Observational Study of the LMA Protector (ADEPT1)

ADEPT 1 - Observational Study of the LMA Protector

The investigators want to investigate the user friendliness, and performance of the LMA Protector. The principal research question is to assess the overall performance of the LMA Protector. The investigators are merely making observations related to use of the device during clinical practice.

Study Overview

• Status: Terminated
• Conditions: Airway Complication of Anesthesia
• Intervention / Treatment: Device: LMA Protector

Detailed Description

There is a lack of research data on regarding the use of the LMA Protector. There is no regulatory requirement to collect or publish patient data on any device, either before CE marking or after. These devices are freely purchased and used.

There is, however, a professional duty to know that a device conforms to established norms for use. These norms are not official standards but rather, reference data against which a device can be clinically judged. Therefore, a device that is easy to insert but has a low 'leak pressure' (see above) is different from one that is more difficult to insert but as a high leak pressure. It is not that one is 'better' than the other, but rather that the data help create a 'usability profile' of the device which can be useful when making a clinical selection for the device.

Preoperative assessment:

During the preoperative visit, patient information leaflet will be given to the patients meeting the eligibility criteria.

Wherever possible, suitable patients will be identified in the preoperative assessment clinic and the information leaflet given. The patients will be given adequate time to read this information and any queries will be answered before being asked to sign a consent form. A detailed airway assessment will be performed by one of the investigators and documented on the study proforma.

Induction of anaesthesia:

On arrival in the anaesthetic room patients will be monitored with pulse oximetry, electrocardiography and invasive or non-invasive blood pressure measurements. After intravenous access is secured and the pre-surgical checklist completed, all patients will be pre-oxygenated using a facemask to achieve end tidal oxygen concentration of at least 80%. A 'sniffing' position of the head and neck and a 20 degree head-up bed tilt will be used for pre-oxygenation. General anaesthesia will be induced intravenously. After induction of anaesthesia, facemask ventilation will be commenced and anaesthesia maintained with an inhalational anaesthetic agent in oxygen or with total intravenous anaesthesia. The volatile agent's (anesthetic gases) concentration of 1 MAC adjusted for the patient's age will be achieved and maintained. This is normal process of anaesthesia applicable for all patients irrespective of participation in the study.

Supraglottic airway device (SAD) insertion:

Once deep plane of anaesthesia is confirmed, with the absence of movement to jaw thrust stimulation the SAD (LMA protector) will be inserted. The size of the device will be based on the manufacturer's recommendations for the body weight. The breathing system will be connected to the device. Ventilation of the lungs will be then confirmed by observing adequate bilateral chest inflation and square end-tidal capnogram wave with positive pressure ventilation. Adequate ventilation will be recorded if three tests are passed: 1) adequate chest movement, 2) an expired tidal volume of at least 7 ml/kg and 3) stable oxygenation. Time would continue until LMA® ProtectorTM inserted successfully. If it is not possible to insert the device or ventilate through it, two more attempts at placement of the device will be allowed. If placement has failed after two further attempts, the study will be abandoned and the other device will be used. If this fails on first attempt a different LMA or tracheal tube will be used as appropriate.

Maintenance of anaesthesia and recovery

The main interventions refer to the insertion of the airway device into the patient to obtain a airway and allow the conduct of the anaesthetic and therefore the surgery. However, if there are problems with the device and the airway obtained is suboptimal then the below interventions are allowed (which will be noted in the data collection form):

1. Neck extension - move patient's neck upward
2. Neck flexion - move patient's neck downward
3. Chin lift - manoeuvre to open the airway
4. Jaw thrust - manoeuvre to open the airway
5. Reposition of the device At the end of operation, anaesthetic agents will be discontinued while the device is left in place. The device will be removed after the patient has regained consciousness, and has responded to verbal command to open the mouth. Any complications that occur during the use of the device will be recorded.

Postoperative assessment Postoperatively in recovery or on the ward, the investigators will visit each patient and determine whether the following airway complications are present after surgery: sore throat (constant pain, independent of swallowing), dysphagia (difficulty in, or pain provoked by, swallowing), sore jaw, dysphonia (difficulty in, or pain on, speaking), numbness of the tongue or the oropharynx, ear pain, neck or mouth ache, hearing changes. Each complication will be graded as none, mild, moderate or severe. The same questions will be asked 24-48 hours later.

First visit During the first visit by the anaesthetist to the participant, at the anaesthetist's earliest opportunity, either in the recovery area or on the ward, the participants will be asked about the following complications, which will be graded as none, mild, moderate or severe.

1. Vomiting
2. Lip or tongue swelling
3. Hearing changes
4. Ear pain
5. Sore throat
6. Pain on swallowing
7. Jaw pain
8. Neck or mouth ache
9. Pain on speaking
10. Numbness of the tongue

Second visit (or telephone consultation) During the second visit 24-48 hours post-operatively on the ward or via telephone the participants will be asked about the following complications, which will be graded as none, mild, moderate or severe.

1. Vomiting
2. Lip or tongue swelling
3. Hearing changes
4. Ear pain
5. Sore throat
6. Pain on swallowing
7. Jaw pain
8. Neck or mouth ache
9. Pain on speaking
10. Numbness of the tongue

• Study Type: Observational
• Enrollment (Actual): 112

Contacts and Locations

Study Locations

• United Kingdom
  • Bath, United Kingdom
    • Royal United Hospital
  • Cardiff, United Kingdom
    • Aneurin Bevan University Health Board
  • Northampton, United Kingdom
    • Nothampton General Hospital
  • Oxford, United Kingdom
    • Oxford University Hospitals
  • Reading, United Kingdom
    • Royal Berkshire Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients undergoing operation under general anaesthesia with a supraglottic airway device

Description

Inclusion Criteria

• Adult participants who are having a general anaesthetic.
• Participant is willing and able to give informed consent for participation in the study.
• Male or Female, aged 18 years or above.
• ASA 1 - 3 category patients
• Elective operations
• Urgent operations
• Patients suitable for an SAD based on patient and operation factors.

Exclusion Criteria

The participant may not enter the study if ANY of the following apply:

• Refusal of consent
• Age less than 18 years
• Require intubation for the operation
• Risk of regurgitation
• ASA 4 and above
• Mouth opening less than 2.5cm Require awake intubation

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
LMA Protector; The LMA Protector will be used	Device: LMA Protector; The LMA Protector will be inserted when a supraglottic device is needed

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
First go Insertion Success Rate	Whether insertion during first go was successful or not	Day 1
First go Successful Ventilation Rate	Whether ventilation during first go was successful or not	Day 1
Number of Participants With Complication Free Insertions	Number of participants with complication free insertions divided by total number of participants	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to First Square Capnography Waveform	Record time in seconds of time to first capnography trace	Day 1
Lowest Oxygen Saturation Level	Record of lowest oxygen saturation reading across all participants	Day 1
Interventions Needed to Ensure Airway Patency	Collect number of predefined interventions needed to keep airway patent	Day 1
Number of Participants With Visible Chest Movement	The success of ventilation will depend on whether there was visible chest movement	Day 1
Number of Participants With Adequate Tidal Volume at Attempt of Ventilation	The success of ventilation will depend on whether there was tidal volume > 7ml/kg	Day 1
Number of Participants With Stable Oxygen Saturations	The success of ventilation will depend on whether there was stable SpO2	Day 1
Number of Participants With Square Capnography Trace	The success of ventilation will depend on whether there was square capnography trace	Day 1
Complications Occurrence During Insertion of Device, During Anaesthesia, and on Device Removal	Collect number of pre-defined complications of device usage	Day 1
Complications Occurrence During Insertion of Device, During Anaesthesia, and on Device Removal	Collect number of pre-defined complications of device usage. Secondary complication where asked about on Day 2 to ensure patients had recovered from the effects of the anaesthetic and are able to report any complications.	Day 2

Collaborators and Investigators

• Sponsor: Oxford University Hospitals NHS Trust
• Collaborators: Northampton General Hospital NHS Trust; University Hospital of Wales; Royal Berkshire NHS Foundation Trust; Royal United Hospital Bath NHS Trust
• Investigators: Principal Investigator: Vassilis Athanassoglou, Oxford University Hospitals NHS Trust

Study record dates

Study Major Dates

• Study Start (Actual): November 5, 2019
• Primary Completion (Actual): August 1, 2021
• Study Completion (Actual): August 1, 2021

Study Registration Dates

• First Submitted: July 26, 2018
• First Submitted That Met QC Criteria: September 7, 2018
• First Posted (Actual): September 10, 2018

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 10, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: Supraglottic airway device; LMA Protector
• Other Study ID Numbers: 1338

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

Data will be collected prospectively on data collection sheets completed by the anaesthetist / investigator during anaesthesia. Each site will manage their own data set and the data will be pooled at the end of the recruitment phase across all sites. Data will be sent from sites to the lead study team only at the end of the data collection.

Consent form and initial data collection forms will be filed in the master folder and kept locked in the dedicated research locker in the department. The PI at each site will have access to this log. Each site will assign a study ID for each participant and a record of these IDs will be kept in the site file. Only anonymised data will be sent from each trust to the main study team. No personal data will be sent to the coordinating centre.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No