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 VARIABLEAmbu LMAI-Gel Ease of insertion Size (3/4) 9/11 8/12 Insertion attempts (1/2) 18/2 Failed insertion 0 0 Size changes 1 1 Insertion time (sec)23.75 +/_3.8 (18 – 45 ) P=0.0001 16.7 +/- 5.3 (13 – 35)

20. Results – (Mean +/ SD) VARIABLE AMBU LMA I GEL AGE 24+/ 3 (19-31 yrs) 24+/3 yr (18 – 30 yrs) WEIGHT50 +/ 7.78 (35 – 65 kg) 51+/ 8.16 (35 – 65 kg) SEX (m : f) (9:11) (8:12)

21. Hemodynamic variable VARIABLE AMBU LMA I GEL Heart Rate (Pre- insertion) 80.75+/7.6 P=0.94 80.8+/7.8 Heart Rate (1 min after insertion) 86.45+/4.65 P=0.1053 87.65+/4.3 Heart Rate (5 min after insertion) 82+/4.21 P=0.5585 82.45+/4.36

22. Hemodynamic variable VARIABLEAMBU LMA I GEL Mean arterial pressure (Pre- insertion) 89.50+/6.7 P=0.3160 90.55+/5.6 Mean arterial pressure (1 min after insertion) 92.55+/5.9 p=0.5837 93.2+/5.43 Mean arterial pressure (5 min after insertion) 90.60+/6.4 P=0.2183 92+/4.7

23. RESULTS VARIABLES AMBU LMAI GEL SPO2 97+/2 98+/2 ETCo2 37+/5 38+/5

24. Weight

25. SEX

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

39. References  i-gel user guide; http://www.i-gel.comhttp://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 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; ww w.ncbi.nlm.nih.gov/pubmed/17323667Ng SYTeoh WHLim YCheong VG