• Alparslan Kus, Cigdem N Gok, Tulay Hosten, Yavuz Gurkan, Mine Solak, and Kamil Toker.
• From the Medical Faculty of Kocaeli University, Department of Anesthesiology and Reanimation, Umuttepe/Kocaeli, Turkey.
• Eur J Anaesthesiol. 2014 May 1;31(5):280-4.

BackgroundSupraglottic airway devices such as the LMA-Supreme (LMA-S) and I-gel, which have an additional lumen for the insertion of a gastric tube, can be useful in the management of the difficult airway.ObjectiveTo test the performance of these two devices in the difficult paediatric airway.DesignRandomised double-blind study.SettingAnaesthesia department, university hospital.PatientsSixty American Society of Anesthesiologists (ASA) I-II children undergoing elective surgery.InterventionAfter obtaining ethical approval and written informed consent from the parents, we compared the size 2 LMA-S with the I-gel in a simulated airway scenario made more difficult by using a cervical collar to limit mouth opening and neck movement.Main Outcome MeasuresThe primary aim was to compare the oropharyngeal leak pressure of the LMA-S and the I-gel. The secondary aims were to compare success rate, insertion time, time to pass a gastric tube and fibreoptic view of the larynx.ResultsOropharyngeal leak pressure (mean ± SD) for the LMA-S was significantly higher than with the I-gel (20.9 ± 3.2 versus 18.9 ± 3.2 cmH2O, P = 0.019). First attempt success rate for the LMA-S was 100 and 90% for the I-gel (P > 0.05). Insertion time of the LMA-S was shorter than I-gel (11.2 ± 1.8 versus 13.5 ± 2.4 s, P = 0.001). Gastric tube placement was possible in all patients. The mean insertion time of the gastric tube was shorter with the LMA-S than with the I-gel (10.3 ± 3.6 versus 12.7 ± 3.2 s, P = 0.009). Fibreoptic laryngeal views were similar in both groups.ConclusionIn the simulated difficult airway in children, both airway devices provided effective ventilation. Paediatric size 2 LMA-S sustained a higher airway pressure before leaking and was quicker to insert than the I-gel equivalent. These differences may not be clinically significant.

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