Transcript Comparison of clinical performance of I

Comparison of
clinical performance of
I-GEL and AURA ONCE LMA
Dr. N. Anuradha, final year
M.D Anaesthesia, Stanley Medical College.Chennai.
Prof. Dr. R. Subramaniya Bharathiyar; Professor and H.O.D
Prof. Dr. R. Lakshmi, Associate Professor
Prof. Dr.Ponnambala Namasivayam, Associate Professor
Dr. Saravana Kumar, Assistant professor
AIMS AND OBJECTIVES:
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Comparison of clinical performance of two
supraglottic devices, aura once LMA and
I GEL.
The ease of insertion,
Placement success rate
Hemodynamic response
Intra-operative and post-operative
complications
Study design
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Single blind
Prospective
Randomised
Place of study
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General surgery theatre in stanley medical
college.
PATIENTS AND METHODS:
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Institutional Ethics Committee approval was
obtained
Informed written consent was obtained
40 patients (n=40) belonging to ASA PS 1 &2
MPC 1 & 2 of both sexes between age group
18 to 40 years presenting short elective
procedures in supine position were included.
Inclusion Criteria:
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Age 18 to 40 years
Weight 30-60 kg
ASA physical status 1-2
Patients undergoing elective surgery under
general anesthesia,
Both sexes
Exclusion criteria:
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Restricted mouth opening (<2cms)
Anticipated difficult airway
Disease of oral cavity
Patients at increased risk of aspiration, or
having an history of symptomatic gastroesophageal reflux
Materials
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Aura Once Laryngeal mask airway
I Gel
IV cannulae
Monitors
Drugs for general anaesthesia
I GEL
Aura Once LMA
Study methods
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Randomly divide the patients into two groups
Written informed consent to be obtained
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Group 1 (n=20) : patients who will receive general
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anaesthesia with Aura once LMA
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Group 2 (n=20): patients who will receive general
anaesthesia with I Gel.
METHODS
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Premedication:
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Inj. Ranitidine 1mg / kg iv,
Inj. Metoclopramide 0.1 mg/kg iv.
Inj. Glycopyrolate 0.004 mg/kg iv,
Inj. Midazolam 0.02mg /kg iv,
Inj. Fentanyl 2 mcg/kg iv.
METHODS
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Anaesthesia was induced with
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Inj. Propofol 2mg/kg iv and
Inj succinylcholine 1mg /kg iv
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relaxation, an appropriately sized supra-glottic
airway was inserted by an experienced
anaesthetist.
 placement confirmed
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Anaesthesia was maintained with
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N2O: O2 70:30%,
Isoflurane 1% in spontaneous ventilation
Monitor
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During maintenance of anesthesia
Heart rate, Mean arterial blood pressure,
Spo2, respiratory rate, end-tidal CO2
concentration,
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Supraglottic airway was removed after
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protective airway reflexes,
the patient’s ability to follow commands.
During extubation,
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Coughing
blood staining on the device,
trauma to the tongue, lips, or teeth
Intraoperative complications
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Aspiration/regurgitation,
Bronchospasm,
Airway obstruction,
Coughing,
Gagging, vomiting
Postoperative complication
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sore throat
dysphonia
RESULTS
VARIABLE
Ambu LMA
I-Gel
Ease of insertion
Size (3/4)
9/11
8/12
Insertion attempts (1/2)
18/2
18/2
Failed insertion
0
0
Size changes
1
1
Insertion time (sec)
23.75 +/_3.8
(18 – 45 )
P=0.0001
16.7 +/- 5.3
(13 – 35)
Results – (Mean +/ SD)
VARIABLE
AMBU LMA
I GEL
AGE
24+/ 3
(19-31 yrs)
24+/3 yr
(18 – 30 yrs)
WEIGHT
50 +/ 7.78
(35 – 65 kg)
51+/ 8.16
(35 – 65 kg)
SEX (m : f)
(9:11)
(8:12)
Hemodynamic variable
VARIABLE
AMBU LMA
Heart Rate
(Pre- insertion)
80.75+/7.6
Heart Rate
(1 min after insertion)
86.45+/4.65
Heart Rate
(5 min after insertion)
82+/4.21
I GEL
80.8+/7.8
P=0.94
87.65+/4.3
P=0.1053
P=0.5585
82.45+/4.36
Hemodynamic variable
VARIABLE
AMBU LMA
Mean arterial pressure
(Pre- insertion)
89.50+/6.7
Mean arterial pressure
(1 min after insertion)
92.55+/5.9
Mean arterial pressure
(5 min after insertion)
90.60+/6.4
I GEL
90.55+/5.6
P=0.3160
93.2+/5.43
p=0.5837
P=0.2183
92+/4.7
RESULTS
VARIABLES
AMBU LMA
I GEL
SPO2
97+/2
98+/2
ETCo2
37+/5
38+/5
Weight
I GEL
AMBU LMA
WEIGHT
WEIGHT
30-49
30-49
50-80
50-80
SEX
12
14
10
12
10
8
6
Series1
8
Series1
6
Series2
4
4
2
2
0
0
male
female
ambu LMA
male
female
I GEL
RESULTS
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All patients were ASA I/II.
The mean length of anesthesia was 30+/15min
(20 – 45 min)
The immediate recovery period was uneventful in 36
patients.
Two patients in each group complained mild sore
throat in one hour and had no pain after 24 hours.
There was no incidence of aspiration/regurgitation,
bronchospasm, airway obstruction, coughing,
vomiting.
RESULTS
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There were no differences in the demographic
data and haemodynamic data immediately
after insertion of device
The median insertion time for the i-gel was
significantly less than for the aura once LMA
[16.7s+/5.3s vs 23.75 s+/3.8s ; P=0.0001]
This gives a statistically significant value in
insertion time of I gel.
CONCLUSION
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We found no difference in success rate of
first-time insertion between the i-gel and the
aura once LMA.
Time to successful insertion was significantly
shorter for the i-gel.
PROFORMA
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Name of the patient
Group
Age
IP No
SEX
ASA Status
WEIGHT
HEIGHT
AIRWAY - MPC
Associated medical illness
Informed Consent
Last Oral intake
Premedication
Shifted to theatre
Monitors
IV ACCESS :
PREOXYGENATION
INDUCTION
RELAXANT
PROFORMA
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SUPRAGLOTTIC DEVICE INSERTION:
TIME
Number of attempts
Monitoring:
Heart rate, Mean arterial blood pressure,
Spo2, respiratory rate, end-tidal CO2 concentration,
Intraop:
Aspiration/regurgitation,
Bronchospasm,
airway obstruction,
Coughing
Post op:
 sore throat
 dysphonia
I-GEL
I-gel
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The I-gel is a device for airway management
I-gel is produced from a medical grade
thermoplastic called SEBS (Styrene Ethylene
Butadiene Styrene).
The soft, non-inflatable cuff fits snugly onto
the perilaryngeal framework,
Its used for both spontaneously breathing
patients and for IPPV.
I-Gel (2)
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I-gel has an artifical epiglottis called the 'epiglottis blocker'.
This helps to prevent the epiglottis from down-folding
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When correctly inserted, the tip of the i-gel will be located
into the upper oesophageal opening, providing a conduit via
the gastric channel to the oesophagus and stomach.
This then allows for suctioning, passing of a nasogastric
tube and can facilitate venting.
I- Gel (3)
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Buccal cavity Stabilizer :
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It is the main stem of the device which contains the
integral bite block and the airway and gastric channels.
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It eliminates the potential for rotation after insertion,
thereby reducing the risk of malposition.
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It also provides vertical strength to aid insertion.
I-gel (5)
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available in three adult sizes
an innovative, colour-coded polypropylene
‘protective cradle’.
The maximum size of nasogastric tube that
can pass through each size of I –gel:
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Size 3 : 12G nasogastric tube
Size 4 : 12G nasogastric tube
Size 5 : 14G nasogastric tube
AURA ONCE LMA
AURA ONCE LMA
References
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i-gel user guide; http://www.i-gel.com
A Multicenter Study of the Ambu® Laryngeal Mask in Nonparalyzed,
Anesthetized Patients Anesth Analg December 2005 101:1862-1866;
doi:10.1213/01.ANE.0000184181.92140.7C
Randomized crossover comparison between the i-gel and the LMAUnique in anaesthetized, paralysed adults
V. Uppal1,*, S. Gangaiah1, G. Fletcher2 and J. Kinsella1, BJA VOL103
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http://www.ambu.co.uk/UK/Airway_Management
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Comparison of the AMBU Laryngeal Mask and the LMA Classic in
anaesthetised, spontaneously breathing patients.
Ng SY, Teoh WH, Lim Y, Cheong VG;
www.ncbi.nlm.nih.gov/pubmed/17323667