Comparison of LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia: a randomized trial

Introduction Second-generation supraglottic airway devices, such as the laryngeal tube suction disposable (LTS-D) and i-gel, are widely used in pediatric anesthesia due to advantages such as improved sealing and gastric drainage. This randomized controlled trial compared the efficacy and safety of the LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia. Material and methods Eighty ASA I children aged 2–8 years (12–25 kg), scheduled for short elective surgical procedures, were randomized to the LTS-D (n = 40) or i-gel (n = 40) group. Primary outcomes were oxygen saturation (SpO₂) and end-tidal CO₂ (EtCO₂). Secondary outcomes included insertion time, oropharyngeal leak pressure, fiberoptic view, tidal volumes (Vt), and adverse events. Results Both devices maintained comparable oxygenation. Mean EtCO₂ was slightly higher in the i-gel group, with a mean difference of 2.56 mmHg (95% CI: 1.86–3.26; P < 0.001). The i-gel had significantly faster insertion times (24.53 ± 2.00 s vs. 31.20 ± 1.95 s; P < 0.001) and superior fiberoptic visualization (optimal grades in 99% vs. 70%; P < 0.001). The LTS-D showed higher oropharyngeal leak pressures (37.63 ± 3.71 cmH₂O vs. 24.43 ± 1.72 cmH₂O; P < 0.001). Vt and adverse event rates were similar, with no severe complications reported (P = 0.65). Conclusions Both the LTS-D and i-gel are safe and effective for airway management in non-paralyzed children undergoing short procedures. The i-gel enables faster insertion and better anatomical positioning, while the LTS-D offers higher leak pressures, making it preferable when a better seal is needed. Device choice should be guided by clinical context and patient characteristics.