Comparison of the clinical performance of airway management with the i-gel® and laryngeal mask airway SupremeTM in geriatric patients: a prospective and randomized study

Abstract

Background: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA SupremeTM) in geriatric patients.

Methods: The subjects were American Society of Anesthesiologists physical status classification I-III geriatric (65-85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA SupremeTM group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events.

Results: Insertion time was significantly shorter for the i-gel® than the LMA SupremeTM (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA SupremeTM (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA SupremeTM (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups.

Conclusions: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA SupremeTM in geriatric patients.

Keywords: Aging; Airway management; Geriatric; Intubation; Morbidity; Supraglottic devices.

Fig. 1.

CONSORT flow diagram. Thirtyeight patients were randomly allocated into the i-gel^® or LMA Supreme^TM group. Three patients in the LMA SupremeTM group were excluded due to failed device insertion. However, data were collected before and during device insertion. LMA: laryngeal mask airway.