Comparison of i-gel and lma supreme without neuromuscular blocker in laparoscopic gynecological surgery

SUMMARY Comparison of I-gel and LMA Supreme Without Neuromuscular Blocker in Laparoscopic Gynecological Surgery Aim: Supraglottic airway devices have gained common popularity ,n anesthesia administration. Additional new modifications have currently allowed them to enter the field of use of the endotracheal tube (ETT). Additionally, the lack of neuromuscular blocker agent (NBA) requirement provides advantages leading to common use such as use in many outpatient surgical interventions and causing less stress response compared to endotracheal intubation. Aim of tis study is to compare the effects of i-gel and LMA-Supreme on ventilation parameters and surgical view during laparoscopic gynecological surgery in cases administered positive pressure ventilation without the use of neuromuscular blocker agents. Materıal And Method: One hundred and twelve patients in ASA classification group I-II, aged from 18 to 65 years undergoing elective laparoscopic gynecological surgery, were included to this double blind, randomised, controlled study with informed patient consent. Patients were decided into two groups: İ-gel group (n=55) and LMA-S group (n=51). All patients received total intravenous general anesthesia and a standart ventilation protocol has been carried out. The number of insertion attempts, insertion times, the ease of insertion, oropharyngeal leak pressure, ventilation parameteres and ease of gastric tube insertion were recorded. At the same time gastric distention was scored by a blinded surgeon. Postoperative laryngopharyngeal morbidity was also recorded. Results: Insertion success rate at the first attempt was similar for both groups. Insertion times was shorter for the i-gel group (11,49±2,86s) compared with the LMA-S group (13,59±4,22s) (p=0,003). Ease of insertion was significantly more easier for the i-gel group (p=0,011).The oropharyngeal leak pressure was significantly higher for the LMA-S group at the measurements made second minutes of device insertion, compared with the i-gel group (p=0.016). Gastric tubes were easier to insert in the LMA-S group (p < 0.001). Visible blood on removal of the device were recorded at eleven patients in the LMA-S group and none at the İ-gel group (p<0,001). There were no significant differances in the peak airway pressure, mean airway pressure, end tidal carbon dioxide, tidal volume and gastrik distension between two groups. Conclusion: Both the LMA-S and i-gel were used successfully and safely in laparoscopic gynecological surgery without the use of neuromuscular blocker agents. LMA-S was shown to be easier for gastric tube insertion and higher for the oropharyngeal leak pressure but associated with more difficult and longer insertion and postoperative laryngopharengeal morbidity like visible blood.. Keywords: Laringeal Mask Airway SupremeTM, İ-GelTM,Laparoscopic gynecological surgery, Neuromuscular blocker agent