Comparative evaluation of blind supraglottic airway device insertion versus videolaryngoscope-guided technique in adults undergoing laparoscopic cholecystectomy

ABSTRACT

Objectives

A videolaryngoscope may decrease the high incidence of aberrant positioning of supraglottic airway devices (SAD) inserted with blind techniques. We aimed to compare Igel insertion characteristics between blind and videolaryngoscope-assisted techniques.

Methods

In this study 70 adult patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into blind (Group B, n = 35) and videolaryngoscope-guided (Group V, n = 35) Igel insertion. Oropharyngeal leak pressure (OLP), fiber-optic view score, time for device insertion, first attempt success, ease of insertion, ventilation score, maneuvers, and adverse events were assessed.

Results

OLP was significantly higher in group V at 1 and 10 minutes (24.80 ± 1.91 vs 21.71 ± 2.37; p < 0.001 and 32.60 ± 2.32 vs 30.68 ± 2.93; p = 0.006). The mean fiberoptic scoring (3.63 ± 0.49 vs 3.38 ± 0.49; p = 0.043), a fibreoptic score of grade 4 (24 vs 13; p = 0.012) and time-to-device insertion (25.6 ± 3.5 vs 21.7 ± 4.1; p < 0.001) was considerably higher in group V. First-attempt success (p = 0.630), ease of insertion of SAD (p = 0.540) and nasogastric tube (p = 1), ventilation score (p = 1), number of maneuvers required (p = 1), number of attempts (p = 0.592) and postoperative complications (p = 0.800) were comparable in the two groups.

Conclusion

The videolaryngoscope-guided technique provided superior airway sealing and reduced malposition of Igel without an increase in adverse events compared to the blind technique. However, this was at the cost of increased time of device insertion.

Clinical trial registration

www.ctri.nic.in identifier is CTRI/2022/10/046269

KEYWORDS:

• Adult
• anesthesia, general
• hemodynamics, Laryngoscopy
• cholecystectomy, laparoscopic
• Laryngeal Masks

Article highlights

• Blind LMA placement can be frequently malpositioned.

• Videolaryngoscope provides a high resolution around corner view of the laryngopharynx.

• Vision-guided placement of a SAD has been suggested to reduce its malposition, but this is yet to be established.

• This study found a significant improvement in oropharyngeal seal pressures and fiberoptic scores when CMAC was used to guide Igel placement compared to a blind technique in adult patients undergoing laparoscopic cholecystectomy.

• The additional use of a videolaryngoscope did not increase airway morbidity or worsen the hemodynamic parameters compared to the blind technique.

• Further data are required on the particular type of SAD and videolaryngoscope, which can provide the best airway sealing characteristics in combination.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Ethics approval and consent to participate

The study was approved by the Institute Ethics Committee of VMMC and Safdarjung Hospital (S.No. IEC/VMMC/SJH/Thesis/06/2022/CC-31No.2020–024). The consent to participate was obtained from all study subjects.

Author contributions

The authors NK and SS conceived of the study. The authors NK, SS, and AG participated in the study design, data analysis and interpretation of the data. AG and SS participated in drafting/revising the manuscript. NK performed the statistical analysis and revised the manuscript critically. All the authors read and approved the final manuscript.

Data availability statement

The data supporting this study’s findings are available from the corresponding author on reasonable request.

Acknowledgments

We acknowledge the support of our Head of the Department and the surgeons in the smooth conduct of the study.

Additional information

Funding

This paper was not funded.