A comparison between ProSeal laryngeal mask airway and Air-Q Blocker in patients undergoing elective laparoscopic cholecystectomy

Abstract

Background and Aims:ProSeal laryngeal mask airway (PLMA) is an established device for airway management, while Air-Q Blocker (AQB) is a relatively new supraglottic device. The aim of this study is to compare AQB against PLMA in adults undergoing laparoscopic cholecystectomy under general anesthesia.Material and Methods:Eighty-eight adult patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups. A drain tube (gastric tube for PLMA and blocker tube for AQB) was inserted through the drain channel of the respective device. PLMA was inserted in Group P (n = 44) and AQB was inserted in Group A (n = 44) to secure the airway. The primary endpoint was airway seal pressure. Secondarily, we sought to compare overall insertion success, ease of insertion, hemodynamic effects after initial placement, ease of drain tube placement, and perioperative oropharyngolaryngeal morbidity between the devices.Results:Oropharyngeal seal pressures for AQB and PLMA were 31.5 ± 2.41 and 29.41 ± 2.14 cm H2O, respectively (P = 0.01). Insertion time was longer with AQB than PLMA, 25.59 ± 5.71 and 18.66 ± 3.15 seconds, respectively (P = 0.001). Ease and success rate of insertion was better with PLMA compared to AQB. Failure of device insertion was seen in 2 cases of Group A. Gastric distension was seen in 4 patients in Group A, requiring replacement with endotracheal tube in two patients. Ventilation was successful in all 44 patients with PLMA. Both the devices were comparable in providing a patent airway and adequate oxygenation during controlled ventilation. There was an increased trend of airway trauma and complications in the AQB group.Conclusion:Both PLMA and AQB show similar efficacy in maintaining ventilation and oxygenation, during laparoscopic surgery. However, proper positioning and functioning of the blocker tube of AQB is a limiting factor, and needs further evaluation.

Comparison between Air-Q Self Pressurized Airway Device with Blocker and Proseal Laryngeal Mask Airway in anesthetized paralyzed adult female patients undergoing elective gynecological operations

“…Although the PLMA is constructed from silicone, which conforms adequately to supraglottic structures better than PVC, with intra-cuff pressure maintained at 60 cmH 2 O, a significantly higher OLP was found in the SP Blocker group due to the better seal provided by the non-inflatable cuff of the SP Blocker beside its unique design features: the anterior curve of its airway tube that approximates the oropharyngeal airway providing stable end-to-end coupling with the glottis, mask ridges that stabilize the bowl transversely and higher posterior heel height that improves the seal at the tongue [ 38 , 39 ]. Our results clinically corroborate two studies showing that the mean OLP of the Air-Q Blocker and Air-Q SP became higher than that of the PLMA, but they did not agree with a study which found that Air-Q ILA has a lower mean OLP than the PLMA, while previous studies found no statistically significant differences when comparing either the Air-Q ILA and the PLMA or the Air-Q Blocker and the PLMA [ 6 , 31 , 40 – 42 ].…”

“…However, our trial was at odds with another comparison between the Air-Q Blocker and the PLMA by Gupta et al . [ 40 ] which revealed a shorter insertion time and a higher success rate of insertion for the first time with better ease of insertion in the PLMA group than the Air-Q Blocker group, while Moorthy et al . [ 42 ] found no significant difference between the Air-Q ILA and PLMA regarding insertion time, ease and attempts of insertion.…”

“…However, Gupta et al . [ 40 ] found that heart rate (HR), mean (MBP) diastolic (DBP), and systolic blood pressure (SBP) values were comparable and insignificant when the Air-Q Blocker was compared with the PLMA, except during the first 5 minutes immediately after Air-Q Blocker insertion when there was a greater rise in blood pressures than with the PLMA. However, Galgon et al .…”

“…Our findings are in contrast to a study by Gupta et al . [ 40 ]. They recorded a significant difference between the success rate of insertion of the blocker tube in the Air-Q Blocker versus the gastric tube (16 Fr) in the PLMA, where the whole PLMA group was successfully preloaded with its gastric tube with successful stomach evacuation in contrast to the Air-Q Blocker group as the blocker tube could not be passed in 4 patients and in 2 of them the stomach could not be evacuated and the device was replaced with an endotracheal tube.…”

Comparison of Blockbuster LMA with Air Q LMA for Success of Blind Tracheal Intubation in Patients Undergoing General Anesthesia

“…Gupta R et al 12 studied Air Q and extrapolated that Air Q insertion requires a longer time similar to what we encountered. This could be attributed to the hyper-curved airway tube that makes it more flexible thus affecting the ease of placement.…”