Original Research Article DOI: 10.18231/2394-4994.2018.0016 Indian Journal of Clinical Anaesthesia, January-March, 2018;5(1):92-101 92 Comparison of supraglottic airway devices I-Gel and LMA-Supreme in adults V. S. Senthil Kumar 1 , V. Arun Pothan Raj 2,* 1 Associate Professor, IRT Perunthurai Medical College and Hospital, Tamil Nadu, 2 Assistant Professor, Saveetha Medical College and Hospital, Chennai, India *Corresponding Author: Email: dr.vs.md@gmail.com Received: 14 th February, 2017 Accepted: 06 th June, 2017 Abstract Whenever the conventional laryngoscopy fails, insertion of supraglottic airway device may be indicated. The I-Gel and LMA- Supreme are both novel supraglottic airway devices which are disposable, cheap and aids the passage of gastric tube which helps in gastric drainage. Both the devices can be used as an adjunct to endotracheal intubation in patient with difficult airway. This prospective randomized, single blind study was designed to compare the supraglottic airway devices I-Gel and LMA- Supreme in patients undergoing general anaesthesia for elective surgeries. After obtaining the institutional ethical committee approval, 60 adult patients of ASA I and II physical status of either sex undergoing elective surgical procedures under general anaesthesia were randomly allocated into 2 groups. Group A I-Gel group (n=30) and Group B LMA-Supreme (n=30). The study showed no significant difference between the two groups based on demographic variables. The mean insertion time for LMA-Supreme is significantly lower than I-Gel (P<0.05). The airway leak pressure was comparable between the two devices. The first attempt success rate and the ease of insertion was significantly better in LMA-Supreme than I-Gel (P<0.05). There was no significant variation in the hemodynamic response in both the groups. Post-operative sore throat was noted in LMA-Supreme and blood staining was noted in I-Gel group. When compared with I-Gel LMA-Supreme has a higher first attempt success rate and also a lower insertion time. Keywords: Gastric insufflation, LMA-Proseal, LMA-Supreme, I-Gel, Thermoplastic elastomer, Supraglottic. Introduction Airway is life not only for the patient but also for the anaesthesiologist. Adverse respiratory events are responsible for 75% of ASA closed claims. The first oro-tracheal intubation was performed by William Mac even in the year 1878. 1 Although the tracheal intubation is the gold standard method for a patent airway maintenance in anaesthesia, this technique not only requires skill but continuous training, practice and a direct laryngoscopy which is difficult without adequate neuro muscular blockade and may damage cords and tracheal mucosa. Both laryngoscopy and endotracheal intubation produce reflex sympathetic stimulation and may provoke laryngospasm and bronchospasm in a person having a reactive airway. 2-4 The difficulties encountered during intubation and the complications arising following endotracheal tube placement have necessitated the need for alternative techniques. 5-7 Archie Brain revolutionized the airway management by inventing a supraglottic device called Laryngeal Mask Airway (LMA). 8-10 But even this device didn’t offer full protection against complications like aspiration. So the inventor himself improvised the device with a drainage tube and an extra cuff dorsally which was widely believed to replace all other models of LMA called the LMA Proseal. But this LMA Proseal needs digital or an introducer guided techniques which is difficult for assuring proper sealing in laryngeal inlet. So a new LMA which has protective features as that of LMA Proseal and easier for insertion came into use in the last decade called as the LMA-Supreme. I-Gel is a new supraglottic airway device and is an uncuffed peri-laryngeal sealer group of airway devices as classified by Miller 11 . This device also has a gastric channel for drainage of gastric contents. The gel like cuff avoids compression trauma of the other inflatable supraglottic devices. 12-14 Aim To compare the functional differences between LMA-Supreme and I-Gel in such as the ease of insertion, time taken for insertion, attempts for proper placement, airway leak pressure and complications. I-Gel: The I-Gel is a novel and innovative supraglottic airway device made of thermoplastic elastomer which is soft gel like and transparent. It achieves a non- inflatable anatomical seal to the pharyngeal, laryngeal and perilaryngeal structures avoiding the compression trauma that occurs with an inflatable supraglottic device. It has several advantages like easier insertion, minimal compression on tissues, has no latex and is stable. It has a standard airway channel and a separate gastric channel. The gastric channel indicates regurgitation early, helps in venting out the gas from stomach and also helps in nasogastric tube insertion to empty the contents of the stomach. 15