A randomized equivalence trial comparing the i-gel™ and laryngeal mask airway Supreme™ in children

Abstract

Background The laryngeal mask airway Supreme™ (Supreme) is a new single-use supraglottic device with gastric access capability now available in all sizes for children. Objectives To compare the i-gel™ with the Supreme in children for routine airway maintenance. Materials/Methods One hundred and seventy children, aged 3 months to 11 years, 5-50 kg in weight, were randomly assigned to receive either the i-gel™ or the Supreme. The primary outcome measured was airway leak pressure. Secondary outcomes included the following: ease and time for insertion, insertion success rate, fiberoptic grade of view, ease of gastric tube placement, number of airway manipulations, quality of airway during anesthetic maintenance, and complications. Results A total of 168 patients were assessed for the outcomes. The median (IQR [range]) airway leak pressure for the i-gel™ was higher than with the Supreme, 20 (18-25 [9-40]) cm H2O vs 17 (14-22 [10-40]) cm H2O, respectively (P = 0.001). There were no differences in the time for device insertion, fiberoptic grade of view, quality of airway, and complications. Median (IQR[range]) time of successful insertion of a gastric tube was faster with the Supreme, 12 (9.2-14.3 [5.2-44.2]) s than with the i-gel™, 14 (11.9-19 [6.9-75]) s; P = 0.01. The number of airway manipulations during placement was higher with the i-gel™ than with the laryngeal mask airway Supreme (12 vs 13 patients), P = 0.02. Conclusions In infants and children, when a single-use supraglottic device with gastric access capabilities is required, the i-gel™ demonstrated higher airway leak pressures and can be a useful alternative to the Supreme. © 2012 Blackwell Publishing Ltd.