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Lookup NU author(s): Professor Chandra Kumar
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© 2019, Springer Nature B.V. The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an ‘insert-detect-correct-as-you-go’ technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9 cm H 2 O) compared to the LMA-Supreme (27.7 ± 3.5 cm H 2 O) group (mean difference 4.0 cm H 2 O, 95% confidence interval (CI) 2.7–5.3 cm H 2 O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided.
Author(s): van Zundert AAJ, Wyssusek KH, Pelecanos A, Roets M, Kumar CM
Publication type: Article
Publication status: Published
Journal: Journal of Clinical Monitoring and Computing
Year: 2020
Volume: 34
Pages: 285-294
Print publication date: 01/04/2020
Online publication date: 05/04/2019
Acceptance date: 18/03/2019
ISSN (print): 1387-1307
ISSN (electronic): 1573-2614
Publisher: Springer Netherlands
URL: https://doi.org/10.1007/s10877-019-00301-3
DOI: 10.1007/s10877-019-00301-3
PubMed id: 30953222
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