A Randomized Prospective Controlled Trial Comparing the Laryngeal Tube Suction Disposable and the Supreme Laryngeal Mask Airway: the Influence of Head and Neck Position on Oropharyngeal Seal Pressure

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2016 Oct 8

PMID 27716165

Citations 10

Authors

Mostafa Somri

Sonia Vaida

Gustavo Garcia Fornari

Gabriela Renee Mendoza

Pedro Charco-Mora

Naser Hawash

Ibrahim Matter

Forat Swaid

Luis Gaitini

Affiliations

Soon will be listed here.

Abstract

Background: The Laryngeal Tube Suction Disposable (LTS-D) and the Supreme Laryngeal Mask Airway (SLMA) are second generation supraglottic airway devices (SADs) with an added channel to allow gastric drainage. We studied the efficacy of these devices when using pressure controlled mechanical ventilation during general anesthesia for short and medium duration surgical procedures and compared the oropharyngeal seal pressure in different head and-neck positions.

Methods: Eighty patients in each group had either LTS-D or SLMA for airway management. The patients were recruited in two different institutions. Primary outcome variables were the oropharyngeal seal pressures in neutral, flexion, extension, right and left head-neck position. Secondary outcome variables were time to achieve an effective airway, ease of insertion, number of attempts, maneuvers necessary during insertion, ventilatory parameters, success of gastric tube insertion and incidence of complications.

Results: The oropharyngeal seal pressure achieved with the LTS-D was higher than the SLMA in, (extension (p=0.0150) and right position (p=0.0268 at 60 cm HO intracuff pressures and nearly significant in neutral position (p = 0.0571). The oropharyngeal seal pressure was significantly higher with the LTS-D during neck extension as compared to SLMA (p= 0.015). Similar oropharyngeal seal pressures were detected in all other positions with each device. The secondary outcomes were comparable between both groups. Patients ventilated with LTS-D had higher incidence of sore throat (p = 0.527). No major complications occurred.

Conclusions: Better oropharyngeal seal pressure was achieved with the LTS-D in head-neck right and extension positions , although it did not appear to have significance in alteration of management using pressure control mechanical ventilation in neutral position. The fiberoptic view was better with the SLMA. The post-operative sore throat incidence was higher in the LTS-D.

Trial Registration: ClinicalTrials.gov ID: NCT02856672 , Unique Protocol ID:BnaiZionMC-16-LG-001, Registered: August 2016.

Citing Articles

How does head position affect laryngeal vision with a video laryngeal mask airway?.

Castillo-Monzon C, Marroquin-Valz H, Gaszynski T, Cayuela M, Orozco J, Ratajczyk P Front Med (Lausanne). 2025; 11:1469225.

PMID: 39741507 PMC: 11686431. DOI: 10.3389/fmed.2024.1469225.

Choice of supraglottic airway devices: a network meta-analysis of randomised controlled trials.

Kanakaraj M, Bhat A, Singh N, Balasubramanian S, Tyagi A, Aathreya R Br J Anaesth. 2024; 133(6):1284-1306.

PMID: 39406569 PMC: 11589487. DOI: 10.1016/j.bja.2024.09.001.

Use of a laryngeal tube for sialolithotomy in a pediatric patient with left vocal cord paralysis: a case report.

Fujii M, Shime N, Kawabata Y JA Clin Rep. 2023; 9(1):36.

PMID: 37329485 PMC: 10276792. DOI: 10.1186/s40981-023-00629-5.

Efficacy of laryngeal mask airway against postoperative pharyngolaryngeal complications following thyroid surgery: a systematic review and meta-analysis of randomized controlled studies.

Hung K, Wu S, Hsu C, Ko C, Chen J, Huang P Sci Rep. 2022; 12(1):18210.

PMID: 36307459 PMC: 9616911. DOI: 10.1038/s41598-022-21989-5.

Efficacy and Safety of Flexible Laryngeal Mask Ventilation in Otologic Surgery: A Retrospective Analysis.

Liu F, Xi C, Cui X, Wang G Risk Manag Healthc Policy. 2022; 15:945-954.

PMID: 35585872 PMC: 9109885. DOI: 10.2147/RMHP.S354891.

References

Brimacombe J, Keller C . Stability of the LMA-ProSeal and standard laryngeal mask airway in different head and neck positions: a randomized crossover study. Eur J Anaesthesiol. 2003; 20(1):65-9. DOI: 10.1017/s0265021503000127. View

Harding C, McVey F . Interview method affects incidence of postoperative sore throat. Anaesthesia. 1987; 42(10):1104-7. DOI: 10.1111/j.1365-2044.1987.tb05179.x. View

Park S, Han S, Do S, Kim J, Kim J . The influence of head and neck position on the oropharyngeal leak pressure and cuff position of three supraglottic airway devices. Anesth Analg. 2008; 108(1):112-7. DOI: 10.1213/ane.0b013e318192376f. View

Brimacombe J, Berry A . A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg. 1993; 76(2):457. View

Isserles S, Rozenberg B . LMA--reduction of gas leak. Can J Anaesth. 1995; 42(5 Pt 1):449. DOI: 10.1007/BF03015498. View

Cook T, Cranshaw J . Randomized crossover comparison of ProSeal Laryngeal Mask Airway with Laryngeal Tube Sonda during anaesthesia with controlled ventilation. Br J Anaesth. 2005; 95(2):261-6. DOI: 10.1093/bja/aei167. View

Rieger A, Brunne B, Hass I, Brummer G, Spies C, Striebel H . Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation. J Clin Anesth. 1997; 9(1):42-7. DOI: 10.1016/S0952-8180(96)00209-7. View

Dingley J, Whitehead M, Wareham K . A comparative study of the incidence of sore throat with the laryngeal mask airway. Anaesthesia. 1994; 49(3):251-4. DOI: 10.1111/j.1365-2044.1994.tb03434.x. View

Tham H, Tan S, Woon K, Zhao Y . A comparison of the Supreme laryngeal mask airway with the Proseal laryngeal mask airway in anesthetized paralyzed adult patients: a randomized crossover study. Can J Anaesth. 2010; 57(7):672-8. DOI: 10.1007/s12630-010-9312-6. View

10.

Maitra S, Khanna P, Baidya D . Comparison of laryngeal mask airway Supreme and laryngeal mask airway Pro-Seal for controlled ventilation during general anaesthesia in adult patients: systematic review with meta-analysis. Eur J Anaesthesiol. 2013; 31(5):266-73. DOI: 10.1097/01.EJA.0000435015.89651.3d. View

11.

Berry A, Brimacombe J, McManus K, Goldblatt M . An evaluation of the factors influencing selection of the optimal size of laryngeal mask airway in normal adults. Anaesthesia. 1998; 53(6):565-70. DOI: 10.1046/j.1365-2044.1998.00403.x. View

12.

Mihai R, Knottenbelt G, Cook T . Evaluation of the revised laryngeal tube suction: the laryngeal tube suction II in 100 patients. Br J Anaesth. 2007; 99(5):734-9. DOI: 10.1093/bja/aem260. View

13.

Abdi W, Dhonneur G, Amathieu R, Adhoum A, Kamoun W, Slavov V . LMA supreme versus facemask ventilation performed by novices: a comparative study in morbidly obese patients showing difficult ventilation predictors. Obes Surg. 2009; 19(12):1624-30. DOI: 10.1007/s11695-009-9953-0. View

14.

Cork R, Depa R, STANDEN J . Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. Anesth Analg. 1994; 79(4):719-27. DOI: 10.1213/00000539-199410000-00018. View

15.

Keller C, Brimacombe J . The influence of head and neck position on oropharyngeal leak pressure and cuff position with the flexible and the standard laryngeal mask airway. Anesth Analg. 1999; 88(4):913-6. DOI: 10.1097/00000539-199904000-00042. View

16.

Hosten T, Gurkan Y, Ozdamar D, Tekin M, Toker K, Solak M . A new supraglottic airway device: LMA-supreme, comparison with LMA-Proseal. Acta Anaesthesiol Scand. 2009; 53(7):852-7. DOI: 10.1111/j.1399-6576.2009.01986.x. View

17.

Ophir N, Ramaty E, Rajuan-Galor I, Rosman Y, Lavon O, Shrot S . Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices. Am J Emerg Med. 2014; 32(12):1445-9. DOI: 10.1016/j.ajem.2014.08.067. View

18.

Lee A, Tey J, Lim Y, Sia A . Comparison of the single-use LMA supreme with the reusable ProSeal LMA for anaesthesia in gynaecological laparoscopic surgery. Anaesth Intensive Care. 2009; 37(5):815-9. DOI: 10.1177/0310057X0903700537. View

19.

Gaitini L, Vaida S, Somri M, Yanovski B, Ben-David B, Hagberg C . A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients. Anesthesiology. 2004; 101(2):316-20. DOI: 10.1097/00000542-200408000-00011. View

20.

Schalk R, Byhahn C, Fausel F, Egner A, Oberndorfer D, Walcher F . Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes. Resuscitation. 2009; 81(3):323-6. DOI: 10.1016/j.resuscitation.2009.11.007. View