Presentation on theme: "Comparison of clinical performance of I-GEL and AURA ONCE LMA Dr. N. Anuradha, final year M.D Anaesthesia, Stanley Medical College.Chennai. Prof. Dr. R."— Presentation transcript:
Comparison of clinical performance of I-GEL and AURA ONCE LMA Dr. N. Anuradha, final year M.D Anaesthesia, Stanley Medical College.Chennai. Prof. Dr. R. Subramaniya Bharathiyar; Professor and H.O.D Prof. Dr. R. Lakshmi, Associate Professor Prof. Dr.Ponnambala Namasivayam, Associate Professor Dr. Saravana Kumar, Assistant professor
AIMS AND OBJECTIVES: Comparison of clinical performance of two supraglottic devices, aura once LMA and I GEL. The ease of insertion, Placement success rate Hemodynamic response Intra-operative and post-operative complications
Study design Single blind Prospective Randomised
Place of study General surgery theatre in stanley medical college.
PATIENTS AND METHODS: Institutional Ethics Committee approval was obtained Informed written consent was obtained 40 patients (n=40) belonging to ASA PS 1 &2 MPC 1 & 2 of both sexes between age group 18 to 40 years presenting short elective procedures in supine position were included.
Inclusion Criteria: Age 18 to 40 years Weight 30-60 kg ASA physical status 1-2 Patients undergoing elective surgery under general anesthesia, Both sexes
Exclusion criteria: Restricted mouth opening (<2cms) Anticipated difficult airway Disease of oral cavity Patients at increased risk of aspiration, or having an history of symptomatic gastro- esophageal reflux
Materials Aura Once Laryngeal mask airway I Gel IV cannulae Monitors Drugs for general anaesthesia
Study methods Randomly divide the patients into two groups Written informed consent to be obtained Group 1 (n=20) : patients who will receive general anaesthesia with Aura once LMA Group 2 (n=20): patients who will receive general anaesthesia with I Gel.
METHODS Premedication: Inj. Ranitidine 1mg / kg iv, Inj. Metoclopramide 0.1 mg/kg iv. Inj. Glycopyrolate 0.004 mg/kg iv, Inj. Midazolam 0.02mg /kg iv, Inj. Fentanyl 2 mcg/kg iv.
METHODS Anaesthesia was induced with Inj. Propofol 2mg/kg iv and Inj succinylcholine 1mg /kg iv After adequate facemask ventilation and relaxation, an appropriately sized supra-glottic airway was inserted by an experienced anaesthetist. placement confirmed
Anaesthesia was maintained with N2O: O2 70:30%, Isoflurane 1% in spontaneous ventilation
Monitor During maintenance of anesthesia Heart rate, Mean arterial blood pressure, Spo2, respiratory rate, end-tidal CO2 concentration,
Supraglottic airway was removed after protective airway reflexes, the patient’s ability to follow commands. During extubation, Coughing blood staining on the device, trauma to the tongue, lips, or teeth
Results – (Mean +/ SD) VARIABLE AMBU LMA I GEL AGE 24+/ 3 (19-31 yrs) 24+/3 yr (18 – 30 yrs) WEIGHT50 +/ 7.78 (35 – 65 kg) 51+/ 8.16 (35 – 65 kg) SEX (m : f) (9:11) (8:12)
Hemodynamic variable VARIABLE AMBU LMA I GEL Heart Rate (Pre- insertion) 80.75+/7.6 P=0.94 80.8+/7.8 Heart Rate (1 min after insertion) 86.45+/4.65 P=0.1053 87.65+/4.3 Heart Rate (5 min after insertion) 82+/4.21 P=0.5585 82.45+/4.36
Hemodynamic variable VARIABLEAMBU LMA I GEL Mean arterial pressure (Pre- insertion) 89.50+/6.7 P=0.3160 90.55+/5.6 Mean arterial pressure (1 min after insertion) 92.55+/5.9 p=0.5837 93.2+/5.43 Mean arterial pressure (5 min after insertion) 90.60+/6.4 P=0.2183 92+/4.7
RESULTS All patients were ASA I/II. The mean length of anesthesia was 30+/15min (20 – 45 min) The immediate recovery period was uneventful in 36 patients. Two patients in each group complained mild sore throat in one hour and had no pain after 24 hours. There was no incidence of aspiration/regurgitation, bronchospasm, airway obstruction, coughing, vomiting.
RESULTS There were no differences in the demographic data and haemodynamic data immediately after insertion of device The median insertion time for the i-gel was significantly less than for the aura once LMA [16.7s+/5.3s vs 23.75 s+/3.8s ; P=0.0001] This gives a statistically significant value in insertion time of I gel.
CONCLUSION We found no difference in success rate of first-time insertion between the i-gel and the aura once LMA. Time to successful insertion was significantly shorter for the i-gel.
PROFORMA Name of the patient Group Age IP No SEX ASA Status WEIGHT HEIGHT AIRWAY - MPC Associated medical illness Informed Consent Last Oral intake Premedication Shifted to theatre Monitors IV ACCESS : PREOXYGENATION INDUCTION RELAXANT
PROFORMA SUPRAGLOTTIC DEVICE INSERTION: TIME Number of attempts Monitoring: Heart rate, Mean arterial blood pressure, Spo2, respiratory rate, end-tidal CO2 concentration, Intraop: Aspiration/regurgitation, Bronchospasm, airway obstruction, Coughing Post op: sore throat dysphonia
I-gel The I-gel is a device for airway management I-gel is produced from a medical grade thermoplastic called SEBS (Styrene Ethylene Butadiene Styrene). The soft, non-inflatable cuff fits snugly onto the perilaryngeal framework, Its used for both spontaneously breathing patients and for IPPV.
I-Gel (2) I-gel has an artifical epiglottis called the 'epiglottis blocker'. This helps to prevent the epiglottis from down-folding When correctly inserted, the tip of the i-gel will be located into the upper oesophageal opening, providing a conduit via the gastric channel to the oesophagus and stomach. This then allows for suctioning, passing of a nasogastric tube and can facilitate venting.
I- Gel (3) Buccal cavity Stabilizer : It is the main stem of the device which contains the integral bite block and the airway and gastric channels. It eliminates the potential for rotation after insertion, thereby reducing the risk of malposition. It also provides vertical strength to aid insertion.
I-gel (5) available in three adult sizes an innovative, colour-coded polypropylene ‘protective cradle’. The maximum size of nasogastric tube that can pass through each size of I –gel: Size 3 : 12G nasogastric tube Size 4 : 12G nasogastric tube Size 5 : 14G nasogastric tube
References i-gel user guide; http://www.i-gel.comhttp://www.i-gel.com A Multicenter Study of the Ambu® Laryngeal Mask in Nonparalyzed, Anesthetized Patients Anesth Analg December 2005 101:1862-1866; doi:10.1213/01.ANE.0000184181.92140.7C Randomized crossover comparison between the i-gel and the LMA- Unique in anaesthetized, paralysed adults V. Uppal1,*, S. Gangaiah1, G. Fletcher2 and J. Kinsella1, BJA VOL103 http://www.ambu.co.uk/UK/Airway_Management http://www.ambu.co.uk/UK/Airway_Management Comparison of the AMBU Laryngeal Mask and the LMA Classic in anaesthetised, spontaneously breathing patients. Ng SY, Teoh WH, Lim Y, Cheong VG; ww w.ncbi.nlm.nih.gov/pubmed/17323667Ng SYTeoh WHLim YCheong VG