Comparative evaluation of airway dynamics in patients undergoing laparoscopic cholecystectomy under general anaesthesia with controlled ventilation using ProSeal laryngeal mask airway, I-Gel™ and Baska mask

Abstract

Background and Aims: TheProSeal™ laryngeal mask airway (PLMA) and I-Gel™ are second-generation supraglottic airway devices (SADs). The Baska mask is a SAD having a non-inflatable cuff with a tendency to increase the perilaryngeal seal with an increase in airway pressures. This study compared the efficacy of I-Gel™, PLMA and Baska mask with respect to airway dynamics in patients scheduled for laparoscopic surgeries under general anaesthesia (GA). Methods: Ninety patients, of American Society of Anesthesiologists physical status I and II, aged 20–65 years scheduled for laparoscopic cholecystectomy under GA were enroled. The patients were randomised into three groups: Group P (n = 30): airway secured using PLMA, Group I (n = 30): airway secured using I-Gel™ and Group B (n = 30): airway secured using Baska mask. The primary outcome was the change in dynamic compliance, and the secondary outcomes included insertion time, changes in peak inspiratory pressure (PIP) and oropharyngeal leak pressure (OLP) at different time intervals. Results: After insertion of the SADs, the dynamic compliance was highest in group B and least in the group I (p = 0.01). The maximum decrease in dynamic compliance was observed in group I. The insertion time for SAD placement was more in group P. The group B had least PIP as compared to groups P, I at insertion. After carboperitonium, groups P and B had comparable PIP, and group I had highest PIP (p = 0.001). OLP was highest in group B, whereas group I had least OLP. Conclusion: The airway dynamics are better maintained with Baska mask as compared to the PLMA and I-Gel™.

Risk of bias in published randomised controlled trials

“…The demographic data of the 27 included articles are given in Table 1 . [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Overall, 13 out of 27 were judged as having a low risk of bias. [ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases.…”

“…[ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Overall, 13 out of 27 were judged as having a low risk of bias. [ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases. [ 7 8 11 17 18 19 26 29 ] In domain 1, that is, bias arising from the randomisation process, 3 out of 27 had some concerns regarding biases.…”

“…[ 25 28 30 ] Rest of the trials were judged as having a low risk of bias. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 29 ] In domain 2, that is, bias due to deviations from intended interventions, 7 out of 27 had some concerns regarding biases. [ 5 8 11 13 14 18 29 ] and the remaining trials were judged as having a low risk of bias.…”

“…[ 5 8 11 13 14 18 29 ] and the remaining trials were judged as having a low risk of bias. [ 4 6 7 9 10 12 15 16 17 19 20 21 22 23 24 25 26 27 28 30 ] In domain 3, that is, bias due to missing outcome data, all the were considered as having a low risk of bias. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] In domain 4, that is, bias in the measurement of the outcome, 2 out of 27 had a high risk of bias,[ 5 28 ] 6 out of 27 had some concerns regarding the risk of bias,[ 7 17 19 25 26 30 ] and the remaining trials were judged as having a low risk of bias.…”

“…[ 4 6 7 9 10 12 15 16 17 19 20 21 22 23 24 25 26 27 28 30 ] In domain 3, that is, bias due to missing outcome data, all the were considered as having a low risk of bias. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] In domain 4, that is, bias in the measurement of the outcome, 2 out of 27 had a high risk of bias,[ 5 28 ] 6 out of 27 had some concerns regarding the risk of bias,[ 7 17 19 25 26 30 ] and the remaining trials were judged as having a low risk of bias. [ 6 8 9 10 11 12 13 14 15 16 18 20 21 22 23 24 27 29 ] In domain 5, that is, bias in the selection of the reported result, 3 out of 27 had some concerns regarding biases, and the remaining trials were judged as having a low risk of bias [ Figure 1 ].…”