Comparison of First Attempt Success Rates between LMA Protector™ and i-gel™ in Elective Surgical Procedures: A Randomised Controlled Study

Introduction: Supraglottic Airway Devices (SADs) are vital alternatives to endotracheal intubation in anesthesia and critical care. Second generation SADs like the i-gel™ and Laryngeal Mask Airway (LMA) Protector™ offer improved airway management- i-gel™ uses a soft thermoplastic for quick insertion without cuff inflation, while LMA Protector™ features silicone construction with dual gastric drainage channels to reduce aspiration risk. Comparing their leak pressures, first attempt success rate, and postoperative complications is essential to determine their safety and effectiveness. Aim: To compare the effectiveness of the LMA Protector™ and i-gel™ regarding first attempt success rate, insertion time, airway sealing, and postoperative complications in patients undergoing elective surgery. Materials and Methods: The present double-blinded, randomised controlled trial was conducted at SRM Medical College Hospital and Research Centre, a tertiary care facility in Chennai, India. involving 110 elective surgery patients aged 18-60 years with American Society of Anaesthesiologist (ASA) physical status 1 or 2. Participants were randomised into two groups using LMA Protector™ or i-gel™ devices. Patients with Mallampati class I or II were included, excluding those with Body Mass Index (BMI) >30 kg/m2 or histories of Gastroesophageal Reflux Disease (GERD) or Chronic Obstructive Pulmonary Disease (COPD). The primary outcome was first attempt insertion success, with secondary outcomes including insertion time, oropharyngeal leak pressure, and postoperative complications. Data were analysed using Statistical Package for Social Sciences (SPSS) 21.0, intergroup analysis was done using Student’s t-test or Mann-Whitney U test and Chi-square test. Results: The two groups demonstrated similar baseline characteristics, with no statistically significant differences in age, sex distribution, height, weight, or BMI. Group B (i-gel™) had a significantly higher first attempt success rate (100 vs. 71%, p<0.0001) and shorter insertion time (16.35±3.47 vs. 51.69±8.47 sec, p<0.0001) than group A (LMA Protector™). However, LMA Protector™ showed a higher mean oropharyngeal leak pressure (32.11±3.37 vs. 26.53±1.93 cmH2 O, p<0.0001). Postoperative sore throat was more frequent in group A (65.5 vs. 50.9%) but without statistical significance (p=0.122). Conclusion: The i-gel™ showed enhanced efficacy compared to the LMA Protector™ in several key areas. It achieved higher first attempt success rates, insertion time, and minimal postoperative complications. The findings of this study reinforce the clinical preference for utilising the i-gel™ in patients undergoing elective surgeries.