AuraGain and i-Gel laryngeal masks in general anesthesia for laparoscopic cholecystectomy. Performance characteristics and effects on hemodynamics

Abstract

To evaluate and compare the performances of new types of supraglottic airway devices (SADs) with endotracheal intubation regarding their ease of insertions, perioperative complications, and effects on hemodynamic parameters and peak airway pressures in laparascopic cholecystectomy (LC). Methods: One hundred and fourteen patients with ASA 1-2 physical status scheduled for elective LC were recruited for this prospective randomized controlled trial. The study was completed between January 2016 and January 2017 in Adiyaman University Research and Educational Hospital, Adiyaman, Turkey. The patients were divided into AuraGain(Ambu, Ballerup, Denmark) (n=38), i-Gel® (Intersurgical Ltd, UK) (n=35), and endotracheal tube (ETT)(n=32) groups. Ease of insertion, airway pressures, complications, and hemodynamic variables were compared. Results: The trial was completed with 105 patients. Ease of insertion for SADs which was evaluated with insertion procedure duration, attempts, first insertion success rates, and oropharyngeal leak pressures were similar between the groups. Heart rate, systolic and diastolic arterial pressures, and peak airway pressures were significantly lower in the AuraGain and i-Gel® groups, compared with the ETT, p less than 0.017. Conclusion: Both AuraGain and i-Gel® SADs are comparable with ETT used for airway control in general anesthesia for LC, regarding application ease and perioperative complications. Favorable hemodynamic responses to AuraGain and i-Gel® SADs may put them in a better place than ETT.

Figure 1

Heart rate alteration graph of the patients in groups AuraGain, i-Gel®, and ETT. P<0.017 for T1 (both AuraGain and i-Gel®compared with ETT). T0 - time period, preoperatively, T1 - the time following insertion of the airway device, T2 - the time before abdominal carbon dioxide insufflations T3 - the time just after the insufflation T4, T5 - the times every 10 mins after the insufflation, ETT - endotracheal intubation

Figure 2

Mean systolic and diastolic arterial pressure alteration graph of the patients in groups AuraGain, i-Gel®, and ETT. P<0.017 at T0, T1 and T2 for AuraGain compared with ETT; P<0.017 at T1 and T2 for i-Gel® compared with ETT. T0 - time period, preoperatively, T1 - the time following insertion of the airway device, T2 - the time before abdominal carbon dioxide insufflations T3 - the time just after the insufflation T4, T5 - the times every 10 mins after the insufflation. SAP - systolic arterial pressure, DAP - diastolic arterial pressure, ETT - endotracheal intubation

Figure 3

Peak airway pressure alteration graph of the patients in groups AuraGain, i-Gel® and ETT in time. P<0.017 for all times (both AuraGain and i-Gel® compared with ETT). T0 - time period, preoperatively, T1 - the time following insertion of the airway device, T2 - the time before abdominal carbon dioxide insufflations T3 - the time just after the insufflation T4, T5 - the times every 10 mins after the insufflation, ETT - endotracheal intubation