Aim: The Pro Seal laryngeal mask airway (PLMA), i-gel and Combi Tube (CT) in past evaluated alone or in group comparisons but differing study designs make it difficult to compare the results. The aim of this study was to compare the clinical performance of these three alternative devices in terms of efficacy and safety in patients receiving mechanical ventilation during elective surgical procedures.

Material and Methods: This prospective, randomised, double blind study was performed in randomly allocated 3 different groups containing each group 30 American Society of Anesthesiologists physical status I–II patients, undergoing elective surgical procedures under general anaesthesia. PLMA, i-gel or CT appropriate for weight or/and height was inserted. Primary outcome measured was airway sealing pressure. Insertion time, ease of insertion, number of attempts, overall success rate and the incidence of airway trauma and complications were also recorded. Intergroup differences were compared using one way analysis of variance with post hoc correction for continuous data and Chi‑square test for categorical variables.

Results: Overall success rate was comparable between the three devices (i-gel 100%, CT 100%, PLMA 96.6%). Airway sealing pressure was lower with i-gel (24.26 ± 1.96 cm H2O) compared to CT (26.52 ± 2.11 cm H2O) and PLMA (28.6 ± 2.5 cm H2O; P < 0.0005). The mean insertion time was significantly more in PLMA (37.22 ± 2.9 s) compared to i-gel (26.9 ± 2.53 s) and CT (22.22 ± 2.31 s; P < 0.0005).

Conclusion: Airway sealing pressure and insertion time were significantly higher in PLMA compared to i-gel and CT.

Keywords: Airway management, Artificial, i‑gel, Combi tube, Pro Seal laryngeal mask airway, respiration

1. Yarrow S, Hare J, Robinson KN. Recent trends in tracheal intubation: A retrospective analysis of 97904 cases. Anaesthesia 2003;58:1019‑22.
2. Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complica-tions of airway management in the UK: Results of the fourth national audit project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 2011;106:617‑31.
3. Asai T, Morris S. The laryngeal mask airway: Its features,effects and role. Can J Anaesth 1994;41:930‑60.
4. Jadhav PA, Dalvi NP, Tendolkar BA. I‑gel versus laryngeal mask airway‑proseal: Comparison of two supraglottic airway devices in short surgical procedures. J AnaesthesiolClinPharmacol 2015;31:221‑5.
5. Amini A, Zand F, Maghbooli M. Disposable versus reusable laryngeal tube suction for ventilation in patients undergoing laparoscopic cholecystectomy. Rev Bras Anestesiol 2010;60:32‑41.
6. Brimacombe J, Keller C. The ProSeal laryngeal mask airway: A randomized, crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiology 2000;93:104‑9.
7. Kannaujia A, Srivastava U, Saraswat N, Mishra A, Kumar A,Saxena S, et al. A preliminary study of I‑gel: A new supraglottic airway device. Indian J Anaesth 2009;53:52‑6.
8. Liew GH, Yu ED, Shah SS, Kothandan H. Comparison of the clinical performance of I‑gel, LMA supreme and LMA ProSeal in elective surgery. Singapore Med J 2016;57:432‑7.
9. Cook TM, Lee G, Nolan JP. The ProSeal laryngeal mask airway:A review of the literature. Can J Anaesth 2005;52:739‑60.

10.  Morteza Saeedi, Houman Hajiseyed-javadi, Javad Seyedhosseini, et al. Comprarison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin studyInt J CritIllnInj Sci. 2014; 4(4): 303–308

11.  Bein B, Carstensen S, Gleim M, Claus L, Tonner PH, Steinfath M, et al. A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures. Eur J Anaesthesiol. 2005;22:341–6

12. Cavus E, Deitmer W, Francksen H, Serocki G, Bein B, ScholzJ,et al. Laryngeal tube S II, ProSeal laryngeal mask, and EasyTubeduring elective surgery: A randomized controlled comparison with the endotracheal tube in nontrained professionals. Eur J Anaesthesiol 2009;26:730‑5.
13. Brimacombe J, Keller C, Boehler M, Pühringer F. Positive pressure ventilation with the ProSeal versus classic laryngeal mask airway: A randomized, crossover study of healthy female patients. Anesth Analg 2001;93:1351‑3.
14. Kini G, Devanna GM, Mukkapati KR, Chaudhuri S, Thomas D.Comparison of I‑gel with proseal LMA in adult patients undergoing elective surgical procedures under general anesthesia without paralysis: A prospective randomized study J Anaesthesiol Clin Pharmacol 2014; 30:183‑7.
15. Nirupa R, Gombar S, Ahuja V, Sharma P. A randomised trial to compare i‑gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients. Indian J Anaesth 2016;60:726‑31.
16. Rumball CJ, MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care. 1997;1:1–10
17. Weksler N, Tarnopolski A, Klein M, Schily M, Rozentsveig V, Shapira AR, et al. Insertion of the endotracheal tube, laryngeal mask airway and oesophageal-tracheal Combitube. A 6-month comparative prospective study of acquisition and retention skills by medical students. Eur JAnaesthesiol. 2005;22:337–40.
18. Seet E, Rajeev S, Firoz T, Yousaf F, Wong J, Wong DT, Safety and efficacy of laryngeal mask airway supreme versus laryngeal mask airway ProSeal: A randomized controlled trial. Eur J Anaesthesiol 2010;27:602‑7.
19. Park SK, Choi GJ, Choi YS, Ahn EJ, Kang H. Comparison of the I‑gel and the laryngeal mask airway proseal during general anesthesia: A systematic review and meta‑analysis. PLoS One 2015;10:e0119469.
20. Shin HW, Yoo HN, Bae GE, Chang JC, Park MK, You HS, et al. Comparison of oropharyngeal leak pressure and clinical performance of LMA ProSeal™ and I‑gel® in adults: Meta‑analysis and systematic review. J Int Med Res 2016;44:405‑18.
21. Brimacombe J, Keller C. The ProSeal laryngeal mask airway. Anesthesiol Clin North America 2002;20:871‑91.
22. Sharma B, Sehgal R, Sahai C, Sood J. PLMA vs. I‑gel: A Comparative evaluation of respiratory mechanics in laparoscopic cholecystectomy. J Anaest-hesiol Clin Pharmacol 2010;26:451‑7.
23. Das A, Majumdar S, Mukherjee A, Mitra T, Kundu R, HajraBK,et al. I-gel in ambulatory surgery: A Comparison with LMA-ProSeal™ in paralyzed anaestheti-zed patients. J ClinDiagn Res 2014;8:80‑4.
24. Soliveres J, Balaguer J, Richart MT, Sanchez J, Solaz C. Airway morbidity after use of the laryngeal mask airway LMA Proseal vs. I‑gel. Eur J Anaesthesiol 2010;27:257‑8.
25. Keijzer C, Buitelaar DR, Efthymiou KM, Srámek M, ten Cate J,Ronday M, et al. A comparison of postoperative throat and neck complaints after the use of the I‑gel and the la premiere disposable laryngeal mask: A double‑blinded, randomized, controlled trial. AnesthAnalg 2009;109: 1092‑5.
26. Gasteiger L, Brimacombe J, Perkhofer D, Kaufmann M, Keller C.Comparison of guided insertion of the LMA ProSeal vs. the i‑gel. Anaesthesia 2010;65:913‑6.
27. Singh I, Gupta M, Tandon M. Comparison of clinical performance of I‑gel with LMA‑proseal in elective surgeries. Indian J Anaesth 2009;53:302‑5.
28. Helmy AM, Atef HM, El‑Taher EM, Henidak AM. Comparative study between I‑gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients. Saudi J Anaesth 2010;4:131‑6.

Dr Amar Nath Gupta

Assistant Professor, Department of Anaesthesiology,

Gouri Devi Institute of Medical Sciences and Hospital,

Durgapur, West Bengal, India

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