To compare the efficacy of LMA (Laryngeal mask airway) supreme and LMA proseal with LMA classic in paralysed, anaesthetized patients

• Author Details:   
• Anita Kumari
• Lakshmi Mahajan
• Deepika Madaan
• Pankaj Sarangal
• Ruchi Gupta

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Introduction: Proseal LMA(PLMA) and LMA supreme(SLMA) are improved versions of classic LMA and offer additional  safety features such as provision of better glottis seal at low mucosal pressure, presence of a drain tube which prevents gastric insufflation and thus protects against aspiration. In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralysed patients.
Methods: We conducted a randomised prospective study in 60 adult anaesthetized paralysed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. The incidence of aspiration with these LMA devices using pH paper readings from LMA tips and comparing it with gastric content pH obtained through ryle’s tube, perioperative complications and cost effectiveness of the device used were evaluated as secondary outcome.
Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. First attempt insertion was 15/20 in group 1, 18/20 in group 2 and 3 each. Second attempt insertion was 5 patients in CLMA; 2 patients in PLMA & one patient in SLMA. Median insertion time was (22.6±3.8 sec, 20.7±3.9 and in 18.9±4.2 sec) in group 1, 2 and 3 respectively. There was no case of aspiration as evidenced by LMA tip pH which remained in the range of 6-7. The cost of SLMA was found to be more in comparison to PLMA and CLMA. Incidences of intra and post-operative complications were similar in all the three groups.
Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.

Keywords: Laryngeal mask airway, Equipment, Airway, SLMA, PLMA