Reyhan POLAT, Sibel ÇATALCA, Julide ERGİL, İlkay BARAN, Aylin TAMAM, Yağmur POLAT

Comparison of Clinical Performance of Supraglottic Airway Devices in Elderly Patients: A Prospective Randomized Trial

Objective: Airway management in the elderly may be challenging. Supraglottic airway devices(SADs) may be used to provide airway security. The aim of study was to compare the efficacy andsafety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised andnon-paralysed elderly patients.Method: The study was approved by a local ethics committee. Eighty patients, aged older than65 years, who were scheduled to undergo elective urological or orthopaedic surgery participatedin the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n=26),Group P: p-LMA (n=27) or Group I: i-gel (n=27). The primary outcome was oropharyngeal sealingpressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, easeof insertion, success rates, time to insertion, haemodynamic response and complications such assore throat and dysphagia.Results: There were no significant differences among the groups with respect to OSP (p=0.852),whereas there was a statistically significant difference between Group I and Group C in terms ofleak volume and leak fraction (p=0.042 and p=0.020, respectively). Adverse events were similaramong the groups (p>0.05).Conclusion: In this study, although the leak volume and leak fraction were lower in i-gel insertedpatients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patientswho were not applied muscle relaxants and will be operated under general anesthesia.

Yaşlı Hastalarda Supraglottik Hava Yolu Gereçlerinin Klinik Performanslarının Karşılaştırılması: Prospektif Randomize Çalışma

Amaç: Yaşlı hastalarda hava yolu yönetimi zor olabilir. Supraglottik hava yolu gereçleri hava yolu güvenliğini sağlamak için kullanılmaktadırlar. Bu çalışmanın amacı, kas gevşetici uygulanmamış, genel anestezi altında opere edilmesi planlanan yaşlı hastalarda farklı hava yolu gereçlerinin (klasik LMA (c-LMA), proseal LMA (p-LMA) ve i-gel) etkinliğini ve güvenilirliğini karşılaştırmaktır. Yöntem: Çalışma yerel bir etik kurul tarafından onaylandı. Elektif ürolojik veya ortopedik cerrahi geçirmesi planlanan 65 yaş üstü, 80 hasta çalışmaya dahil edildi. Her hasta randomize olarak 3 gruptan birine dahil edildi: Grup C: c-LMA (n=26), Grup P: p-LMA (n=27) veya Grup I: i-gel (n=27). Çalışmamızda birincil sonuç orofaringeal kaçak basıncı (OKB) idi. İkincil sonuçlar ise pozitif basınçlı ventilasyonunun yeterliliği, hava yolu gerecini yerleştirme kolaylığı ve başarı oranları, hava yolu gerecinin yerleştirilme süresi, hemodinamik değişiklikler, boğaz ağrısı ve disfaji gibi komplikasyonları içermekte idi. Bulgular: Gruplar arasında OKB açısından anlamlı fark bulunmadı (p=0.852), Grup I ve Grup C arasında kaçak hacmi ve kaçak fraksiyonu açısından istatistiksel olarak anlamlı fark vardı (sırasıyla p=0.042 ve p=0.020). Yan etkiler gruplar arasında benzerdi (p>0.05). Sonuç: Bu çalışmada, i-gel yerleştirilen hastalarda kaçak hacmi ve kaçak fraksiyonu daha düşük olmakla birlikte i-gel, c-LMA ve p-LMA’nın kas gevşetici uygulanmamış ve genel anestezi altında opere edilecek yaşlı hastalarda yeterli hava yolu sağladığı gösterilmiştir

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1. Brimacombe J. A proposed classification system for extraglottic airway devices. Anesthesiology. 2004;101:559. https://doi.org/10.1097/00000542-200408000-00054

2. Brain AI, Verghese C, Strube PJ. The LMA ‘ProSeal’--a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84:650-4. https://doi.org/10.1093/bja/84.5.650

3. Shin WJ, Cheong YS, Yang HS, Nishiyama T. The supraglottic airway I-gel in comparison with ProSeal laryngeal mask airway and classic laryngeal mask airway in anaesthetized patients. Eur J Anaesthesiol. 2010;6:598- 601. https://doi.org/10.1097/EJA.0b013e3283340a81

4. Goyal R, Shukla RN, Kumar G. Comparison of size 2 i-gel supraglottic airway with LMA-ProSeal™ and LMAClassic™ in spontaneously breathing children undergoing elective surgery. Paediatr Anaesth. 2012;22:355-9. https://doi.org/10.1111/j.1460-9592.2011.03757.x

5. Kim EM, Kim M-S, Koo B-N, et al. Clinical efficacy of the classic laryngeal mask airway in elderly patients: a comparison with young adult patients. Korean Journal of Anesthesiology. 2015;68:568-74. https://doi.org/10.4097/kjae.2015.68.6.568

6. Johnson KN, Botros DB, Groban L, Bryan YF. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management. Clin Interv Aging. 2015;10:1925- 34. https://doi.org/10.2147/CIA.S93796

7. Gatward JJ, Cook TM, Seller C, et al. Evaluation of the size 4 i-gel airway in one hundred non-paralysed patients. Anaesthesia. 2008;63:1124-30. https://doi.org/10.1111/j.1365-2044.2008.05561.x

8. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Bmj. 2010;340:332. https://doi.org/10.1136/bmj.c332

9. Kim MH, Lee JH, Choi YS, Park S, Shin S. Comparison of the laryngeal mask airway supreme and the i-gel in paralysed elderly patients: A randomised controlled trial. Eur J Anaesthesiol. 2018;35:598-604. https://doi.org/10.1097/EJA.0000000000000700

10. Yoon SW, Kang H, Choi GJ, et al. Comparison of supraglottic airway devices in laparoscopic surgeries: A network meta-analysis. J Clin Anesth. 2019;55:52-66. https://doi.org/10.1016/j.jclinane.2018.12.044

11. Brimacombe J, Keller C. The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology. 2000;93:104-9. https://doi.org/10.1097/00000542-200007000-00019

12. Maitra S, Baidya DK, Arora MK, Bhattacharjee S, Khanna P. Laryngeal mask airway ProSeal provides higher oropharyngeal leak pressure than i-gel in adult patients under general anesthesia: a meta-analysis. J Clin Anesth. 2016;33:298-305. https://doi.org/10.1016/j.jclinane.2016.04.020

13. In CB, Cho SA, Lee SJ, Sung TY, Cho CK. Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway SupremeTM in geriatric patients: a prospective and randomized study. Korean J Anesthesiol. 2019;72:39-46. https://doi.org/10.4097/kja.d.18.00121

14. Bouvet L, Albert ML, Augris C, et al. Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients: a prospective, randomized, doubleblind study. Anesthesiology. 2014;120:326-34. https://doi.org/10.1097/ALN.0000000000000094

15. Krishnappa S, Kundra P. Optimal anaesthetic depth for LMA insertion. Indian Journal of Anaesthesia. 2011;55:504-07. https://doi.org/10.4103/0019-5049.89887

16. Van Zundert TC, Brimacombe JR. Similar oropharyngeal leak pressures during anaesthesia with i-gel, LMAProSeal and LMA-Supreme Laryngeal Masks. Acta Anaesthesiol Belg. 2012;63:35-41.

17. Lee JR, Kim MS, Kim JT, et al. A randomised trial comparing the i-gel (TM) with the LMA Classic (TM) in children. Anaesthesia. 2012;67:606-11. https://doi.org/10.1111/j.1365-2044.2012.07072.x

18. Schunk D, Ritzka M, Graf B, Trabold B. A comparison of three supraglottic airway devices used by healthcare professionals during paediatric resuscitation simulation. Emerg Med J. 2013;30:754-7. https://doi.org/10.1136/emermed-2012-201570

19. Choi GJ, Kang H, Baek CW, et al. A systematic review and meta-analysis of the i-gel® vs laryngeal mask airway in children. Anaesthesia. 2014;69:1258-65. https://doi.org/10.1111/anae.12746

20. de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel (®) vs laryngeal mask airway in adults. Anaesthesia. 2014;69:1151-62. https://doi.org/10.1111/anae.12772

21. Chen X, Jiao J, Cong X, Liu L, Wu X. A comparison of the performance of the I-gel™ vs. the LMA-S™during anesthesia: a meta-analysis of randomized controlled trials. PLoS One. 2013;8:e71910. https://doi.org/10.1371/journal.pone.0071910

22. Esler MD, Thompson JM, Kaye DM, et al. Effects of aging on the responsiveness of the human cardiac sympathetic nerves to stressors. Circulation. 1995;91:351-8. https://doi.org/10.1161/01.CIR.91.2.351

23. Habib AS, Parker JL, Maguire AM, Rowbotham DJ, Thompson JP. Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly. Br J Anaesth. 2002;88:430-3. https://doi.org/10.1093/bja/88.3.430

24. Detsky ME, Jivraj N, Adhikari NK, et al. Will this patient be difficult to intubate?: The rational clinical examination systematic review. Jama. 2019;321:493-503. https://doi.org/10.1001/jama.2018.21413

25. Eberhart LH, Arndt C, Cierpka T, et al. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesth Analg. 2005;101:284-9. https://doi.org/10.1213/01.ANE.0000154535.33429.36

26. Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003;96:595-9. https://doi.org/10.1213/00000539-200302000-00053

27. Khan ZH, Arbabi S, Yekaninejad MS, Khan RH. Application of the upper lip catch test for airway evaluation in edentulous patients: An observational study. Saudi Journal of Anaesthesia. 2014;8:73-7. https://doi.org/10.4103/1658-354X.125942