Randomized comparison of the i-gel (TM), the LMA Supreme (TM), and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients

Abstract

Background: The i-gel (TM), LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery. Methods: Prospective, randomized, comparative study of three groups of 40 elective surgical patients each. Speed of insertion and success rates, leak pressures (LP) at different cuff pressures, dynamic airway compliance, and signs of postoperative airway morbidity were recorded. Fibreoptic evaluation was used to determine the devices' position in situ. Results: Leak pressures were similar (i-gel (TM) 25.9, LMA-S 27.1, LTS-D 24.0 cmH(2)O; the latter two at 60 cmH(2)O cuff pressure) as were insertion times (i-gel (TM) 10, LMA-S 11, LTS-D 14 sec). LP of the LMA-S was higher than that of the LTS-D at lower cuff pressures (p < 0.05). Insertion success rates differed significantly: i-gel (TM) 95%, LMA-S 95%, LTS-D 70% (p < 0.05). The fibreoptically assessed position was more frequently suboptimal with the LTS-D but this was not associated with impaired ventilation. Dynamic airway compliance was highest with the i-gel (TM) and lowest with the LTS-D (p < 0.05). Airway morbidity was more pronounced with the LTS-D (p < 0.01). Conclusion: All devices were suitable for ventilating the patients' lungs during elective surgery.