Clinical performance of airway management with the i-gel and laryngeal mask airway supreme in geriatric patients: a prospective and randomized study.

Background: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in elderly patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel™ and LMA Supreme™ (LMA-S) in geriatric patients.

Methods: The subjects were American Society of Anesthesiologists I - III geriatric (> 65 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel™ group and the LMA-S group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events.

Results: Insertion time was significantly shorter for the i-gel™ than the LMA-S (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel™ was also easier to insert than the LMA-S (P = 0.014). After inserting each SAD, gastric insufflation was less frequent with the i-gel™ than the LMA-S (0 vs. 31.3%, P = 0.013). Other measurements were comparable between the two groups.

Conclusions: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel™ was faster and easier compared to the LMA-S in paralyzed elderly patients.