Comparison of gastric insufflation using LMA-supreme and I-gel versus tracheal intubation in laparoscopic gynecological surgery by ultrasound: a randomized observational trial

Abstract

Background: The application of bedside ultrasound to evaluate gastric content and volume can assist in determining aspiration risk. Applying positive pressure ventilation via supraglottic airway devices (SAD) can result in a degree of gastric insufflation. This study assessed and compared the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynecological surgery when managed with different SAD. Methods: One hundred American Society of Anesthesiologists I or II female patients were assessed for inclusion in this study and divided into three groups of different ventilation devices. Patients were randomly allocated into three groups to receive LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). The primary outcome was the antral cross-sectional area and secondary outcomes included haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting. Results: The antral CSA was not significantly different among three groups before induction (P = 0.451), after induction (P = 0.456) and at the end of surgery (P = 0.195). The haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion (P < 0.0001) and after removal (P < 0.01). Sore throat was detected in none in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and fifteen patients (50%) in the tracheal tube group. Hoareness was detected in one (3.3%) in the I-gel group compare to two patients (6.7%) in the LMA-Supreme group and eleven patients (36.7%) in the tracheal tube group. Conclusions: The SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynecological surgery. Trial registration: This trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018212, data of registration, September 2018).

Comparison of Gastric Insufflation Volume Between Ambu AuraGain and ProSeal Laryngeal Mask Airway Using Ultrasonography in Patients Undergoing General Anesthesia: A Randomized Controlled Trial

“…The other method described by Shariffuddin et al was gastric aspirate rather than gastric volume measurement by USG and they found that the gastric volume aspirated with Ambu AuraGain was less and not statistically significant, which was not done in our study [16]. Though the main limitation of SAD is the presence of unprotected airway with the leading risk of aspiration which can be prevented by its correct placement, i.e., its acts as a barrier at the level of upper oesophageal sphincter, and the incidence of aspiration was similar to that of tracheal intubation approximately 0.02% [7,17,18]. However, the antral cross-sectional area was measured in all three LMA's namely LMA supreme, I-gel, and tracheal intubation by Ye et al, and there was no difference, but they failed to find out the gastric volume which helps us to anticipate aspiration following its usage; this is well marked in our study.…”

“…However, the antral cross-sectional area was measured in all three LMA's namely LMA supreme, I-gel, and tracheal intubation by Ye et al, and there was no difference, but they failed to find out the gastric volume which helps us to anticipate aspiration following its usage; this is well marked in our study. And in our study, measured gastric volume was lesser in Ambu AuraGain group than LMA ProSeal group [7].…”

“…And also, its role in positive pressure ventilation is still questionable in certain circumstances as it was not a definitive airway. But a study by Ye et al clearly defined that there was no difference in the antral cross-sectional area with secondgeneration SADs when compared with tracheal intubation during laparoscopic surgeries even in the Trendelenburg position [7]. This makes second-generation SADs equally placed on par with tracheal intubation.…”

“…Second-generation SAD prevents gastric contents aspiration and thereby associated pulmonary complications [3]. Traditionally, oropharyngeal sealing pressure provides insight into the risk of gastric insufflation and aspiration risk [3,[5][6][7]. Measuring the gastric cross-sectional area by ultrasonography to calculate the gastric volume can help predict the risk of aspiration in these patients [8][9][10][11][12].…”

Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients

“…In recent years, the nursing mode in China has gradually changed from “disease-centered” to “patient-centered” [ 17 ]. Based on gynecological malignant tumor surgery and psychological characteristics of patients, targeted nursing intervention is of great significance to postoperative rehabilitation of patients [ 18 ].…”