LMA Supreme ™ vs i‐gel ™ – a comparison of insertion success in novices

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Abstract
Summary: Two new supraglottic airway devices, the LMA Supreme™ (LMA) and the i‐gel™, offer potential benefits when inserted by inexperienced operators. This study compared the insertion success rate and ventilation profile between the LMA Supreme and the i‐gel when inserted by operators without previous airway management expertise. Following a short lecture and manikin training, airway novices were randomly allocated to insert either the LMA Supreme or the i‐gel into 80 patients undergoing breast surgery. The primary outcome was first‐time success rate, and secondary outcomes were overall success rate, insertion time, airway leak pressure, tidal volume during pressure controlled ventilation at 17 cmH 2 O, and adverse events. First‐time insertion success rate was significantly higher for the LMA Supreme than the i‐gel (30/39 (77%) vs 22/41 (54%); p = 0.029). Significantly more placement failures occurred with the i‐gel (6 vs 0, p = 0.025). Mean (SD) leak pressure (29 (8) vs 23 (11) cmH 2 O, p = 0.007) and expired tidal volume (PCV 17 cmH 2 O) (785 (198) vs 654 (91), p = 0.001) were significantly greater with the LMA Supreme than with the i‐gel, respectively. More patients complained of pharyngolaryngeal pain with the LMA Supreme than with the i‐gel (17/39 (44%) vs 8/41 (20%); p = 0.053). We found better first time success rate, fewer failures, and a better seal with the LMA Supreme compared with the i‐gel, indicating that the LMA Supreme may be preferable for emergency airway use by novices.

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