The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Abstract

Background The LMA Supreme TM (SLMA) is a singleuse supraglottic device that provides a good seal for positive pressure ventilation. It has a double aperture design that facilitates the introduction of an orogastric tube to aspirate gastric contents. This observational study evaluated the role of the SLMA in parturients undergoing Cesarean delivery under general anesthesia. Methods Non-obese parturients with at least four hours of fasting and antacid prophylaxis scheduled for uncomplicated Cesarean delivery were recruited from June 2009 through May 2010 at the Quanzhou Women's and Children's Hospital, China. We recorded the number of SLMA insertion attempts, the time to effective ventilation, the incidence of aspiration, and other anesthetic and obstetric outcomes. Postoperatively, we noted the presence of blood on the SLMA, postoperative sore throat, and patient satisfaction. Analysis included comparison of results between parturients having elective and urgent Cesarean delivery. Results We recruited 700 parturients (576 elective, 124 urgent). Mean (standard deviation) body mass index was 25.6 (2.5) kgÁm -2 . All SLMA insertions were successful, with 686 (98%) inserted on first attempt and a time to effective airway of 19.5 (3.9) sec. We maintained ventilation and oxygenation in all parturients with a good seal and there was no evidence of aspiration. Eighteen parturients (2.6%) had blood on the SLMA upon removal, 24 (3.4%) had sore throat, and patient satisfaction was 85 (7)%. These results were similar in elective and urgent cases. Conclusions In a carefully selected group of parturients, the SLMA is a useful alternative to tracheal intubation for Cesarean delivery, providing effective ventilation and a low incidence of side effects or complications.

Can i-gel Replace Endotracheal Tube during Elective Cesarean Section?

“…It suggests that the i-gel is likely to be a better choice as a primary rescue airway device in obstetric anesthesia because of easier insertion, requires fewer insertion attempts and is less traumatic than a laryngeal mask airway. Other studies which use the LMA conclude that "the LMA is effective and probably safe for elective Cesarean section [27][28][29][30].…”

A Comparative Study of Supreme LMA Vs I-gel : Two Supraglottic Airway Devices in Short Surgical Procedures"

“…Cook et al reported that 2 out of 100 patients developed coughing without a fall in arterial oxygen saturation There was no evidence of injury to lip, teeth, tongue or gums and blood on device with either device. Yao et al, reported 2.6% patients had on supreme on removal 16 . Russo et al, reported the incidence of blood stains on Supreme LMA, I-Gel and Laryngeal Tube Suction-D…”

Anesthésie pour césarienne

“…On peut dire que l'intubation impossible est géné-ralement inférieure à 0,5 % et celle de l'intubation difficile inférieure à 5 % [37,38]. Des dispositifs type LMA ont été proposés pour éviter cette intubation sur des séries importantes de patientes [39,40], les résultats sont rassurants, mais aucune société savante n'a encore recommandé ce dispositif en première ligne, mais plutôt en dispositif de secours en cas d'ID. La mise à disposition de vidéolaryngoscope en cas d'ID est un élément sécuritaire important en obstétrique [41], car la pré-diction d'une intubation difficile reste encore problématique avec la plupart des critères anatomiques (Mallampati, etc.).…”