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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Comparison of clinical performance of two supraglottic devices, aura once LMA and
I GEL .
The ease of insertion,
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Placement success rate
Hemodynamic response
Intra-operative and post-operative complications

 Single blind
 Prospective
 Randomised

 General surgery theatre in stanley medical college.

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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.

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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

 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

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

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Randomly divide the patients into two groups
Written informed consent to be obtained
 Group 1 (n=20) : patients who will receive general anaesthesia with Aura once LMA
 Group 2 (n=20): patients who will receive general anaesthesia with I Gel.

 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.

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

 Anaesthesia was maintained with
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N2O: O2 70:30%,
Isoflurane 1% in spontaneous ventilation

 During maintenance of anesthesia
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Heart rate, Mean arterial blood pressure,
Spo2, respiratory rate, end-tidal CO2 concentration,

 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

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

 sore throat
 dysphonia

VARIABLE
Ease of insertion
Size (3/4)
Insertion attempts (1/2)
Failed insertion
Size changes
Insertion time (sec)
Ambu LMA I-Gel
9/11
18/2
0
1
23.75 +/_3.8
(18 – 45 )
P=0.0001
8/12
18/2
0
1
16.7 +/- 5.3
(13 – 35)

VARIABLE AMBU LMA I GEL
AGE
WEIGHT
SEX (m : f)
24+/ 3
(19-31 yrs)
50 +/ 7.78
(35 – 65 kg)
(9:11)
24+/3 yr
(18 – 30 yrs)
51+/ 8.16
(35 – 65 kg)
(8:12)

VARIABLE AMBU LMA I GEL
Heart Rate
(Pre- insertion)
Heart Rate
(1 min after insertion)
Heart Rate
(5 min after insertion)
80.75+/7.6
P=0.94
86.45+/4.65
P=0.1053
82+/4.21
P=0.5585
80.8+/7.8
87.65+/4.3
82.45+/4.36

VARIABLE AMBU LMA I GEL
Mean arterial pressure
(Pre- insertion)
Mean arterial pressure
(1 min after insertion)
Mean arterial pressure
(5 min after insertion)
89.50+/6.7
P=0.3160
92.55+/5.9
p=0.5837
90.60+/6.4
P=0.2183
90.55+/5.6
93.2+/5.43
92+/4.7

VARIABLES AMBU LMA I GEL
SPO2
ETCo2
97+/2
37+/5
98+/2
38+/5

I GEL
WEIGHT
30-49
50-80
AMBU LMA
WEIGHT
30-49
50-80

12
10
8
6
4
2
0 male ambu LMA female
Series1
10
8
6
4
2
0
14
12 male
I GEL female
Series1
Series2

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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.

 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.

 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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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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SUPRAGLOTTIC DEVICE INSERTION:
TIME
Number of attempts
Monitoring :
Heart rate, Mean arterial blood pressure,
Spo2, respiratory rate, end-tidal CO2 concentration,
Intraop:
Aspiration/regurgitation,
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Bronchospasm, airway obstruction,
 Coughing
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Post op:
 sore throat
 dysphonia

 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 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.

 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.

 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

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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 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 ; ww w.ncbi.nlm.nih.gov/pubmed/17323667