Comparison of clinical performance of I-GEL and AURA ONCE LMA

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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

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AIMS AND OBJECTIVES

• 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

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Study design

• Single blind
• Prospective
• Randomised

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Place of study

• General surgery theatre in stanley medical
  college.

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PATIENTS AND METHODS

• Institutional Ethics Committee approval was
  obtained
• Informed written consent was obtained
• 40 patients (n40) 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.

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Inclusion Criteria

• Age 18 to 40 years
• Weight 30-60 kg
• ASA physical status 1-2
• Patients undergoing elective surgery under
  general anesthesia,
• Both sexes

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Exclusion criteria

• Restricted mouth opening (lt2cms)
• Anticipated difficult airway
• Disease of oral cavity
• Patients at increased risk of aspiration, or
  having an history of symptomatic
  gastro-esophageal reflux

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Materials

• Aura Once Laryngeal mask airway
• I Gel
• IV cannulae
• Monitors
• Drugs for general anaesthesia

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I GEL
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Aura Once LMA
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Study methods

• Randomly divide the patients into two groups
• Written informed consent to be obtained
• Group 1 (n20) patients who will receive
  general
• anaesthesia with Aura once LMA
• Group 2 (n20) patients who will receive general
  
• anaesthesia with I Gel.

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METHODS

• Premedication
• 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.

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METHODS

• Anaesthesia was induced with
• Inj. Propofol 2mg/kg iv and
• Inj succinylcholine 1mg /kg iv
• After adequate facemask ventilation and
  relaxation, an appropriately sized supra-glottic
  airway was inserted by an experienced
  anaesthetist.
• placement confirmed

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• Anaesthesia was maintained with
• N2O O2 7030,
• Isoflurane 1 in spontaneous ventilation

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Monitor

• 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
• protective airway reflexes,
• the patients ability to follow commands.
• During extubation,
• Coughing
• blood staining on the device,
• trauma to the tongue, lips, or teeth

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Intraoperative complications

• Aspiration/regurgitation,
• Bronchospasm,
• Airway obstruction,
• Coughing,
• Gagging, vomiting

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Postoperative complication

• sore throat
• dysphonia

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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 ) P0.0001 16.7 /- 5.3 (13 35)
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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) (911) (812)
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Hemodynamic variable
VARIABLE AMBU LMA I GEL
Heart Rate (Pre- insertion) 80.75/7.6 P0.94 80.8/7.8
Heart Rate (1 min after insertion) 86.45/4.65 P0.1053 87.65/4.3
Heart Rate (5 min after insertion) 82/4.21 P0.5585 82.45/4.36
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Hemodynamic variable
VARIABLE AMBU LMA I GEL
Mean arterial pressure (Pre- insertion) 89.50/6.7 P0.3160 90.55/5.6
Mean arterial pressure (1 min after insertion) 92.55/5.9 p0.5837 93.2/5.43
Mean arterial pressure (5 min after insertion) 90.60/6.4 P0.2183 92/4.7
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RESULTS
VARIABLES AMBU LMA I GEL
SPO2 97/2 98/2
ETCo2 37/5 38/5
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Weight
AURA ONCE LMA
IGEL
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SEX
IGEL
AURA ONCE LMA
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RESULTS

• 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/regurgitati
  on, bronchospasm, airway obstruction, coughing,
  vomiting.

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RESULTS

• 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 P0.0001
• This gives a statistically significant value in
  insertion time of I gel.

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CONCLUSION

• 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.

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PROFORMA

• 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

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PROFORMA

• 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

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I-GEL
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I-gel

• 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.

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I-Gel (2)

• I-gel has an artifical epiglottis called the
  'epiglottis blocker'. This helps to prevent the
  epiglottis from down-folding
• 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.

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I- Gel (3)

• Buccal cavity Stabilizer
• It is the main stem of the device which contains
  the integral bite block and the airway and
  gastric channels.
• It eliminates the potential for rotation after
  insertion, thereby reducing the risk of
  malposition.
• It also provides vertical strength to aid
  insertion.

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I-gel (5)

• 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
• Size 3 12G nasogastric tube
• Size 4 12G nasogastric tube
• Size 5 14G nasogastric tube

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AURA ONCE LMA
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AURA ONCE LMA
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References

• 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 1011862-1866
  doi10.1213/01.ANE.0000184181.92140.7C
• Randomized crossover comparison between the i-gel
  and the LMA-Unique in anaesthetized, paralysed
  adults
• V. Uppal1,, S. Gangaiah1, G. Fletcher2
  and J. Kinsella1, BJA VOL103
• http//www.ambu.co.uk/UK/Airway_Management
• 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

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THANK YOU