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A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®

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Abstract

The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an ‘insert-detect-correct-as-you-go’ technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9 cm H2O) compared to the LMA-Supreme (27.7 ± 3.5 cm H2O) group (mean difference 4.0 cm H2O, 95% confidence interval (CI) 2.7–5.3 cm H2O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided.

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Acknowledgements

The authors thank our research nurses Heather Reynolds, Simon Holz, Molly Clarris and Lizanne Dalgleish for their expert assistance in this study.

Funding

This study was supported by departmental resources from the Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia only.

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Authors and Affiliations

  1. Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD, Australia

    André A. J. van Zundert, Kerstin H. Wyssusek & Michelle Roets

  2. Statistics Unit, QIMR Berghofer Medical Research Institute, The University of Queensland, Brisbane, QLD, Australia

    Anita Pelecanos

  3. Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central, Singapore

    Chandra M. Kumar

  4. Newcastle University, Newcastle, UK

    Chandra M. Kumar

  5. Queensland University of Technology, Brisbane, QLD, Australia

    André A. J. van Zundert

Authors
  1. André A. J. van Zundert
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  2. Kerstin H. Wyssusek
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  3. Anita Pelecanos
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  4. Michelle Roets
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  5. Chandra M. Kumar
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Corresponding author

Correspondence to André A. J. van Zundert.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no competing interests.

Ethical approval

The Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC/15/QRBW/248, Chairperson Dr. Conor Brophy, dd 03.07.2015) approved the study. This study was registered with the Australia and New Zealand Clinical Trial Registry (ACTRN12615000783527).

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Written patient’s informed consent was obtained from all participants.

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van Zundert, A.A.J., Wyssusek, K.H., Pelecanos, A. et al. A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®. J Clin Monit Comput 34, 285–294 (2020). https://doi.org/10.1007/s10877-019-00301-3

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  • DOI: https://doi.org/10.1007/s10877-019-00301-3

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