Air-Q® SP Versus Air-Q® and I-gel: A Randomized Clinical Trial
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Comparison of the Air-Q® Self-Pressurizing (SP) Intubating Laryngeal Airway With the Air-Q® Intubating Laryngeal Airway and I-gel for Airway Maintenance in Adults Under General Anesthesia|
- Airway Seal Pressure After Device Placement [ Time Frame: Measured within 5 minutes after device placement/study initiation ]Airway seal pressure is defined as the pressure in cmH2O at which the needle of a manometer attached to the anesthesia circuit reaches equilibration, associated with an audible air leak from the subject's oropharynx or gastric insufflation, limited to a maximum pressure of 40 cmH2O. It is measured with the subject's head and neck in neutral position, the expiratory valve on the anesthesia machine closed, and the fresh gas flow set to five liters per minute.
- Device Placement Time [ Time Frame: Measured at device placement/study initiation ]Device placement time is the time measured in seconds from when the study investigator picks up the airway device to confirmation of ventilation by the presence of an adequate end-tidal carbon dioxide tracing on the monitor.
- Device Placement Success Rate [ Time Frame: Measured at the time of attempted study device placement immediately after the induction of general anesthesia ]Device placement success rate is defined as the proportion of devices successfully placed within three attempts at device placement.
- Device Ease of Insertion [ Time Frame: Reported by the device operator at the time successful device placement is recorded. ]Device ease of insertion is graded as either easy, slightly difficult, difficult, or impossible. The outcome measure is the proportion of successful study device placements recorded as easy versus slightly difficult versus difficult versus impossible.
- Device Position in Relation to the Vocal Cords [ Time Frame: Measured within 5 minutes of successful study device placement ]Device position in relation to the vocal cords is assessed with a flexible fiberoptic camera and graded as follows: 1 = full view of the vocal cords, 2 = partial view of the vocal cords including the arytenoids, 3 = view of the epiglottis only, and 4 = other (device cuff, pharynx or other structures).
- Device Use Time (Min) [ Time Frame: End of Device Use Time ]Device Use Time is the time recorded to the nearest minute of the period bounded by the time the device placement was determined to be adequate in the study subject to its withdrawal from the study subject.
- Incidence of Gastric Insufflation [ Time Frame: Measured within 5 minutes of device placement/study initiation ]Gastric insufflation is present when audible air sounds are heard by stethoscope over the subject's epigastrium.
- Incidence of Gastric Aspiration [ Time Frame: Measured between successful device placement and device removal for any reason. ]Gastric aspiration is present when gross gastric contents or bile is observed on or within the device or within the subject's oropharynx. The outcome is the proportion of study subjects in whom the outcome measure was observed.
- Incidence of Oropharyngeal Injury [ Time Frame: Measured in the post-anesthesia care unit/recovery room within 15 minutes after device removal ]Oropharyngeal injury is defined as a new lip, tongue, buccal, or pharyngeal abrasion or laceration or dental damage observed in the immediate recovery area after use of a study device.
- Overall Clinical Usefulness [ Time Frame: Reported by the device operator at the time of device removal ]Excellent, good, fair, or inadequate. Scale defined by clinical measures and observations.
- Oropharyngolaryngeal Morbidity at Discharge [ Time Frame: Measured prior to discharge from phase II of the post-anesthesia care unit/recovery room ]Perioperative oropharyngolaryngeal morbidity is assessed by the subject's response to standardized questions regarding oropharyngeal complaints.
- Oropharyngolaryngeal Morbidity at 24 Hours Post-operatively [ Time Frame: Measured at 24 hours after device placement/study initiation ]Perioperative oropharyngolaryngeal morbidity is assessed by the subject's response to standardized questions regarding oropharyngeal complaints.
|Study Start Date:||May 2012|
|Study Completion Date:||August 2014|
|Primary Completion Date:||August 2014 (Final data collection date for primary outcome measure)|
Experimental: air-Q SP
air-Q Self-Pressurizing Intubating Laryngeal Airway, sizes 3.5 and 4.5 (Mercury Medical, Clearwater, FL, USA)
Device: air-Q SP
air-Q SP placement for airway maintenance.
Active Comparator: air-Q
air-Q Intubating Laryngeal Airway, sizes 3.5 and 4.5 (Mercury Medical, Clearwater, FL, USA)
air-Q placement for airway maintenance.
Active Comparator: i-gel
i-gel, sizes 3, 4, and 5 (Intersurgical Inc., Liverpool, NY, USA)
i-gel placement for airway maintenance.
Laryngeal mask airways (LMAs) are a group of airway devices, alternatively referred to as supraglottic airways (SGAs), used in anesthesia that are positioned in the back of the throat (pharynx) above (supra) the glottis (windpipe opening) and the vocal cords. This is in contradistinction to a tracheal tube, which is an airway device that is placed through the vocal cords and extends to a position below the glottis (infraglottic) and resides in the trachea (windpipe). Since their first approval for use in the United States by the US Food and Drug Administration in the early 1990s, the application of SGAs has become more widespread. Initially, they were only used in anesthetized patients who were breathing on their own (i.e., spontaneously ventilating). This was, in large part, due to a relatively low airway seal pressure, the pressure with which the device seals against the throat, thereby, keeping the air pushed in by a breathing machine (ventilator) from getting into the stomach or leaking out around the device and out through the mouth - in either case, not going into the patient's lungs. The relatively low airway seal pressure (18 - 20 cmH2O) did not allow for the use of muscle relaxant (paralyzing) drugs and positive pressure ventilation. Successive generations of SGAs by a variety of manufacturers have overcome and continue to attempt to overcome limitations of earlier devices. In addition, accumulated clinical experience has made anesthesia providers more comfortable with their use. No SGA, however, is yet ideal, and incremental changes continue to appear to improve airway management and reduce airway morbidity (e.g., sore throat, jaw pain, etc.).
The air-Q® Intubating Laryngeal Airway (aILA, Mercury Medical, Clearwater, FL) is a newer, commercially-available, SGA designed for use as a primary airway and as an intubation conduit. It is available in polyvinyl chloride (PVC)-based, single use and silicone-based, reusable models. Information on its safety and effectiveness from a randomized, controlled trial in adults, undergoing general anesthesia, compared to that of the silicone-based, reusable aILA versus the LMA-Proseal™ (pLMA, North America, San Diego, CA), the current "gold standard" for SGA airway seal pressure, is available.
The air-Q® Self-Pressurizing (SP) Intubating Laryngeal Airway (aILA-SP, Mercury Medical, Clearwater, FL) is a commercially-available, modification of the silicone-based, reusable aILA. Its overall design is identical to the aILA, but incorporates a communication orifice between the air tube and cuff, which regulates airflow into and from the cuff during periods of positive pressure and spontaneous ventilation. As such, it incorporates a self-pressurizing cuff that does not require manual inflation. Such a cuff may be advantageous insofar as it dynamically adjusts its intra-cuff pressure and fit with the patient's pharyngeal and periglottic anatomy, which may lead to a reduction in airway morbidity, while still providing the high seal pressure afforded by the aILA design.
Lastly, the i-gel (Intersurgical Inc., Liverpool, NY) is a commercially-available SGA that uses a thermoplastic elastomer to create a non-inflating, anatomically-conforming, periglottic cuff. Studies have shown it to be an easily inserted, effective airway device with a lower incidence of sore throat and neck complaints. With exception to the aILA-SP, it is the only other commercially-available SGA that does not require cuff inflation.
To date, no reports are available on the clinical performance of the aILA-SP in relation to other SGAs. Thus, the primary purpose of this study is to compare the airway seal pressure (ASP) of the aILA-SP against the aILA and i-gel in adults undergoing general anesthesia. Airway seal pressure is the most common surrogate for ventilatory capacity used in SGA studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01592760
|United States, Wisconsin|
|University of Wisconsin Hospital and Clinics|
|Madison, Wisconsin, United States, 53792|
|Principal Investigator:||Richard E Galgon, MD, MS||Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health|