Comparison Of Proseal Laryngeal Mask Airway And I-Gel Supraglottic Airway For Ease Of Insertion And Airway Sealing Pressure In Adult Patients Under General Anaesthesia – A One Year Randomized Clinical Trial

Abstract

Introduction: Airway management by anaesthesiologists is no longer confined to endotracheal intubation. The use of supraglottic airway devices has added a whole new dimension to airway management.The proseal laryngeal mask airway(PLMA) has been a boon to anaesthesiologists ever since it came into clinical practice.The i-gel is a recent novel supraglottic airway device designed to fit the pharyngeal, laryngeal and perilaryngeal structures without use of an inflatable cuff. Hence, we designed this study to compare the clinical efficacy of PLMA (size 4) and i-gel (size 4) for ease of insertion, airway sealing pressure, duration of insertion and complications in anaesthetized ,paralysed adult patients undergoing positive pressure ventilation. Methodology: The present randomized clinical trial was conducted in 60 ASA I and II patients aged between 18-50 years, weighing 50 to 70 Kgs posted for elective surgeries under general anaesthesia in KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Patients were allocated into two equal groups, Group A. i-gel (n=30) and Group B. PLMA (n=30). All the data collected were analysed. The demographic data, duration of insertion and airway sealing pressure were analysed using unpaired‘t’ test. Sex and complications were compared using chi square test. Ease of insertion was analysed using fisher exact test. Results: In our study, the i-gel was easier to insert in comparison to PLMA. Difficult insertion was seen in 2 patients in i-gel group(6.67%) and 8 patients in PLMA group(26.7%).However the difference was not statistically significant.(p=0.08). The mean duration of insertion was 20.73+2.12 sec in i-gel group and 27.37+2.44 sec in PLMA group which was statistically significant (p<0.001). The PLMA provided a more effective seal than i-gel for positive pressure ventilation. The mean airway sealing pressure was 29.83+1.39 in PLMA group and 25.07+1.44 in i-gel group which was statistically significant (p<0.001).Visible blood on the device was noted in 6 patients in the PLMA group and 1 patient in i-gel group which was statistically insignificant. No bronchospasm and laryngospam were noted in patients of either group. Conclusion: The i gel was easier to insert than PLMA in anaesthetized paralysed adult patients, but airway sealing pressure was higher for the PLMA. The PLMA provided a more effective seal than i gel for positive pressure ventilation. The PLMA was associated with higher incidences of visible blood on the device and both devices had no incidences of laryngospasm and bronchospasm.