Unique (14 (12–17 [6–22]) s; p = 0.05). There were no statistically significant differences between the air‐Q SP and LMA‐Unique in initial airway leak pressures (16 (14–18 [10–29]) compared with 18 (15–20 [10–30]) cmH₂O, p = 0.12), an airway leak pressures at 10 min (19 (16–22 [12–30]) compared with 20 (16–22 [10–30]) cmH₂O, p = 0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air‐Q SP is an alternative to the LMA‐Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.     

Comparative efficacy and safety of the Ambu® AuraOnce™ laryngeal mask airway during general anaesthesia in adults: a systematic review and meta‐analysis

Previous comparisons between the Ambu^® AuraOnce^? and other laryngeal mask airways have revealed different results across various clinical studies. We aimed to perform a systematic review with meta‐analysis on the efficacy and safety of the AuraOnce compared with other laryngeal mask airways for airway maintenance in adults undergoing general anaesthesia. Our search of PubMed, PubMed Central, Scopus and the Central Register of Clinical Trials of the Cochrane Collaboration yielded nine randomised controlled trials eligible for inclusion. Comparator laryngeal mask airways were the LMA Unique^? (four trials), the LMA Classic^® (five trials) and the Portex^® Soft Seal^® (three trials). The AuraOnce provided an oropharyngeal leak pressure higher than the LMA Unique (304 participants, mean (95% CI) difference 3.1 (1.6–4.7) cmH₂O, p < 0.0001) and equivalent to the LMA Classic. The Soft Seal provided a higher leak pressure than the AuraOnce (229 participants, mean (95% CI) difference 3.5 (0.4–6.7) cmH₂O, p = 0.03). Insertion was significantly faster with the AuraOnce than the LMA Unique (304 participants, mean (95% CI) difference 5.4 (2.1–8.71) s, p = 0.001) and Soft Seal (229 participants, mean (95% CI) difference 9.5 (3.0–15.9) s, p = 0.004), but similar to the LMA Classic. The first‐insertion success rate of the AuraOnce was equivalent to the LMA Unique, LMA Classic and Soft Seal. We found a higher likelihood of bloodstaining on the cuff with the Soft Seal and a higher incidence of sore throat with the LMA Classic. We conclude that the AuraOnce is an effective alternative to the LMA Classic and LMA Unique, and easier to insert than all three other devices studied.     

A randomised comparison of the LMA SupremeTM and LMAProSealTM in children

We conducted a randomised trial comparing the size‐2 LMA Supreme? with the LMA ProSeal? in 60 children undergoing surgery. The outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement, quality of the airway during anaesthetic maintenance and complications. There were no statistically significant differences between the LMA Supreme and LMA ProSeal in median (IQR [range]) insertion time (12 (10–15 [7–18]) s vs 12 (10–13 [8–25]) s; p = 0.90), airway leak pressures (19 (16–21 [12–30]) cmH₂O vs 18 (16–24 [10–34]) cmH₂O; p = 0.55), fibreoptic position of the airway or drain tube, ease of gastric access and complications. Both devices provided effective ventilation requiring minimal airway manipulation. The LMA Supreme can be a useful alternative to the LMA ProSeal when single‐use supraglottic devices with gastric access capabilities are required.     

Reduced air leakage by adjusting the cuff pressure in pediatric laryngeal mask airways during spontaneous ventilation

Background: Optimal inflation of the laryngeal mask airway (LMA) cuff should allow ventilation with low leakage volumes and minimal airway morbidity. Manufacturer’s recommendations vary, and clinical end‐points have been shown to be associated with cuff hyperinflation and increased leak around the LMA. However, measurement of the intra‐cuff pressure of the LMA is not routine in most pediatric institutions, and the optimal intra‐cuff pressure in the LMA has not been determined in clinical studies. Methods: This was a prospective audit in100 pediatric patients undergoing elective general anesthesia breathing spontaneously via LMA (size 1.5–3). Cuff pressure within the LMA was adjusted using a calibrated pressure gauge to three different values (60, 40, and 20 cmH₂O) within the manufacturers’ recommended LMA cuff pressure range (≤60 cmH₂O). Three corresponding inspiratory and expiratory tidal volumes were recorded, and the differences were calculated as the ‘leak volume’. Results: Compared with 20 and 60 cmH₂O intra‐cuff pressure, measured leakage volumes were the lowest at cuff inflation pressures of 40 cmH₂O [median (range) 0.42 (0.09–1.00) ml·kg^?1] in most patients (83%), while 17% of children demonstrated minimally smaller leakages at 20 cmH₂O [0.51 (0.11–1.79) ml·kg^?1]. Maximum leakage values occurred with cuff pressures of 60 cmH₂O in all groups [0.65 (0.18–1.27) ml·kg^?1] and were not associated with the smallest value of air leakage in any patient. Conclusion: Using cuff manometry, an intra‐cuff pressure of 40 cmH₂O was associated with reduced leak around the LMA while higher (60 cmH₂O) and lower (20 cmH₂O) cuff pressures resulted in higher leak volumes during spontaneous ventilation. In spontaneously breathing children, reducing the intra‐cuff pressure of pediatric‐sized LMAs even below the manufacturers’ recommendations allows ventilation with minimized leakage around the LMA cuff.     

The LMA® ProtectorTM in anaesthetised,non-paralysed patients: a multicentre prospective observational study

We evaluated the LMA ^® Protector^TM in 280 ASA physical status 1–3 patients aged 18–75 years by assessing the ease of insertion, insertion time, oropharyngeal leak pressure, ease of gastric tube passage and complications. First-attempt and overall insertion success was 234/280 (84; 95%CI 79–88%) and 274/280 (98; 95–99%). Median (IQR [range]) insertion time was 17 (12–25 [5–44]) s, and manoeuvres to facilitate insertion were required in 56 (50–63)% of patients. Median oropharyngeal leak pressure was 31 (26–36 [14–40]) cmH₂O. Multivariate analysis identified two risk factors for oropharyngeal leak pressure < 25 cmH₂O: male sex (OR 2.44; 1.01–5.91, p = 0.048) and the insertion of a LMA size different to that recommended by weight (OR 1.98; 0.97–4.03, p = 0.06). Gastric tube insertion was possible in 256 out of 274 patients (93%). On fibreoptic view, vocal cords were visible in 86% of patients. During maintenance, 14 patients (5%) required airway manipulation. There were no episodes of regurgitation or aspiration. Blood staining on LMA removal was present in 70 out of 280 patients (25%). Use of the LMA Protector appears safe and is associated with a high success rate, provision of a highly effective seal and low rates of clinical complications. These attributes would suggest considerable potential for use during anaesthesia.     

The I‐gel®, a single‐use supraglottic airway device with a non‐inflatable cuff and an esophageal vent: an observational study in children

Background: The I‐gel^® is a new single‐use supraglottic airway device with a non‐inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel‐like cuff that adapts to the hypopharyngeal anatomy. Like the LMA‐ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I–II, undergoing a short‐duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I‐gel^®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH₂O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I‐gel^® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management.     

Comparison of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery

The aim of our study was to compare leakage pressure, ease and time of insertion of the i‐gel and the LMA‐Unique laryngeal mask airway in patients with mild to moderate obesity during elective short‐term surgery. In this prospective, randomised crossover trial, we included patients with a body mass index (BMI) > 25 and < 35 kg.m^?2, and , age > 18 years, undergoing elective surgery in the supine position with an expected duration of surgery < 2 h. Leakage pressures, insertion difficulty, time and number of insertion attempts were evaluated. We included 50 patients consisting of 29 mildly (BMI > 25 and < 30 kg.mg^?2) and 21 moderately (BMI > 30 and < 35 kg.mg^?2) obese patients. Mean (SD) leakage pressures were 23.7 (9.2) cmH₂O (i‐gel) and 17.4 (7.0) cmH₂O (LMA‐Unique) (p < 0.01). Subgroup analyses showed leakage pressures of 22.2 (9.4) cmH₂O (i‐gel) and 17.5 (7.5) cmH₂O (LMA‐Unique) (p = 0.013) in the mild subgroup, and 25.7 (8.6) cmH₂O (i‐gel) and 17.0 (6.2) cmH₂O (LMA‐Unique) (p < 0.01), in the moderate subgroup. Insertion of the i‐gel was associated with significantly higher leakage pressures compared with the LMA‐Unique in mildly and moderately obese patients.     

A randomised,non‐crossover study of the GuardianCPV™ Laryngeal Mask versus the LMA Supreme™ in paralysed,anaesthetised female patients

We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV? and the LMA Supreme? in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10‐ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20–40 ml were 31 (7) cmH₂O for the GuardianCPV and 27 (7) cmH₂O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH₂O and 88 (43) cmH₂O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.     

Insertion of laryngeal mask airway does not increase the intraocular pressure in children with glaucoma

Objectives:  It is hypothesized that in children with glaucoma, the insertion of laryngeal mask airway (LMA) will cause lesser rise in intraocular pressure (IOP) than tracheal tube (TT). Aim:  To compare the IOP response to LMA and TT insertion in children with glaucoma. Methods/Materials:  A prospective, randomized, single‐blind study was conducted in 30 glaucomatous ASA‐1 children, aged 1–10 years scheduled to undergo trabeculectomy. Anesthesia was induced with halothane and maintained for 5 min with 1 MAC of halothane after administering atracurium 0.5 mg·kg^?1 following which LMA or TT was introduced. IOP was measured in both the eyes before and after insertion of airway device for 5 min. Results:  The IOP increased significantly from 27.3 ± 5.2 to 31.2 ± 5.4 mmHg (P < 0.001) after tracheal intubation but returned to baseline within 5 min. The IOP did not change from the baseline after insertion of LMA. The IOP was significantly higher in group TT compared to group LMA at 2 min (P = 0.004) and 5 min (P = 0.01) after the device insertion. The heart rate (HR) increased significantly after tracheal intubation and returned to baseline 4 min after intubation. The HR increase was significantly more in TT group compared to LMA group at all times of observation. Both systolic blood pressure (SBP; P = 0.01) and diastolic blood pressure (DBP; P = 0.02) showed an increase at 1 min in children in group TT. Conclusion:  Insertion of LMA in glaucomatous children is not associated with an increased IOP response or cardiovascular changes.     

Evaluation of the LMA Supreme™ in 100 non‐paralysed patients*

We studied the LMA Supreme^? in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10–25 (5–120)] s. During ventilation, an expired tidal volume of 7 ml.kg^?1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20–28 (13–40)] cmH₂O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side‐effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices.     

A systematic review and meta‐analysis of the i‐gel® vs laryngeal mask airway in children

We systematically reviewed randomised controlled trials of the i‐gel^® vs different types of laryngeal mask airway in children. We included nine studies. There was no evidence for differences in: rate of insertion at first attempt; insertion time; ease of insertion; or gastric tube insertion. The mean (95% CI) oropharyngeal leak pressure was 3.29 (2.25–4.34) cmH₂O higher with the i‐gel, p < 0.00001. The relative rate (95% CI) of a good fibreoptic view through the i‐gel was 1.10 (1.01–1.19), p = 0.02. There were no significant differences in the rates of complications, except for blood on the airway, relative rate with the i‐gel 0.46 (0.23–0.91), p = 0.02. We concluded that the clinical performance of the i‐gel and LMA was similar, except for three outcomes that favoured the i‐gel.     

Efficacy of a new dual channel laryngeal mask airway,the LMA®Gastro™ Airway,for upper gastrointestinal endoscopy: a prospective observational study

Background

Significant cardiorespiratory events are frequent in patients undergoing gastrointestinal endoscopy. Central to the occurrence of respiratory events is an unsecured airway. This study sought to determine the efficacy of a new laryngeal mask airway, the LMA^®Gastro^TM Airway (Teleflex Medical, Athlone, Ireland), in patients undergoing upper gastrointestinal endoscopy. New design features include a dedicated channel for oesophageal intubation and separate channel with terminal cuff for lung ventilation.

Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway

A prototype armoured laryngeal mask airway (LMA) was compared with tracheal intubation (ETT) for anaesthesia for adenotonsillectomy. Fifty-five children were randomised into the LMA group and 54 into the ETT group. During insertion of the LMA, peripheral oxyhaemoglobin desaturation (SpO₂) < 94% occurred in ten patients (18.2%) and in seven patients (13%) during tracheal intubation (NS). After opening the Boyle-Davis gag, airway obstruction occurred in ten patients (18.2%) in the LMA group and in three patients (6%) in the ETT group (P = 0.07). In five patients (9%) the LMA was abandoned in favour of tracheal intubation. In all others (91%), when the need for adequate depth of anaesthesia was realized, a satisfactory airway was achieved more rapidly than with tracheal intubation (P < 0.001), and maintained throughout surgery. Manually assisted ventilation was required in all patients in the ETT group, mean duration 373 ± 385 sec, and in 26 patients (52%) in the LMA group, mean duration 134 ± 110 sec, P < 0.001. Mean end-tidal CO₂ (PetCO₂) was 45.5 ± 6.21 mmHg in the ETT group and 46.6 ± 6.09 in the LMA group (NS). The LMA did not limit surgical access. Heart rate, MAP and blood loss in the LMA group were 110 ± 21, 74 ± 9 mmHg and 1.92 ± 1.22 ml · kg^?1 respectively, compared with 143 ± 13 (P < 0.001), 85 ± 12 mmHg (P < 0.001) and 2.62 ± 1.36 ml · kg^?1 (P < 0.05) with tracheal intubation. Fibreoptic laryngoscopy at the end of surgery in 19 patients in the LMA group revealed no blood in the larynx. In the LMA group postintubation stridor and laryngospasm occurred in five and three patients respectively, compared with 14 (P < 0.05) and six patients respectively (NS) with tracheal intubation. SpO₂ on admission to the PACU in the LMA group was 95.9 ± 2.21, and 93.5 ± 4.53 (P < 0.05) after tracheal intubation. Our study demonstrated that the LMA is a safe alternative to tracheal intubation for adenotonsillectomy. Control of airway reflexes by ensuring sufficient depth of anaesthesia is essential for successful use of the LMA in children.