Ambu AuraOnce versus i-gel laryngeal mask airway in infants and children undergoing surgical procedures. A randomized controlled trial

Abdulrahman M Alzahem, Mansoor Aqil, Tariq A Alzahrani, Ayman H Aljazaeri, Abdulrahman M Alzahem, Mansoor Aqil, Tariq A Alzahrani, Ayman H Aljazaeri

Abstract

To compare the efficacy and performance of the pediatric Ambu AuraOnce (Ambu AO) mask (Ambu, Copenhagen, Denmark) and i-gel mask (Intersurgical Ltd., Wokingham, United Kingdom). Methods: From May 2015 to September 2016, 112 patients, 0-14 years old, underwent elective surgery at a tertiary university hospital (Riyadh, Saudi Arabia). They were randomly assigned to the Ambu AO or i-gel group. Three groups underwent a subgroup analysis: ≤5 kg (group 1), 5.1-10.0 kg (group 2), and >10 kg (group 3). Results: The oropharyngeal leak pressure was significantly higher for the i-gel (25.4±4.1 cm H2O) than for the Ambu AO (22.5±3.9 cm H2O, p less than 0.001). The Ambu AO had a slightly higher ease of insertion compared to the i-gel (100% versus 94%, p=0.08) and required less manipulation (2% versus 11%, p=0.07).The Ambu AO and i-gel showed non-significant differences in performance between weight groups. There were statistically significant differences for higher leak pressure in group 2 (p=0.01) and group 3 (p=0.002) in favor of the i-gel, and for less manipulation in the Ambu AO in group 1 (p=0.04). Fiberoptic viewing was superior in group 2 for the i-gel (p=0.03) and in group 3 for the Ambu AO (p=0.02). Conclusion: Both devices demonstrated equally good performance with low morbidity. The Ambu AO had a statistical tendency towards easier insertion and less manipulation. Confirming this finding will require large scale trials.

Figures

Figure 1
Figure 1
Flow chart of the 112 infants and children undergoing elective surgical procedures recruited for this study.
Figure 2
Figure 2
Ergonomics of supraglottic airway devices. I-gel® mask (left) and Ambu® AO (right). The shape of Ambu® AOTM ventilating tube has a 90-degree angle.

References

    1. Brain AI. The laryngeal mask--a new concept in airway management. Br J Anaesth. 1983;55:801–806.
    1. Peker G, Takmaz SA, Baltacı B, Başar H, Kotanoğlu M. Comparison of four different supraglottic airway devices in terms of efficacy, intra-ocular pressure and haemodynamic parameters in children undergoing ophthalmic surgery. Turk J Anaesthesiol Reanim. 2015;43:304–312.
    1. Ismail SA, Bisher NA, Kandil HW, Mowafi HA, Atawia HA. Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube. Eur J Anaesthesiol. 2011;28:443–448.
    1. Miller DM. A proposed classification and scoring system for supraglottic sealing airways: a brief review. Anesth Analg. 2004;99:1553–1559.
    1. Theiler LG, Kleine-Brueggeney M, Luepold B, Stucki F, Seiler S, Urwyler N, et al. Performance of the pediatric-sized i-gel compared with the Ambu AuraOnce laryngeal mask in anesthetized and ventilated children. Anesthesiology. 2011;115:102–110.
    1. Polat R, Aydin GB, Ergil J, Sayin M, Kokulu T, Öztürk İ. Comparison of the i-gel™ and the Laryngeal Mask Airway Classic™ in terms of clinical performance. Braz J Anesthesiol. 2015;65:343–348.
    1. Shariffuddin II, Wang CY. Randomised crossover comparison of the Ambu AuraOnce Laryngeal Mask with the LMA Classic laryngeal mask airway in paralysed anaesthetised patients. Anaesthesia. 2008;63:82–85.
    1. Lopez AM, Valero R, Bovaira P, Pons M, Sala-Blanch X, Anglada T. A clinical evaluation of four disposable laryngeal masks in adult patients. J Clin Anesth. 2008;20:514–520.
    1. Beylacq L, Bordes M, Semjen F, Cros AM. The I-gel, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: an observational study in children. Acta Anaesthesiol Scand. 2009;53:376–379.
    1. Urbaniak GC, Plous S. Research Randomizer (Version 4.0) [Computer software] [[Updated 2017 January 7]]. Available from:
    1. Drage MP, Nunez J, Vaughan RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anaesthesia. 1996;51:1167–1170.
    1. Zaballos M, Bastida E, Jiménez C, Agustí S, López-Gil MT. Predicted end-tidal sevoflurane concentration for insertion of a Laryngeal Mask Supreme: a prospective observational study. Eur J Anaesthesiol. 2013;30:170–174.
    1. Maino P, Dullenkopf A, Keller C, Bernet-Buettiker V, Weiss M. Cuff filling volumes and pressures in pediatric laryngeal mask airways. Paediatr Anaesth. 2006;16:25–30.
    1. Lopez-Gil M, Brimacombe J, Keller C. A comparison of four methods for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA) in paediatric patients. Paediatr Anaesth. 2001;11:319–321.
    1. Brimacombe J, Keller C, Kurian S, Myles J. Reliability of epigastric auscultation to detect gastric insufflation. Br J Anaesth. 2002;88:127–129.
    1. Gasteiger L, Brimacombe J, Oswald E, Perkhofer D, Tonin A, Keller C, et al. LMA ProSeal(TM) vs. i-Gel(TM) in ventilated children: a randomised, crossover study using the size 2 mask. Acta Anaesthesiol Scand. 2012;56:1321–1324.
    1. Monclus E, Garcés A, De Jose Maria B, Artés D, Mabrock M. Study of the adjustment of the Ambu laryngeal mask under magnetic resonance imaging. Paediatr Anaesth. 2007;17:1182–1186.
    1. Goyal R, Shukla RN, Kumar G. Comparison of size 2 i-gel supraglottic airway with LMA-ProSeal and LMA-Classic in spontaneously breathing children undergoing elective surgery. Paediatr Anaesth. 2012;22:355–359.
    1. Weiss M, Gerber AC, Schmitz A. Continuous ventilation technique for laryngeal mask airway (LMA) removal after fiberoptic intubation in children. Paediatr Anaesth. 2004;14:936–940.
    1. Brimacombe J, Berry A. A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg. 1993;76:457.
    1. Inagawa G, Okuda K, Miwa T, Hiroki K. Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients. Paediatr Anaesth. 2002;12:322–326.
    1. Hagberg CA, Jensen FS, Genzwuerker HV, Krivosic-Horber R, Schmitz BU, et al. A multicenter study of the Ambu laryngeal mask in nonparalyzed, anesthetized patients. Anesth Analg. 2005;101:1862–1866.
    1. Beringer RM, Kelly F, Cook TM, Nolan J, Hardy R, Simpson T, et al. A cohort evaluation of the paediatric i-gel airway during anaesthesia in 120 children. Anaesthesia. 2011;66:1121–1126.
    1. Gernoth C, Jandewerth O, Contzen M, Hinkelbein J, Genzwürker H. Comparison of two different laryngeal mask models for airway management in patients with immobilization of the cervical spine. Anaesthesia. 2006;55:263–269.
    1. Vaida SJ, Yodfat UA. Angulation of the airway tube in the AMBU laryngeal mask could be responsible for improved insertion success. Anesth Analg. 2006;103:264.
    1. Jagannathan N, Sohn LE, Chang E, Sawardekar A. A cohort evaluation of the laryngeal mask airway-Supreme in children. Paediatr Anaesth. 2012;22:759–764.
    1. Jagannathan N, Sommers K, Sohn LE, Sawardekar A, Shah RD, Mukherji II, et al. A randomized equivalence trial comparing the i-gel and laryngeal mask airway Supreme in children. Paediatr Anaesth. 2013;23:127–133.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться