Comparison of i-gel, LMA-supreme, LMA-classic and LMAproseal as conduits of endotracheal intubation in newborns and infants: A manikin study

Özet

Many types of supraglottic airway devices (SAD) including the traditionalLMA (Laryngeal Mask Airway) are commonly used as conduits for intubationin pediatric patients with difficult airway. The aim of this study was toevaluate the feasibility of four types of commonly used neonatal and infantsized SADs as conduits of intubation. Fiberoptic-guided tracheal intubationwith uncuffed, cuffed and armored uncuffed endotracheal tubes (ETT) sizedbetween 2.5 and 4.5 through four commonly used types of size 1 and 1.5SADs (i-gel, LMA-classic, LMA-supreme, LMA-proseal) were performed bytwo investigators on an infant manikin. The investigators scored two mainoutcomes with a 5-point scale: 1) passage of ETT during intubation throughthe SAD, and 2) passage of SAD over the ETT during SAD removal. Thedifferences between the study groups were evaluated using the Bonferroniadjusted Mann-Whitney U test and p<0.0083 was considered as statisticallysignificant according to Bonferroni correction. i-gel sizes 1 and 1.5 bothperformed better as conduits for fiberoptic-guided intubation compared withLMA-proseal, LMA-classic and LMA-supreme with most of the uncuffed ETTsinvestigated (p<0.0083). We found i-gel sizes 1 and 1.5 easily feasible to useeven with uncuffed ETTs with an inner diameter of 3.5 mm and 4.5 mm,respectively. i-gel was the only SAD that was feasible for use as a conduit forarmored ETTs. The passage of cuffed ETTs was problematic with all types ofstudied SADs. In conclusion; the choice of i-gel as a conduit for intubationcould be safer than LMA-classic, LMA-supreme and LMA-proseal.