Chulalongkorn Medical Journal


Background : Tracheal intubation with manual in-line stabilization (TT-MILS) isthe standard management in patients with cervical spine injury.The procedure of which is not practical for inexperienced personnel.Supraglottic airway device has a role in difficult airway managementand been proved to be easy for new users. It may be effective forairway management in the setting of limited cervical spinemovement.Objective : To compare airway management by i-gel, LMA-ProSeal™ andTT-MILS in anesthetized, paralyzed patients with simulated difficultairway by rigid cervical collar.Research design : A randomized, double-blind comparison study.Setting : In the operating rooms and surgical wards, King ChulalongkornMemorial Hospital, a tertiary hospital with 1500 beds.Materials and Methods : Sixty patients scheduled for superficial surgery which requiredgeneral anesthesia were recruited and randomized into threegroups as follows, i-gel, LMA-ProSeal™ and TT-MILS. The patientsand assessors were blinded. Primary outcome was the time tosuccessful ventilation. Other measurements were insertion attempts,positive leak pressure, fiber optic-assessed glottic view,intraoperative and postoperative complications.Results : Twenty patients were assigned to each groups. Times to successfulventilation were not statistically different (i-gel 43.01 ± 26.94 s;LMA-ProSeal™ 50.05 ± 45.73 s; TT-MILS 68.43 ± 46.69 s;P = 0.113). The success rate for i-gel was 90% in the first attemptand 10% in second attempt vs. that of LMA-ProSeal™ which was95% in the first attempt and 5% in the second attempt (P = 0.536).The positive leak pressure was significantly higher in LMA-ProSeal™group than that of in the i-gel group (25.55 ± 3.01 cmH2O vs.23.35 ± 3.31 cmH2O; P = 0.035). The glottic views were notstatistically different between the groups. The incidences of sorethroat and odynophagia were significantly lower in the i-gel andLMA-ProSeal™ groups, compared to that of the TT-MILS group(P = 0.000, 0.017 respectively).Conclusion : I-gel had shorter insertion time compared to LMA-Proseal™ andTT-MILS. Regarding the less seal, i-gel might be a reasonablealternative to the LMA-Proseal™ and TT-MILS in patients withreduced neck movement and limited mouth opening.


Faculty of Medicine, Chulalongkorn University

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