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Comparison of clinical performance of I-GEL and AURA ONCE LMA

Comparison of clinical performance of I-GEL and AURA ONCE LMA. Dr. N. Anuradha, final year M.D Anaesthesia, Stanley Medical College.Chennai. Prof. Dr. R. Subramaniya Bharathiyar; Professor and H.O.D Prof. Dr. R. Lakshmi, Associate Professor

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Comparison of clinical performance of I-GEL and AURA ONCE LMA

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  1. Comparison of clinical performance of I-GEL and AURA ONCE LMA Dr. N. Anuradha, final year M.D Anaesthesia, Stanley Medical College.Chennai. Prof. Dr. R. Subramaniya Bharathiyar; Professor and H.O.D Prof. Dr. R. Lakshmi, Associate Professor Prof. Dr.Ponnambala Namasivayam,Associate Professor Dr. Saravana Kumar, Assistant professor

  2. AIMS AND OBJECTIVES: Comparison of clinical performance of two supraglottic devices, aura once LMA and I GEL. • The ease of insertion, • Placement success rate • Hemodynamic response • Intra-operative and post-operative complications

  3. Study design • Single blind • Prospective • Randomised

  4. Place of study • General surgery theatre in stanley medical college.

  5. PATIENTS AND METHODS: • Institutional Ethics Committee approval was obtained • Informed written consent was obtained • 40 patients (n=40) belonging to ASA PS 1 &2 MPC 1 & 2 of both sexes between age group 18 to 40 years presenting short elective procedures in supine position were included.

  6. Inclusion Criteria: • Age 18 to 40 years • Weight 30-60 kg • ASA physical status 1-2 • Patients undergoing elective surgery under general anesthesia, • Both sexes

  7. Exclusion criteria: • Restricted mouth opening (<2cms) • Anticipated difficult airway • Disease of oral cavity • Patients at increased risk of aspiration, or having an history of symptomatic gastro-esophageal reflux

  8. Materials • Aura Once Laryngeal mask airway • I Gel • IV cannulae • Monitors • Drugs for general anaesthesia

  9. I GEL

  10. Aura Once LMA

  11. Study methods • Randomly divide the patients into two groups • Written informed consent to be obtained • Group 1(n=20) : patients who will receive general anaesthesia with Aura once LMA • Group 2(n=20): patients who will receive general anaesthesia with I Gel.

  12. METHODS • Premedication: • Inj. Ranitidine 1mg / kg iv, • Inj. Metoclopramide 0.1 mg/kg iv. • Inj. Glycopyrolate 0.004 mg/kg iv, • Inj. Midazolam 0.02mg /kg iv, • Inj. Fentanyl 2 mcg/kg iv.

  13. METHODS • Anaesthesia was induced with • Inj. Propofol 2mg/kg iv and • Inj succinylcholine 1mg /kg iv • After adequate facemask ventilation and relaxation, an appropriately sized supra-glottic airway was inserted by an experienced anaesthetist. • placement confirmed

  14. Anaesthesia was maintained with • N2O: O2 70:30%, • Isoflurane 1% in spontaneous ventilation

  15. Monitor • During maintenance of anesthesia • Heart rate, Mean arterial blood pressure, • Spo2, respiratory rate, end-tidal CO2 concentration,

  16. Supraglottic airway was removed after • protective airway reflexes, • the patient’s ability to follow commands. • During extubation, • Coughing • blood staining on the device, • trauma to the tongue, lips, or teeth

  17. Intraoperative complications • Aspiration/regurgitation, • Bronchospasm, • Airway obstruction, • Coughing, • Gagging, vomiting

  18. Postoperative complication • sore throat • dysphonia

  19. RESULTS

  20. Results – (Mean +/ SD)

  21. Hemodynamic variable

  22. Hemodynamic variable

  23. RESULTS

  24. Weight AURA ONCE LMA IGEL

  25. SEX AURA ONCE LMA IGEL

  26. RESULTS • All patients were ASA I/II. • The mean length of anesthesia was 30+/15min (20 – 45 min) • The immediate recovery period was uneventful in 36 patients. • Two patients in each group complained mild sore throat in one hour and had no pain after 24 hours. • There was no incidence of aspiration/regurgitation, bronchospasm, airway obstruction, coughing, vomiting.

  27. RESULTS • There were no differences in the demographic data and haemodynamic data immediately after insertion of device • The median insertion time for the i-gel was significantly less than for the aura once LMA [16.7s+/5.3s vs 23.75 s+/3.8s ; P=0.0001] • This gives a statistically significant value in insertion time of I gel.

  28. CONCLUSION • We found no difference in success rate of first-time insertion between the i-gel and the aura once LMA. • Time to successful insertion was significantly shorter for the i-gel.

  29. PROFORMA • Name of the patient • Group • Age IP No • SEX • ASA Status • WEIGHT • HEIGHT • AIRWAY - MPC • Associated medical illness • Informed Consent • Last Oral intake • Premedication • Shifted to theatre • Monitors • IV ACCESS : • PREOXYGENATION • INDUCTION • RELAXANT

  30. PROFORMA • SUPRAGLOTTIC DEVICE INSERTION: • TIME • Number of attempts • Monitoring: • Heart rate, Mean arterial blood pressure, • Spo2, respiratory rate, end-tidal CO2 concentration, • Intraop: • Aspiration/regurgitation, • Bronchospasm, • airway obstruction, • Coughing • Post op: • sore throat • dysphonia

  31. I-GEL

  32. I-gel • The I-gel is a device for airway management • I-gel is produced from a medical grade thermoplastic called SEBS (Styrene Ethylene Butadiene Styrene). • The soft, non-inflatable cuff fits snugly onto the perilaryngeal framework, • Its used for both spontaneously breathing patients and for IPPV.

  33. I-Gel (2) • I-gel has an artifical epiglottis called the 'epiglottis blocker'. This helps to prevent the epiglottis from down-folding • When correctly inserted, the tip of the i-gel will be located into the upper oesophageal opening, providing a conduit via the gastric channel to the oesophagus and stomach. This then allows for suctioning, passing of a nasogastric tube and can facilitate venting.

  34. I- Gel (3) • Buccal cavity Stabilizer : • It is the main stem of the device which contains the integral bite block and the airway and gastric channels. • It eliminates the potential for rotation after insertion, thereby reducing the risk of malposition. • It also provides vertical strength to aid insertion.

  35. I-gel (5) • available in three adult sizes • an innovative, colour-coded polypropylene ‘protective cradle’. • The maximum size of nasogastric tube that can pass through each size of I –gel: • Size 3 : 12G nasogastric tube • Size 4 : 12G nasogastric tube • Size 5 : 14G nasogastric tube

  36. AURA ONCE LMA

  37. AURA ONCE LMA

  38. References • i-gel user guide; http://www.i-gel.com • A Multicenter Study of the Ambu® Laryngeal Mask in Nonparalyzed, Anesthetized Patients Anesth Analg December 2005 101:1862-1866; doi:10.1213/01.ANE.0000184181.92140.7C • Randomized crossover comparison between the i-gel and the LMA-Unique in anaesthetized, paralysed adults V. Uppal1,*, S. Gangaiah1, G. Fletcher2 and J. Kinsella1, BJA VOL103 • http://www.ambu.co.uk/UK/Airway_Management • Comparison of the AMBU Laryngeal Mask and the LMA Classic in anaesthetised, spontaneously breathing patients. Ng SY, Teoh WH, Lim Y, Cheong VG; www.ncbi.nlm.nih.gov/pubmed/17323667

  39. THANK YOU

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