Study compares Air-Q SP and PLMA Efficacy in patients undergoing elective surgery under GA

New supraglottic airway devices have been introduced with innovative capabilities.Recently published randomized controlled trial compared the performance of the Air-Q self-pressurized laryngeal airway (Air-Q SP) and the Proseal laryngeal mask airway (Proseal LMA) in 90 adult patients undergoing elective surgery under general anesthesia. The primary outcome measure was oropharyngeal leak pressure (OLP), while secondary outcomes included device insertion time, fiberoptic view of the larynx, hemodynamic and respiratory parameters, and postoperative complications.

OLP and Device Insertion Time -

All supraglottic airway devices were successfully inserted within two attempts. The mean initial OLP and OLP at 10 minutes were significantly lower in the Air-Q SP group compared to the Proseal LMA group (24.09 ± 1.66 cmH2O vs 29.62 ± 2.15 cmH2O initially, and 28.53 ± 1.66 cmH2O vs 36.73 ± 2.64 cmH2O at 10 minutes). However, the device insertion time was significantly shorter for the Air-Q SP compared to the Proseal LMA (12.29 ± 1.52 seconds vs 18.82 ± 1.43 seconds).

Fiberoptic Laryngeal View and Other Parameters -

The fiberoptic laryngeal view grading was significantly better with the Air-Q SP, with more patients having a grade 3 or 4 view (vocal cords plus posterior epiglottis visible or only vocal cords visible) compared to the Proseal LMA group. There were no significant differences between the groups in terms of ease of insertion, number of manipulations required, hemodynamic parameters, respiratory parameters, or postoperative sore throat.

Conclusion and Implications

The authors concluded that while the Proseal LMA had a higher oropharyngeal leak pressure than the Air-Q SP, the Air-Q SP had a faster insertion time and better fiberoptic laryngeal view. Overall, both devices were effective for positive pressure ventilation. The authors suggest the Air-Q SP may offer advantages over the Proseal LMA, particularly the faster insertion time and superior fiberoptic view, which could make it a more attractive option in certain clinical situations.

The study was limited by the lack of blinding of the anesthesiologist performing the device insertions, as well as only including patients with expected "easy" airways. Further research would be needed to evaluate the performance of these devices in patients with more difficult airways or compromised respiratory function. Nonetheless, this study provides useful comparative data on the clinical performance of these two supraglottic airway devices in adult patients undergoing elective surgery.

Key Points -

Here are the 3 key points of the research paper:

1. The study compared the performance of the Air-Q self-pressurized laryngeal airway (Air-Q SP) and the Proseal laryngeal mask airway (Proseal LMA) in 90 adult patients undergoing elective surgery under general anesthesia. The primary outcome measure was oropharyngeal leak pressure (OLP), while secondary outcomes included device insertion time, fiberoptic view of the larynx, hemodynamic and respiratory parameters, and postoperative complications.

2. The Proseal LMA had significantly higher initial and 10-minute OLP compared to the Air-Q SP, but the Air-Q SP had a significantly shorter device insertion time. The fiberoptic laryngeal view was also significantly better with the Air-Q SP, with more patients having a grade 3 or 4 view. There were no significant differences between the groups in other secondary outcomes.

3. The authors concluded that while the Proseal LMA had higher OLP, the Air-Q SP offered advantages such as faster insertion time and superior fiberoptic view, suggesting it may be a more attractive option in certain clinical situations. However, the study was limited by lack of blinding and only including patients with expected "easy" airways, so further research is needed to evaluate the devices in patients with more difficult airways or compromised respiratory function.

Reference –

Rana S, Anand LK, Singh M, Kapoor D, Gupta D, Kaur H. Comparative evaluation of self‑pressurized Air‑Q® and ProsealTM LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial. J Anaesthesiol Clin Pharmacol 2024;40:336‑43.