Comparison of Three Disposable Extraglottic Airway Devices in Spontaneously Breathing Adults: The LMA-Unique ™, the Soft Seal Laryngeal Mask, and the Cobra Perilaryngeal Airway |
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Authors: | van Zundert, Andr M.D., Ph.D., F.R.C.A. Al-Shaikh, Baha F.C.A.R.C.S.I., F.R.C.A. Brimacombe, Joseph M.D., M.B., Ch.B., F.R.C.A. Koster, Jurgen M.D.
Koning, Dick M.D. Mortier, Eric P. M.D., Ph.D.# |
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Affiliation: | van Zundert, André M.D., Ph.D., F.R.C.A.*; Al-Shaikh, Baha F.C.A.R.C.S.I., F.R.C.A.†; Brimacombe, Joseph M.D., M.B., Ch.B., F.R.C.A.‡; Koster, Jurgen M.D.§; Koning, Dick M.D.∥; Mortier, Eric P. M.D., Ph.D.# |
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Abstract: | Background: The authors compared three disposable extraglottic airway devices in spontaneously breathing anesthetized adults: the LMA-Unique (TM) (LMA-U; The Laryngeal Mask Company, San Diego, CA), the Soft Seal(R) laryngeal mask (SS-LM; Portex Ltd., Hythe, United Kingdom), and the Cobra perilaryngeal airway (Cobra-PLA (TM); Engineered Medical Systems, Inc. Indianapolis, IN). Methods: Three hundred twenty consecutive adults (American Society of Anesthesiologists physical status I-III; aged 18-80 yr) were randomly allocated for airway management with one of the three devices. Anesthesia was with fentanyl-propofol for induction and a sevoflurane-nitrous oxide-oxygen-fentanyl mixture for maintenance. Intraoperative data were collected by an unblinded observer about ease of insertion, effective airway time, oropharyngeal leak pressure, anatomical position (determined with a rigid endoscope), intracuff pressure changes, and airway trauma. Data were collected by a blinded observer about sore throat, dysphagia, and dysphonia 2 h after surgery. Results: Insertion was easier with the LMA-U and SS-LM than with the Cobra-PLA (P < 0.02), but the overall failure rates were similar. Effective airway times were similar among groups. Oropharyngeal leak pressure was lower with the LMA-U than with the SS-LM and Cobra-PLA (P < 0.001). Intracuff pressure increased during surgery with all extraglottic airway devices. Anatomical position was better with the Cobra-PLA than with the SS-LMA (P < 0.001) and better with the SS-LM than with LMA-U (P < 0.001). Blood staining was detected more frequently with the Cobra-PLA than with the LMA-U and SS-LM (P < 0.001), but there were no differences in airway morbidity. |
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