• Myoung H Kim, Jae H Lee, Yong S Choi, Sujung Park, and Seokyung Shin.
• From the Department of Anaesthesiology and Pain Medicine, Severance Hospital, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea (MHK, JHL, YSC, SP, SS).
• Eur J Anaesthesiol. 2018 Aug 1; 35 (8): 598-604.

BackgroundThe laryngeal mask airway supreme (LMA-S) and i-gel are both popular second-generation supraglottic airway devices that have been widely studied in surgical patients, but their differences in clinical performance in the elderly are not clear.ObjectiveWe compared the efficacy and safety of the LMA-S and i-gel in anaesthetised and paralysed elderly patients.DesignA randomised study.SettingSingle-centre trial, study period January 2014 from to October 2016.PatientsOne hundred and six elderly patients who underwent urological or orthopaedic surgery with an expected duration less than 2 h.InterventionPatients were allocated to either the LMA-S (n = 53) or i-gel (n = 53) group. All insertions were performed in a standardised manner according to the manufacturers' instructions.Main Outcome MeasuresOur primary endpoint was the rate of successful insertion at the first attempt. The adequacy of positive pressure ventilation and airway sealing, fibreoptic laryngoscopy grades and stability of airway maintenance during anaesthesia were also assessed.ResultsAlthough the rate of successful insertion at the first attempt was similar between the two groups (94.3 vs. 82.7%, P = 0.072), more patients required device manipulation during insertion with the LMA-S than the i-gel (42.3 vs. 18.9%, P = 0.011). Good fibreoptic laryngoscopy grades were significantly more common with the i-gel than the LMA-S (79.3 vs. 55.8%, P = 0.042), and peak inspiratory pressures were lower in the i-gel group both immediately after insertion and at the end of surgery. Leak pressures were significantly higher in the i-gel group than the LMA-S group, both immediately after insertion and at the end of surgery (25.8 vs. 23.0, P = 0.036; and 28.1 vs. 23.7, P < 0.001, respectively).ConclusionBoth the LMA-S and i-gel were used successfully and safely in elderly patients. However, the i-gel demonstrated better airway sealing than the LMA-S at insertion and during maintenance of anaesthesia.Trial RegistrationNCT02026791 at clinicaltrial.gov.

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