Comparison Of Laryngeal Mask Airway Proseal And Laryngeal Mask Airway Supreme For Ease Of Insertion And Airway Sealing Pressure In Anaesthetized Paralyzed Adult Patients Undergoing Positive Pressure Ventilation - A Randomized Clinical Trial

Abstract

Background and objectives ABSTRACT Newer supraglottic airway devices have been recently introduced, motivated by the need for a single use equivalent to the reusable LMA Proseal. LMA Supreme is a new single use laryngeal mask airway with gastric access providing an easy, reliable airway and good airway seal. The objectives of the present study were to compare LMA Proseal and LMA Supreme for ease of insertion and airway sealing pressure in anaesthetized paralyzed adult patients undergoing positive pressure ventilation. Methodology: We conducted a prospective randomized study in 60 ASA grade I and II adult patients posted for elective surgeries under general anaesthesia. The patients were randomly allocated to group LMA Proseal ( n=30 ) or group LMA Supreme ( n=30) . After anaesthesia induction, the airway devices were ( all size 4 ) were inserted in strict accordance with the manufacturer’s recommendations. The ease of insertion was recorded and oropharyngeal leak pressure and intra cuff pressures were determined at 0 to 40 ml cuff volume in 10ml increments. Results First attempt and overall success of insertion were similar ( LMA Proseal 93.33% and 100%; LMA Supreme 96.66% and 100% ) . Guided insertion was always successful following failed digital insertion. There was no difference in the mean duration of insertion for both the devices ( 23.92 ± vs 23.44 ± seconds) ( p<0.05) . The mean oropharyngeal leak pressure was significantly higher for the IV LMA Proseal than the LMA Supreme ( 23.24 vs 19.37 cm of H 2 O ) ( p<0.05) . The intra cuff pressures were significantly higher for LMA Proseal in comparison to LMA Supreme at all cuff volumes of inflation range ( p<0.05) . Conclusions The ease of insertion was similar for the LMA Proseal and LMA Supreme, but oropharyngeal leak pressure and intracuff pressures were higher for the LMA Proseal. The LMA Proseal provides a more effective seal than LMA Supreme for positive pressure ventilation.