I-gel vs LMA Supreme in Laparoscopic Gynecological Surgery

Study Overview
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Brief Summary
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To compare the effects of i-gel and Laryngeal mask airway Supreme (LMA-Supreme) on ventilation parameters and surgical view during Trendelenburg Position laparoscopic gynecological surgery in cases administered positive pressure ventilation without the use of neuromuscular agents.

Detailed Description
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Prospective, randomized and double-blind study, aged from 18 to 65 years undergoing elective laparoscopic gynecological surgery. The patients are randomly assigned to 2 groups: Group 1: i-gel Group 2: LMA- Supreme Procedure: The investigation protocol contains the following sections: Induction of anaesthesia. For preoperative sedation 0.02 mg/kg midazolam IV will be administered. 2 minutes of 0.2 µ/kg/min remifentanil and 6 mg kg st-1 propofol infusion, IV 1-2 mg kg-1 propofol . No muscle relaxant will be used for insertion of the airway device. Bispectral index values will be held between 40-60.Bispectral index values will be within this interval by increasing or decreasing propofol infusion by 1 mg/kg after additional bolus dose of propofol (1 mg/kg). Insertion of the airway device. The size of the airway device used is based on the manufacturers' recommendations. All devices are deflated a lubricated prior to use. Once inserted, the cuff is be inflated with a manometer up to 60 cm H20 Data recorded: size of airway device, time an number of attempts. Anesthesia maintenance will be ensured by 50% O2/air with 0.1-0.4 µ kg/min-1 remifentanil and 50-150 µ kg/ min-1 (4-10 mg/kg/hr) propofol IV infusion Functionality of the gastric drainage channel of the airway device: passage of a 14 G size tube. Measurement of airway seal pressure (oropharyngeal leak pressure (OLP): at baseline, and at 2 minutes after airway device insertion (T1), 10 minutes after insufflation (T2), before desufflation (T3), before removal of airway device (T4). The maximum pressure allowed is 40 cm H2O. Ventilatory mechanics and parameters and hemodynamic parameters are measured at baseline, and at T1, T2, T3 and T4. Perioperative complications: Cough, vomiting, laryngeal spasm, laryngeal Stridor, airway intervention requirements, hypoxia (SpO2 < 92%) Removal of the airway device: Presence of blood - 3 level grading (1:no blood; 2: trace amounts of blood; 3: clear amounts of blood). Complications: sore throat ( VAS:10-point scale), dysphonia (yes/no), dysphagia (yes/no).

Official Title
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Comparison of I-gel and LMA Supreme Without Neuromuscular Blocker in Laparoscopic Gynecological Surgery

Conditions
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Airway Morbidity, Anaesthesia

Intervention / Treatment
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* Device: Laryngeal mask Supreme Evaluation
* Device: i-gel Evaluation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists classification group I-II between 18-65 years undergoing elective laparoscopic gynecological surgery Exclusion Criteria: Those with any neck or upper respiratory tract pathology Those at risk of gastric content regurgitation/aspiration (previous upper Gastrointestinal system surgery, known hiatus hernia, gastroesophageal reflux, history of peptic ulcers, full stomach, pregnancy) Those with low pulmonary compliance or high airway resistance (chronic pulmonary diseases) Obese patients (BMI >35) Those with throat pain, dysphagia and dysphonia Those with possible or previous difficult airway Those with operations planned for longer than 4 hours Conversion to laparatomy Neuromuscular blocking agent used

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Laryngeal mask Supreme<br>Insertion of the Laryngeal mask Supreme and evaluation of its clinical performance | Device: Laryngeal mask Supreme Evaluation<br>* Evaluation of clinical performance in terms of Insertion, ventilation and complications<br>|
| Experimental: i-gel<br>Insertion of the i-gel and evaluation of its clinical performance | Device: i-gel Evaluation<br>* Evaluation of clinical performance in terms of Insertion,ventilation and complications<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Airway Seal Pressure Values | This value is important as it indicates the feasibility of positive pressure ventilation and the degree of airway protection from supracuff soiling. It is also used in LMA studies as an index of successful placement.Airway pressures of ≈20 cm H2O are typically required in routine practice. | At baseline and at 15, 30 and 60 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Quality | quality of surgical view will evaluate by the scala. quality of surgical view will be assessed with points from 1 to 4 by the surgeon blind to the airway device; (1:best, 4: worst). | during pneumoperitoneum | 
| Gastric Tube Insertion | Number of Participants According to Ease of Gastric Tube Insertion.Ease of passage of a gastric tube as: very easy, easy, difficult or very difficult. | following airway device insertion up to 5 minutes | 
| Postoperative Pharyngolaryngeal Morbidity | Sore throat evaluted by Visual Analogue Scale. The visual analog scale, also known as the graphic rating scale is a simple, valid and reliable subjective measure. Scores are ranked on a 10-cm line that stretches between two extremes - no pain and worst pain. Total range provided0 (no pain) to 10 (worst pain). | postoperative first hour and 24th hour | 
| Sufficiency of Pneumoperitoneum | Number of Participants with Sufficiency of Pneumoperitoneum. Sufficiency of pneumoperitoneum for the surgical procedure according to surgeon, described as sufficient or insufficient questionaire. | baseline | 
| Mean Airway Pressure Values | Mean airway pressure typically refers to the mean pressure applied during positive-pressure mechanical ventilation. Mean airway pressure correlates with alveolar ventilation, arterial oxygenation, hemodynamic performance, and barotrauma. | At baseline and at 15, 30 and 60 minutes | 
| Dysphonia With Yes/no. | We evaluated while a patient was talking with us that the patient has dysphonia or not . | postoperative first hour and 24th hour | 
| Disphagia | We asked the question that you have a pain while you were swallowing, yes or not. | postoperative first hour and 24th hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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i-gel, laryngeal mask Supreme, laparoscopic gynecological surgery