I-gel ve laringeal mask airway-supreme’in klinik performans yönünden karşılaştırılması: prospektif çalışma
Öz
Amaç: Çalışmamızda; genel anestezi altında ürolojik cerrahi girişim planlanan hastalarda, ikinci jenerasyon supraglottik havayolu gereçlerinden I-gel ve LMA-Supreme’in (Laringeal Mask Airway- Supreme) klinik performans ve postoperatif faringolaringeal komplikasyonlar açısından karşılaştırılmasını amaçladık.
Gereç ve Yöntem: Hastane etik kurul onayı (19-8.1T/53) ve hasta yazılı onamı alındıktan sonra, genel anestezi altında elektif ürolojik cerrahi planlanan, 18-65 yaş arası, ASA (The American Society of Anesthesiologists) skoru I-II olan, 120 hasta prospektif olarak çalışmamıza dahil edildi. Hastalar randomize olarak I-gel (n=60) ve LMA-Supreme (n=60) olarak iki gruba ayrıldı. İki grup; supraglottik havayolu gereci yerleştirme kolaylığı, yerleştirme süresi, ilk yerleştirmede başarı oranı, deneme sayısı, gastrik tüp yerleştirme kolaylığı, orofaringeal kaçak basıncı, intraoperatif ve postoperatif komplikasyonlar açısından karşılaştırıldı.
Bulgular: Supraglottik havayolu gereci yerleştirme süresi I-gel grubunda anlamlı olarak daha kısa bulundu (p: 0,039). Tüm ölçüm zamanlarında, orofaringeal kaçak basıncı ‘mükemmel’ olan hasta sayısı I-gel grubunda daha yüksekti (p<0,05). Gastrik tüp yerleştirme, LMA-Supreme grubunda anlamlı olarak daha kolay bulundu (p: 0,029). Postoperatif 12. saat boğaz ağrısı (p: 0,049) ve ses kısıklığı (p:0,046) LMA-Supreme grubunda daha fazla görüldü. LMA-Supreme ve I-gel; yerleştirme kolaylığı, ilk yerleştirmede başarı oranı, deneme sayısı ve intraoperatif komplikasyonlar açısından benzer özelliklere sahipti.
Sonuç: I-gel’de yerleştirme süresinin daha kısa, orofaringeal kaçağın ve postoperatif komplikasyonların daha az olması LMA-Supreme’e göre tercih nedeni olabilir.
Anahtar Kelimeler
Havayolu supraglottik hava yolu gereci I-gel; LMA-Supreme klinik performans
Kaynakça
- Walsh K, Cummins F. Difficult Airway Equipment in Departments of Emergency Medicine in Ireland: Results of a National Survey. Eur J Anaesthesiol 2004; 21: 128-31.
- Michalek P, Donaldson W, Graham C, Hinds JD. A Comparison of the I-gel Supraglottic Airway as a Conduit for Tracheal İntubation with the Intubating Laryngeal Mask Airway: A Manik in Study. Resuscitation 2010; 81: 74-7.
- Ramachandran SK, Kumar AM. Supraglottic Airway Devices. Respıratory Care 2014; 59: 920-32.
- Van Zundert A, Brimacombe J. The LMA Supreme- A Pilot Study. Anaesthesia 2008; 63: 209-10.
- Levitan RM, Kinkle WC. Initial Anatomic İnvestigations of the I-Gel Airway: A Novel Supraglottic Airway Without İnflatable Cuff. Anaesthesia 2005; 60: 1022-6.
- Park SY, Rim JC, Kim H, Lee JH, Chung CJ. Comparison of i-gel and LMA Supreme during laparoscopic cholecystectomy. Korean J Anesthesiol 2015; 68: 5: 455-61.
- Teoh WH, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia AT. Comparison of the LMA Supreme vs the I-Gel in Paralysed Patients Undergoing Gynaecological Laparoscopic Surgery with Controlled Ventilation. Anaesthesia. 2010; 65 (12):1173-9.
- Middleton PM, Simpson PM, Thomas RE, Bendall JC. Higher Insertion Success with the I-Gel Supraglottic Airway in out of hospital Cardiac Arrest: A Randomised Controlled Trial. Resuscitation. 2014; 85: 893-7.
- Leventis C, Chalkias A, Sampanis MA, Foulidou X, Xanthos T. Emergency Airway Management by Paramedics: Comparison Between Standard Endotracheal Intubation, Laryngeal Mask Airway and I-gel. Eur J Emerg Med. 2014; 21: 371-3.
- Chew EFF, Hashim NHM, Wang CY. Randomised Comparison of the LMA Supreme (TM) with the I-Gel (TM) in Spontaneously Breathing Anaesthetised Adult Patients. Anaesth and Intensive Care. 2010; 38 (6): 1018-22.
- Chen X, Jiao J, Cong X, Liu L, Wu X. A Comparison of the Performance of the I-gel™ vs. the LMA-S™ During Anesthesia: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2013; 8 (8):e71910.
- Kim MH, Lee JH, Choi YS, Park S, Shin S. Comparison of the Laryngeal Mask Airway Supreme and the I-Gel in Paralysed Elderly Patients: A Randomised Controlled Trial. Eur J Anaesthesiol. 2018; 35 (8): 598-604.
- Fernández DA, Pérez VA, Bermejo GJ, Marcos VJ. Supreme Laryngeal Mask Airway vs the I-Gel Supraglottic Airway in Patients Under General Anesthesia and Mechanical Ventilation with No Neuromuscular Block: A Randomized Clinical Trial. Rev Esp Anestesiol Reanim. 2009; 56 (8): 474-8.
- Belena JM, Nu ez M, Anta D, et al. Comparison of Laryngeal Mask Air- way Supreme and Laryngeal Mask Airway Proseal with Respect to Oro- Pharyngeal Leak Pressure During Laparoscopic Cholecystectomy: A Randomised Controlled Trial. Eur J Anaesthesiol 2013; 30: 119-23.
- Bağuş F, Yıldız TŞ, Solak M, Toker K. Pediyatrik Hastalarda Klasik ve Proseal LMA’nın Etkinliklerinin Karşılaştırılması. Türk Anest Rean Der Dergisi 2011; 39 (6): 311-7.
- Ragazzi R, Finessi L, Farinelli I, Alvisi R, Volta CA. LMA Supreme™ vs I-gel™a Comparison of Insertion Success in Novices. Anaesthesia, 2012; 67 (4): 384-8.
- Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, Vogt A, et al. Crossover Comparison of the Laryngeal Mask Supreme™ and the I-Gel™ in Simulated Difficult Airway Scenario in Anesthetized Patients. Anesthesiology, 2009; 111 (1): 55-62.
- Rieger A, Brunne B, Striebel HW. Intracuff Pressures do not predict Laryngopharyngeal Discomfort After Use of the Laryngeal Mask Airway. Anesthesiology. 1997; 87: 63-7.
- Weber U, Oguz R, Potura LA, Kimberger O, Kober A, Tschernko E. Comparison of the I-Gel and the LMA-Unique Laryngeal Mask Airway in Patients with Mild to Moderate Obesity During Elective Short-Term Surgery. Anaesthesia. 2011; 66: 481-7.
Öz
Aim: In our study; we aimed to compare the second generation supraglottic airway devices, I-gel and LMA-Supreme (Laryngeal Mask Airway-Supreme) in patients scheduled for urological surgery under general anesthesia in terms of clinical performance and postoperative pharyngolaryngeal complications.
Materials and Methods: After hospital ethics committee approval (19-8.1T/53) and written informed consent from the patient, 120 patients aged 18-65 years, ASA score (The American Society of Anesthesiologists) I-II, who were scheduled for elective urological surgery under general anesthesia, were included in our prospective study.
The patients were randomly divided into two groups as I-gel (n=60) and LMA-Supreme (n=60). Two groups were evaluated; in the aspect of ease of supraglottic airway device insertion, time of insertion, success rate at first insertion, number of attempts, ease of gastric tube insertion, oropharyngeal leak pressure, intraoperative and postoperative complications.
Results: Supraglottic airway device insertion time was significantly lower in the I-gel group (p: 0.039). It was noted that the number of patients with ‘perfect’ oropharyngeal leak pressure at all measurement times was higher in the I-gel group (p<0.05). Gastric tube placement was found to be significantly easier in the LMA-Supreme group (p:0.029). Postoperative 12th hour sore throat (p:0.049) and hoarseness (p:0.046) were more common in the LMA- Supreme group. LMA- Supreme and I-gel have similar were featured in terms of ease of insertion, success rate at first insertion, number of attempts and intraoperative complications.
Conclusion: The shorter insertion time, lower oropharyngeal leak and fewer postoperative complications might be the reason of preference of I-gel over LMA- Supreme.
Anahtar Kelimeler
Airway supraglottic airway device I-gel; LMA-Supreme clinical performance
Kaynakça
- Walsh K, Cummins F. Difficult Airway Equipment in Departments of Emergency Medicine in Ireland: Results of a National Survey. Eur J Anaesthesiol 2004; 21: 128-31.
- Michalek P, Donaldson W, Graham C, Hinds JD. A Comparison of the I-gel Supraglottic Airway as a Conduit for Tracheal İntubation with the Intubating Laryngeal Mask Airway: A Manik in Study. Resuscitation 2010; 81: 74-7.
- Ramachandran SK, Kumar AM. Supraglottic Airway Devices. Respıratory Care 2014; 59: 920-32.
- Van Zundert A, Brimacombe J. The LMA Supreme- A Pilot Study. Anaesthesia 2008; 63: 209-10.
- Levitan RM, Kinkle WC. Initial Anatomic İnvestigations of the I-Gel Airway: A Novel Supraglottic Airway Without İnflatable Cuff. Anaesthesia 2005; 60: 1022-6.
- Park SY, Rim JC, Kim H, Lee JH, Chung CJ. Comparison of i-gel and LMA Supreme during laparoscopic cholecystectomy. Korean J Anesthesiol 2015; 68: 5: 455-61.
- Teoh WH, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia AT. Comparison of the LMA Supreme vs the I-Gel in Paralysed Patients Undergoing Gynaecological Laparoscopic Surgery with Controlled Ventilation. Anaesthesia. 2010; 65 (12):1173-9.
- Middleton PM, Simpson PM, Thomas RE, Bendall JC. Higher Insertion Success with the I-Gel Supraglottic Airway in out of hospital Cardiac Arrest: A Randomised Controlled Trial. Resuscitation. 2014; 85: 893-7.
- Leventis C, Chalkias A, Sampanis MA, Foulidou X, Xanthos T. Emergency Airway Management by Paramedics: Comparison Between Standard Endotracheal Intubation, Laryngeal Mask Airway and I-gel. Eur J Emerg Med. 2014; 21: 371-3.
- Chew EFF, Hashim NHM, Wang CY. Randomised Comparison of the LMA Supreme (TM) with the I-Gel (TM) in Spontaneously Breathing Anaesthetised Adult Patients. Anaesth and Intensive Care. 2010; 38 (6): 1018-22.
- Chen X, Jiao J, Cong X, Liu L, Wu X. A Comparison of the Performance of the I-gel™ vs. the LMA-S™ During Anesthesia: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2013; 8 (8):e71910.
- Kim MH, Lee JH, Choi YS, Park S, Shin S. Comparison of the Laryngeal Mask Airway Supreme and the I-Gel in Paralysed Elderly Patients: A Randomised Controlled Trial. Eur J Anaesthesiol. 2018; 35 (8): 598-604.
- Fernández DA, Pérez VA, Bermejo GJ, Marcos VJ. Supreme Laryngeal Mask Airway vs the I-Gel Supraglottic Airway in Patients Under General Anesthesia and Mechanical Ventilation with No Neuromuscular Block: A Randomized Clinical Trial. Rev Esp Anestesiol Reanim. 2009; 56 (8): 474-8.
- Belena JM, Nu ez M, Anta D, et al. Comparison of Laryngeal Mask Air- way Supreme and Laryngeal Mask Airway Proseal with Respect to Oro- Pharyngeal Leak Pressure During Laparoscopic Cholecystectomy: A Randomised Controlled Trial. Eur J Anaesthesiol 2013; 30: 119-23.
- Bağuş F, Yıldız TŞ, Solak M, Toker K. Pediyatrik Hastalarda Klasik ve Proseal LMA’nın Etkinliklerinin Karşılaştırılması. Türk Anest Rean Der Dergisi 2011; 39 (6): 311-7.
- Ragazzi R, Finessi L, Farinelli I, Alvisi R, Volta CA. LMA Supreme™ vs I-gel™a Comparison of Insertion Success in Novices. Anaesthesia, 2012; 67 (4): 384-8.
- Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, Vogt A, et al. Crossover Comparison of the Laryngeal Mask Supreme™ and the I-Gel™ in Simulated Difficult Airway Scenario in Anesthetized Patients. Anesthesiology, 2009; 111 (1): 55-62.
- Rieger A, Brunne B, Striebel HW. Intracuff Pressures do not predict Laryngopharyngeal Discomfort After Use of the Laryngeal Mask Airway. Anesthesiology. 1997; 87: 63-7.
- Weber U, Oguz R, Potura LA, Kimberger O, Kober A, Tschernko E. Comparison of the I-Gel and the LMA-Unique Laryngeal Mask Airway in Patients with Mild to Moderate Obesity During Elective Short-Term Surgery. Anaesthesia. 2011; 66: 481-7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Aralık 2022 |
| Gönderilme Tarihi | 1 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 61 Sayı: 4 |
