A randomised comparison of the i‐gel™ and the Laryngeal Mask Airway Classic™ in infants

We performed a randomised comparison of the i‐gel? and the Laryngeal Mask Airway (LMA) Classic? in children aged less than a year who were undergoing general anaesthesia for elective surgery. Fifty‐four infants were randomly allocated to either the i‐gel or the LMA Classic. We measured performance characteristics, fibreoptic views through the device and complications. Success rate at first insertion attempt was 100% (27/27) in the i‐gel group compared with 88% (23/26) in the LMA Classic group. Insertion of the device was considered easy in 26/27 (96%) patients in the i‐gel group compared with 18/26 (69%) patients in the LMA Classic group (p = 0.009). There were no differences between the groups in insertion times, fibreoptic views through the device, airway leak pressures or complications. We conclude that the i‐gel was considered easier to insert than the LMA Classic in infants.     

ORIGINAL ARTICLE: Comparison of guided insertion of the LMA ProSeal™ vs the i‐gel™

In a randomised, non‐crossover study, we tested the hypothesis that the ease of insertion using a duodenal tube guided insertion technique and the oropharyngeal leak pressure differ between the LMA ProSeal? and the i‐gel? in non‐paralysed, anesthetised female subjects. One hundred and fifty‐two females aged 19–70 years were studied. Insertion success rate, insertion time and oropharyngeal leak pressure were measured. First attempt and overall insertion success were similar (LMA ProSeal, 75/76 (99%) and 76/76 (100%); i‐gel 73/75 (97%) and 75 (100%), respectively). Mean (SD) insertion times were similar (LMA ProSeal, 40 (16) s; i‐gel 43 (21) s). Mean oropharyngeal leak pressure was 7 cmH₂O higher with the LMA ProSeal (p < 0.0001). Insertion of the LMA ProSeal and i‐gel is similarly easy using a duodenal tube guided technique, but the LMA ProSeal forms a more effective seal for ventilation.     

A comparison of fibreoptic‐guided tracheal intubation through the Ambu®Aura‐i™, the intubating laryngeal mask airway and the i‐gel™: a manikin study

We compared the Aura‐i ^? , intubating laryngeal mask airway and i‐gel ^? as conduits for fibreoptic‐guided tracheal intubation in a manikin. Thirty anaesthetists each performed two tracheal intubations through each device, a total of 180 intubations. The median (IQR [range]) time to complete the first intubation was 40 (31–50 [15–162]) s, 37 (34–48 [25–75]) s and 28 (22–35 [14–59]) s for the Aura‐i, intubating laryngeal mask airway and i‐gel, respectively. Tracheal intubation through the i‐gel was the quickest (p < 0.01). Resistance to railroading of the tracheal tube over the fibrescope was significantly greater through the Aura‐i compared with the intubating laryngeal mask airway and the i‐gel (p = 0.001). There were no failures to intubate through the intubating laryngeal mask airway or the i‐gel but six intubation attempts through the Aura‐i were unsuccessful, in five owing to a railroading failure and in one owing to accidental oesophageal intubation. We conclude that the Aura‐i does not perform as well as the intubating laryngeal mask airway or the i‐gel as an adjunct for performing fibreoptic‐guided tracheal intubation.     

Awake intubation using the LMA‐CTrach™ in patients with difficult airways*

We studied 21 patients with known difficult airways who underwent awake tracheal intubation using the LMA CTrach^?. Patients were given midazolam, atropine, a continuous infusion of remifentanil and topical lidocaine applied to the oropharyx. We limited the number of insertion attempts to three and the time to adjust the view to 5 min. In case of failure, we performed awake fibreoptic tracheal intubation. We found insertion of the device was successful and well tolerated in all patients. Vocal cords could be seen immediately in nine patients and following corrective manoeuvres in 10 patients. Tracheal intubation was successful in 20 patients: 19 cases under direct vision and in one blindly. In one patient with undiagnosed lingual tonsil hyperplasia, tracheal intubation was impossible using the device. No patient had an unpleasant recall of the procedure. We conclude that the LMA CTrach is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.     

A performance comparison of the paediatric i‐gel™ with other supraglottic airway devices

We performed a review of published literature comparing the i‐gel^? with other supraglottic airway devices in children. Sixty‐two articles were identified following a literature search; we included data from 14 randomised controlled trials and eight observational studies that compared i‐gel sizes 1–2.5 with other commonly used, equivalently‐sized, devices. The primary outcome in most studies was oropharyngeal leak pressure. In the 14 randomised trials the i‐gel performed the same as the comparator device in five trials, significantly better in eight studies (p < 0.05) and significantly worse in one (p < 0.01). Seven studies assessed fibreoptic views of the larynx through the device; two found significantly better views through the i‐gel. Three studies reported a shorter insertion time for the i‐gel, whereas two reported a longer time. Insertion success rate, gastric tube placement and complications were similar for all the devices. Seven of the eight observational studies measured average oropharyngeal leak pressures of 20–27 cmH₂O and all had first‐time insertion success rates exceeding 90%. We conclude that the i‐gel is at least equivalent to other supraglottic airway devices currently available for use in children, and may enable a higher oropharyngeal leak pressure and an improved fibreoptic view of the glottis.     

A randomised,non‐crossover study of the GuardianCPV™ Laryngeal Mask versus the LMA Supreme™ in paralysed,anaesthetised female patients

We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV? and the LMA Supreme? in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10‐ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20–40 ml were 31 (7) cmH₂O for the GuardianCPV and 27 (7) cmH₂O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH₂O and 88 (43) cmH₂O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.     

A cohort evaluation of the Laryngeal Mask Airway‐Supreme™ in children

Objectives: To assess the clinical performance of the laryngeal mask airway‐Supreme in children. Aim: The purpose of this prospective audit was to evaluate the feasibility of the laryngeal mask airway‐Supreme in clinical practice and generate data for future comparison trials. Background: The laryngeal mask airway‐Supreme is a new second‐generation supraglottic airway that was recently released in limited pediatric sizes (sizes 1, 2). Methods: One hundred children, ASA I‐III, newborn to 16 years of age, and undergoing various procedures requiring a size 1, 2, or 3 laryngeal mask airway‐Supreme were studied. Assessments included insertion success rates, airway leak pressures, success of gastric tube insertion, quality of airway, and perioperative complications. Results: The first‐time insertion success rate was 97%, with an overall insertion success rate of 100%. The mean initial airway leak pressure for all patients was 22.3 ± 6.6 cm H₂O. Gastric tube placement was possible in 98% of patients. Complications were noted in six patients: coughing or laryngospasm (n = 3), sore throat (n = 1), and dysphonia (n = 2). Conclusions: The laryngeal mask airway‐Supreme was inserted with a high degree of success on the first attempt by clinicians with limited prior experience with the device. It was effectively used for a variety of procedures in children undergoing spontaneous and mechanical ventilation with minimal complications. The leak pressures demonstrated in this study, along with access for gastric decompression, suggest that the laryngeal mask airway‐Supreme may be an effective device for positive pressure ventilation in children.     

A laboratory comparison of the performance of the buddy lite™ and enFlow™ fluid warmers

Maintenance of normothermia is crucial to avoid patient morbidity. Newly released fluid warming devices have become smaller in size, but this change might impair efficacy. We performed an evaluation of the buddy lite? and enFlow? fluid warmers. We measured inflow and outlet temperatures of the devices at flow rates between 25 and 100 ml.min^?1 using saline at room temperature or cooled to 10 °C. At a flow rate of 25 ml.min^?1, the outlet temperature of the buddy lite was significantly higher than that of the enFlow (p < 0.0001), but at flow rates of 75 and 100 ml.min^?1, it was significantly lower (p < 0.0001). This pattern was the same for both room temperature and cooled saline. There was a significant drop in the temperature of saline along the length of a 1‐m outflow tube. We conclude that both devices provide effective fluid warming at a low flow rate, although the heating capability of the buddy lite is limited at high flow rates.     

Prostatectomy by transurethral balloon Laserthermia™ (PROSTALASE™) in the canine

Prostatectomy by transurethral balloon Laserthermia (PROSTA-LASE?) was performed in a canine model. This balloon device monitored by transrectal ultrasound can cylindrically irradiate with a laser beam. The treatment was performed in 8 canines using 15 watts for 20 minutes at 60°C at a 5 mm depth of the prostate from the urethral surface. Immediately following the laser therapy, an area of coagulation necrosis was observed around the urethra to a depth of 4–5 mm from the surface. After 1 week, cavitation formation was seen in 3 or 4 canines by ultrasound, and the urethral reepithelialization was shown in 1 of 2 canines. After 2 weeks, cavitation formation was observed in both canines, and the urethra was completely reepithelialized in one canine. There was no tissue damage in the bladder neck of urethral sphincter and no urinary incontinence in any animal. This system is thought to be simple and, satisfactorily performed, is an effective transurethral prostatectomy. © 1994 Wiley-Liss, Inc.     

Evaluation of the LMA Supreme™ in 100 non‐paralysed patients*

We studied the LMA Supreme^? in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10–25 (5–120)] s. During ventilation, an expired tidal volume of 7 ml.kg^?1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20–28 (13–40)] cmH₂O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side‐effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices.     

A comparison of the i‐gel™ and the PRO‐Breathe® laryngeal mask during pressure support ventilation in children

Many studies comparing the i‐gel^? with laryngeal masks include patients in whom laryngeal mask cuff inflation pressures are higher than recommended, or involve the use of neuromuscular blocking drugs and positive pressure ventilation. We compared the i‐gel with the PRO‐Breathe^® laryngeal mask in anaesthetised, spontaneously breathing children. Two hundred patients aged up to 16 years were randomly allocated to either the i‐gel or the PRO‐Breathe laryngeal mask. The PRO‐Breathe was inflated to an intracuff pressure of 40 cmH₂O. All patients received pressure support of 10 cmH₂O and positive end‐expiratory pressure of 5 cmH₂O. Successful insertion at the first attempt was 82% for the i‐gel compared with 93% for the PRO‐Breathe (p = 0.019). Leakage volume was significantly higher with i‐gel sizes 1.5 (p = 0.015), 2 (p = 0.375), 2.5 (p = 0.021) and 3 (p = 0.003) compared with the equivalent‐sized PRO‐Breathe device. Device dislodgement following successful initial placement was more frequent with the i‐gel (5%) compared with the PRO‐Breathe laryngeal mask (0%). We conclude that the PRO‐Breathe laryngeal mask is superior to the i‐gel in terms of leakage volume and device dislodgement.     

A randomised crossover comparison of manikin ventilation through Soft Seal®, i‐gel™ and AuraOnce™ supraglottic airway devices by surf lifeguards

Forty surf lifeguards attempted to ventilate a manikin through one out of three supraglottic airways inserted in random order: the Portex^® Soft Seal^®; the Intersurgical^® i‐gel?; and the Ambu^® AuraOnce?. We recorded the time to ventilate and the proportion of inflations that were successful, without and then with concurrent chest compressions. The mean (SD) time to ventilate with the Soft Seal, i‐gel and AuraOnce was 35.2 (7.2)s, 15.6 (3.3)s and 35.1 (8.5) s, respectively, p < 0.0001. Concurrent chest compression prolonged the time to ventilate by 5.0 (1.3–8.1)%, p = 0.0072. The rate of successful ventilations through the Soft Seal (100%) was more than through the AuraOnce (92%), p < 0.0001, neither of which was different from the i‐gel (97%). The mean (SD) tidal volumes through the Soft Seal, i‐gel and AuraOnce were 0.65 (0.14) l, 0.50 (0.16) l and 0.39 (0.19) l, respectively. Most lifeguards (85%) preferred the i‐gel. Ventilation through supraglottic airway devices may be considered for resuscitation by surf lifeguards.     

Haemorrhoidectomy with Ligasure™vs conventional excisional techniques: meta‐analysis of randomized controlled trials

Objective To compare the use of LigaSure devices with conventional excisional techniques, circular stapling and use of Harmonic Scalpel in patients with symptomatic haemorrhoids and to review literature on LigaSure technology (Valleylab Inc. USA). Method A literature review was performed using the National Library of Medicine’s Pubmed Database using the keywords Ligasure, haemorrhoidectomy, vessel sealing technology. Randomized trials comparing LigaSure with other techniques of excisional haemorrhoidectomy with valid end points were reviewed in the present article and included in a quantitative meta‐analysis. Results There was no significant difference in the proportion of patients cured after Ligasure haemorrhoidectomy or other excisional techniques (P > 0.05). Patients treated with LigaSure had a significantly shorter operative time (P < 0.001), postoperative pain VAS Score (P < 0.001), wound healing time and time‐off from work (P < 0.001), than the patients submitted to excisional techniques. Postoperative bleeding did not significantly differ between the two groups (P = 0.056); however, the surgeons observed a reduction of intra‐ and postoperative bleeding using LigaSure?. In comparison to the circular stapler and Harmonic Scalpel the authors found similar postoperative outcomes and a slightly favourable trend for LigaSure regarding postoperative complications, ease of handling and length of the procedure. Conclusion Our meta‐analysis shows that Ligasure haemorrhoidectomy is a fast procedure characterized by limited postoperative pain, short hospitalization, fast wound healing and convalescence.