Comparison of i-gel® and LMA Supreme® during laparoscopic cholecystectomy

Abstract

Background: In laparoscopic surgical procedures, many clinicians recommend supraglottic airway devices as good alternatives to intubation. We compared the i-gel® (i-gel) and LMA Supreme® (Supreme Laryngeal Mask Airway, SLMA) airway devices during laparoscopic cholecystectomy regarding sealing pressure and respiratory parameters before, during, and after pneumoperitoneum.

Methods: Following Institutional Review Board approval and written informed consent, 93 patients were randomly allocated into the i-gel (n = 47) or SLMA group (n = 46). Insertion time, number of insertion attempts, and fiberoptic view of glottis were recorded. Oropharyngeal leak pressure (OLP), the use of airway manipulation, peak inspiratory pressure, lung compliance, and hemodynamic parameters were measured before, during, and after pneumoperitoneum.

Results: There were no significant differences between the two groups regarding demographic data, insertion time, fiberoptic view of glottis, and the use of airway manipulation. The gastric tube insertion time was longer in the i-gel group (20.4 ± 3.9 s) than in the SLMA group (16.7 ± 1.6 s) (P < 0.001). All devices were inserted on the first attempt, excluding one case in each group. Peak inspiratory pressure, lung compliance, and OLP changed following carbon dioxide pneumoperitoneum in each group, but there were no significant differences between the groups.

Conclusions: Both the i-gel and SLMA airway devices can be comparably used in patients who undergo laparoscopic cholecystectomy, and they offer similar performance including OLP.

Keywords: I-gel; Laparoscopic cholecystectomy; Supreme laryngeal mask airway.

Fig. 1. CONSORT flow diagram for the study patients.

Fig. 2. Changes of heart rate and blood pressure between the i-gel group (○) and the SLMA group (●). Values are mean ± SD. There was no significant difference in heart rate and blood pressure between the groups. T0: baseline, T1: 1 min after induction, T2: 5 min before CO₂ pneumoperitoneum, T3: 5 min after start of CO₂ pneumoperitoneum, T4: 5 min before removal of pneumoperitoneum, T5: 5 min after removal of pneumoperitoneum.

Fig. 3. Changes of oropharyngeal leak pressure between both i-gel (□) and SLMA (■) groups at various points. Data are represented as the mean ± SD. ^*P < 0.01 compared with TO1 in each group. TO1: 1 min after induction, TO2: 5 min after start of CO₂ pneumoperitoneum and TO3: 5 min after removal of pneumoperitoneum.

Fig. 4. Changes of peak inspiratory pressure and lung compliance between the i-gel group (○) and the SLMA group (●). Values are mean ± SD. ^*P < 0.05 compared with T2 value in each group. There were no significant differences in peak inspiratory pressure and lung compliance between the groups. T1: 1 min after induction, T2: 5 min before CO₂ pneumoperitoneum, T3: 5 min after start of CO₂ pneumoperitoneum, T4: 5 min before removal of pneumoperitoneum, T5: 5 min after removal of pneumoperitoneum.