A COMPARATIVE EVALUATION OF I-GEL AND LMA SUPREME IN LAPAROSCOPIC SURGERIES- A RANDOMIZED COMPARATIVE STUDY
Journal Title: International Journal Of Advances In Surgery - Year 2018, Vol 2, Issue 2
Abstract
Background: Laparoscopic surgery is associated with increased hemodynamics responses and use of supraglottic airway device instead of endotracheal tube results in lesser increase in these hemodynamics responses. But laparoscopic surgery also results in high peak airway pressure so the supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation. Aim: To compare the efficiency of the I-Gel with SLMA in patients undergoing laparoscopic cholecystectomy surgeries Setting: Randomized comparative study. Methods: Sixty patients were randomized in to two groups, Group A where I-gel (size 3 for patient weight 30-60 kg, size 4 for patient weight 50-90 kg) was considered for airway management and Group B where LMA Supreme (size 3 for patient weight 30-50 kg, size 4 for patient weight 50-70 kg) was the device chosen for airway management of the patients. Oropharyngeal seal pressure, peak airway pressure, difference between inspired and expired tidal volume, hemodynamics, attempts taken for airway device insertion, airway device insertion time, nasogastric tube insertion time and complications were compared between the two groups. Results: Oropharyngeal seal pressure was significantly higher in group A than group B. 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant (p=0.0001) difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in Group A than Group B. Before pneumoperitoneum peak airway pressure were 21.07±1.11cm H2O and 18.63±1.10 cm H2O in group A and group B, respectively and after creating pneumoperitoneum peak airway pressure increased in both groups and after pneumoperitoneum ceased it decreased to pre pneumoperitoneum values. Hemodynamics was comparable between the two groups. Time taken to insert the airway device and Ryle's tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in Group A than Group B with no significant (p>0.05) association. For airway device insertion one attempt was in majority of patients in both groups i.e. in Group A it was 80% and Group B it was 93.3%. Conclusion: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. Ventilation was not compromised in any patient in our study, with delivery of adequate tidal volumes and anesthetic agents for the duration of surgery. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to Igel group.
Authors and Affiliations
Reetu Verma, Nitin Kumar Tiwari, Sateesh Verma, Dr Hemlata, Dinesh Singh, Vinod Kumar Bhatia
Keywords
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