Comparison of the Proseal, Supreme, and I‐Gel SAD in Gynecological Laparoscopic Surgeries

Abstract

We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp., P = 0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel.

Comparison of the clinical performance of i-gel, LMA Supreme and LMA ProSeal in elective surgery

“…In general, it is thought that higher oropharyngeal leak pressures in SADs allow the use 2 O, respectively, which were similar to the leak pressures recorded in our study. (9) A possible reason for the i-gel's higher leak pressure in our study, as compared with previous studies, is the modification applied to its weight-based size selection criteria to account for the 10-kg overlap between sizes 3 and 4. Nevertheless, there was a higher incidence of significant air leakage in the i-gel group, with three cases of the size 3 i-gel as opposed to none in the other devices.…”

“…Mukadder et al encountered no difference among the devices in terms of insertion success, although the insertion time was found to be shorter with i-gel. (9) Similarly, Teoh et al's trial of both the i-gel and Supreme SADs demonstrated comparable ease and duration of insertion between the two tested devices. (14) A meta-analysis comparing the i-gel and Supreme SADs also concluded that there was no statistical difference in device placement time and first attempt insertion success rates.…”

“…Mukadder et al showed in their study that gastric tube insertion had a similar success rate for the i-gel and Supreme groups, but was more difficult with the ProSeal group. (9) Teoh et al demonstrated no difference in the success rate of gastric tube insertion for the Supreme and i-gel groups. (12) A number of other studies reported gastric tube insertion failure in patients who used ProSeal, although it has not been reported in i-gel patients.…”

“…Sample size was estimated from a previous similar study that detected oropharyngeal leak pressure differences among the i-gel (mean ± standard deviation [SD] = 28.3 ± 2.4 cmH 2 O), ProSeal (mean ± SD = 25.0 ± 2.3 cmH 2 O) and Supreme (mean ± SD = 25.0 ± 1.9 cmH 2 O) SADs, p < 0.001; that study used a sample size of 35 patients in each group at 30 minutes upon insertion. (9) Therefore, we recruited 50 patients for each group and expected a similar effect size at the 0.05 level of significance with a power of 100%. Statistical analysis was performed using IBM SPSS Statistics version 20.0 for Macintosh (IBM Corp, Armonk, NY, USA).…”

“…One study testing the three devices used the laryngoscope-guided and gastric tubeguided methods of insertion, while another was conducted on paralysed, ventilated patients undergoing laparoscopic surgery. (8,9) In contrast, our randomised clinical study employed the standard, manufacturer-recommended insertion techniques. We compared the clinical efficacy of all three devices in non-paralysed patients undergoing elective surgery, taking oropharyngeal leak pressure as the primary outcome measure.…”