Shaikh Noorulhaque Mohammad Shafi^1*, Patil Mohan Nana², Bhojraj Shilpa Shekhar³, Halbe Alka Ram⁴

^1,2Resident Doctors, ³Senior Consultant, ⁴HOD, Department of Anaesthesiology, Breach Candy Hospital Trust, Mumbai, INDIA.

Email: dr_noorulshaikh@yahoo.co.in

Table 1: General characteristics

Statistically there was no significant difference in the SAD Sizes, Surgical Procedures, ease of insertion in both the groups. The insertion of I-Gel in group I patients was graded easy in 35 patients (81.40%) and was moderately difficult in 8 patients (18.60%). The insertion of SLMA in group S patients was graded easy in 34 patients (80.23%), moderately difficult in 8 patients (18.60%) and very difficult in 1 patient (1.16%). 38 of 43 (88.37%) insertions in group I were in the first attempt and only 5 (11.63%) patients required 2^nd attempt, none (0%) required 3^rd attempt. 36 of 43 (86.05%%) in the group S required only one attempt and 6 (13.95%) patients required 2^nd attempt and 1 (1.16%) patient required 3^rd attempt. In 3rd attempt for insertion, airway manipulation with jaw thrust was required

Table 2: Supraglottic Airway Device characteristics

The basal heart rate was, mean SBP, mean basal DBP, mean basal MAP and mean SpO2 were comparable in both groups. Blood Tinged SAD was noted in 6 patients in both group I (I-Gel) and group S (SLMA). None of the patients in group I (I-Gel) out of 43 patients had Lip or Dental Injury, whereas 2 patients in group S (SLMA) out of 43 patients had Lip or Dental Injury. Only 4 of the patients in group I (I-Gel) out of 43 patients had Sore Throat within 24 hours post removal of SAD, whereas 6 patients in group S (SLMA) out of 43 patients had Sore Throat within 24 hours post removal of SAD,. Incidence of blood tinged SAD, lip/dental injury and sore throat was not statistically significant when compared between both the groups.

Table 3: SAD related complications

DISCUSSION

Since the introduction of LMA into clinical practice has been used in over a million patients and the efficacy is proven beyond doubt. One of the primary objectives was to compare the ease of insertion between the two devices. The grading of insertion was done similar to the study conducted by Siddiqui et al., where insertion of device was recorded as; easy (when assistant help was not required), moderately difficult (when jaw thrust was needed by assistant), difficult (when jaw thrust and deep rotation or third attempt was used for proper device insertion) and impossible to insert The insertion of I-Gel was found comparatively easier and required less skill as compared to SLMA but the results were not statistically significant. The I-Gel having a non-inflatable cuff and firm in consistency is much easier for insertion as compared to SLMA. Our study compared the ease of insertion of the devices with the study conducted by Ali A et al.,⁵ Siddiqui et al.,⁶ Janakiram et al.,⁷ who also did not find any statistically significant difference. Insertion of I-Gel in our study was similar to Richez B et al.² study, who graded insertion of no. 4 I-Gel as very easy in 93% (66 of 71) patients and easy in remaining 7% (5 of 71) patients. Insertion of SLMA in our study was comparable with Janakiram et al.,⁷ studies where 90% (45 of 50) SLMA insertions were easy insertions. In this study, insertion of I-Gel was successful in first attempt in 88.37% patients as compared to 83.72% first time insertion with SLMA. Airway manipulation like jaw thrust was required during second attempt insertion in 8 patients of both I-Gel and SLMA insertions. None of the I-Gel group patient required third attempt as compared to SLMA group in which 1 patient required third attempt with airway manipulation like jaw thrust and deep rotation. Very similar results were found in other studies.^7-10 In Janakiram et al.,⁷ studies, the success rate with first time I-Gel insertion was only 54%, and with SLMA of 86% which was statistically highly significant. This was because, during the use of I-Gel in 14 patients a larger size I-Gel had to be used due to presence of audible leak and hence required 2^nd attempt. However, in our study we did not have such problem and hence the success rate of first-time insertion was comparable between both the devices. In our study, there were no statistically significant differences between I-Gel and SLMA with regard to heart rate, systolic, diastolic and mean blood pressure, and oxygen saturation (SpO2). The results of our study were similar to the studies done by Helmy AM et al.,¹¹ Franksen H et al.,⁹ who in their studies found no significant difference between I-Gel and SLMA with regard to heart rate, arterial BP and SpO2. Jindal P et al.,¹² in their study observed that I-Gel produced less hemodynamic changes compared to other SADs. The authors concluded that I-Gel effectively conforms to the perilaryngeal anatomy despite the lack of an inflatable cuff; it consistently achieves proper positioning for supraglottic ventilation and causes less hemodynamic changes as compared to other supraglottic airway devices like SLMA which because of an inflatable cuff can produce more hemodynamic changes. The inflatable supra glottis airway devices, during insertion, the deflated leading edge of the mask can catch the epiglottis edge and cause it to down-fold or impede proper placement beneath the tongue and can cause pharyngeal injury.¹³ Inflatable masks also have the potential to cause tissue distortion, venous compression and nerve injury.¹³ In our study, the patients were inspected for any injury of the lips or teeth and the device for blood stain after its removal at the end of the surgery similar to study done by Siddiqui AS et al.⁶ Six cases in both the I-Gel group and the SLMA group had blood stain on the device on removal. Similar results have been observed in studies done by Helmy AM et al.¹¹ In the study conducted by Siddiqui AS et al.,⁶ blood on device was noted in 18% patients of SLMA group while none in the I-Gel group which was statistically significant. The authors attributed the cause may be due to inflatable masks having the potential to cause tissue distortion, venous compression and nerve injury. Our results were consistent with the studies done by Siddiqui AS et al.⁶, Helmy AM et al.,⁹ Fanksen H et al.,¹¹ where the difference between LMA and I-Gel regarding post-operative complications was not statistically significant except nausea and vomiting which was significantly higher in LMA due to high incidence of gastric insufflation. Keijzer C et al.,¹⁴ in their study compared the post-operative throat and neck complications between LMA and I-Gel. There was a higher incidence of sore throat and dysphagia at 1, 24, and 48 h in the LMA group compared with the I-Gel group. Neck pain was also more common at 24 and 48 h in the LMA group. Because of the absence of an inflatable cuff, the authors hypothesized that use of the I-Gel produced fewer postoperative throat and neck complaints compared with a SLMA.

CONCLUSION

Both LMA Supreme and I-Gel can be used effectively and comfortably in selected adult patients during general anaesthesia. Both LMA Supreme and I-Gel are easy to insert, both are almost inserted in first attempt, no significant difference in hemodynamic changes during usage is noted.

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