Comparison of the I-gel Laryngeal Mask Airway With the LMA-Supreme for Airway Management in Patients Undergoing Elective Lumbar Vertebral Surgery

Background: The single-use supreme-laryngeal mask airway (SLMA) has been reported to be suitable for airway management in the prone position. However, there are a limited number of cases using the I-gel in the prone position. In this study, we compared the clinical use of the 2 devices in adult patients undergoing elective lumbar vertebral surgery in the prone position. Materials and Methods: Two hundred and sixty-four consecutive patients scheduled for lumbar surgery in the prone position were randomized to receive either the I-gel or the SLMA for airway management. All I-gels and SLMAs were inserted in the supine position by experienced anesthesiologists using standard techniques. Time and number of attempts needed for insertion, quality of ventilation, airway peak pressure, airway seal pressure, fiberoptic view, and complications were compared between the 2 groups. Results: No differences were observed in insertion time between groups. The I-gel required significantly more attempts at insertion (P < 0.001). Airway seal pressure was lower in prone than in supine position in both groups (P < 0.001). The I-gels provided a higher airway seal pressure ([28.4 +/- 5.4] vs. [24.8 +/- 4.6] cm H2O; P < 0.001) in the prone position. There was no difference observed in fiberoptic view of the vocal cords between the 2 groups. The complication rate was low and was similar between the groups. There was little fluid in the mask of both the I-gel and the SLMA and the pH value was 6.8 +/- 0.7 versus 6.6 +/- 0.9, respectively. Conclusions: The I-gel laryngeal mask airway can also be used safely in airway management of patients undergoing lumbar surgery in the prone position as well as the SLMA.