van Zundert, Andre, Al-Shaikh, Baha, Brimacombe, Joseph, Koster, Jurgen, Koning, Dick, and Mortier, Eric P. (2006) Comparison of three disposable extraglottic airway devices in spontaneously breathing adults. Anesthesiology, 104 (6). pp. 1165-1169.

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Abstract

Background: The authors compared three disposable extraglottic airway devices in spontaneously breathing anesthetized adults: the LAM-Unique™ (LMA-U; The Laryngeal Mask Company, San Diego, CA), the Soft Seal® laryngeal mask (SS-LM; Portex Ltd., Hythe, United Kingdom), and the Cobra perilaryngeal airway (Cobra-PLA™; Engineered Medical Systems, Inc. Indianapolis, IN). Methods: Three hundred twenty consecutive adults (American Society of Anesthesiologists physical status I-III; aged 18-80 yr) were randomly allocated for airway management with one of the three devices. Anesthesia was with fentanyl-propofol for induction and a sevoflurane-nitrous oxide-oxygen-fentanyl mixture for maintenance. Intraoperative data were collected by an unblinded observer about ease of insertion, effective airway time, oropharyngeal leak pressure, anatomical position (determined with a rigid endoscope), intracuff pressure changes, and airway trauma. Data were collected by a blinded observer about sore throat, dysphagia, and dysphonia 2 h after surgery. Results: Insertion was easier with the LMA-U and SS-LM than with the Cobra-PLA (P < 0.02), but the overall failure rates were similar. Effective airway times were similar among groups. Oropharyngeal leak pressure was lower with the LMA-U than with the SS-LM and Cobra-PLA (P < 0.001). Intracuff pressure increased during surgery with all extraglottic airway devices. Anatomical position was better with the Cobra-PLA than with the SS-LMA (P < 0.001) and better with the SS-LM than with LMA-U (P < 0.001). Blood staining was detected more frequently with the Cobra-PLA than with the LMA-U and SS-LM (P < 0.001), but there were no differences in airway morbidity. Conclusion: The LMA-U and SS-LM are easier to insert and cause less trauma than the Cobra-PLA, but the Cobra-PLA has a more effective seal than the LMA-U and better endoscopically determined anatomical position than the LMA-U and SS-LM.

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