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Comparison of Insertion of the Modified i-gel Airway for Oral Surgery With the LMA Flexible: A Manikin Study
Takuro SanukiDDS, PhD,
Shingo SugiokaDDS, PhD,
Nobuyasu KomasawaMD,
Ryusuke UekiMD, PhD,
Yoshiroh KaminohMD, PhD, and
Junichiro KotaniDDS, PhD
Article Category: Other
Volume/Issue: Volume 61: Issue 4
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.4.145
Page Range: 145 – 149

The first laryngeal mask (LMA) was the LMA Classic, developed by Dr Brain. It was later followed by a number of groundbreaking new products, such as the LMA ProSeal, which features a high-pressure seal and a gastric tube orifice, and the LMA Fastrack that can be used to pass an endotracheal tube into the trachea. Today, these and other products comprise the LMA family. One of them, the LMA Flexible (Laryngeal Mask Company, Jersey, UK; Figure 1 : top) was developed for oral and maxillofacial surgery and other types of head and neck surgery

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Airway Complications in Intubated Versus Laryngeal Mask Airway–Managed Dentistry: A Meta-Analysis
Jordan PrinceDDS, MSc,
Cameron GoertzenDDS, MSc,
Maryam ZanjirDDS,
Michelle WongDDS, MSc, EdD, and
Amir AzarpazhoohDDS, MSc, PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 4
Online Publication Date: Dec 15, 2021
DOI: 10.2344/anpr-68-04-02
Page Range: 193 – 205

providers may utilize less-invasive nonintubation techniques to avoid many of these potential complications. One method of nonintubated airway management is the use of a laryngeal mask airway (LMA) device that is placed above the vocal cords in the hypopharynx. 10 , 11 Unlike most medical surgeries, dental procedures typically impinge upon the airway. In North America, approximately 60% of dentist anesthesiologists do not routinely intubate, 12 which clearly identifies variance in practice. Airway management is a topic of interest because the loss of airway

Figure 1.; LMA Flexible (top) and modified i-gel airway (bottom).
Takuro Sanuki,
Shingo Sugioka,
Nobuyasu Komasawa,
Ryusuke Ueki,
Yoshiroh Kaminoh, and
Junichiro Kotani
Figure 1.
Figure 1.

LMA Flexible (top) and modified i-gel airway (bottom).

Figure 1.; Preferred Reporting Items for Systematic Reviews and Meta-Analyses Flow Diagram Flow diagram of study inclusion and exclusions. LMA indicates laryngeal mask airway; ASA, American Society of Anesthesiologists; and RCT, randomized controlled trial.
Cameron Goertzen,
Erin Goertzen,
Maryam Zanjir,
Christopher Dare,
Amir Azarpazhooh, and
Michelle Wong
Figure 1.
Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Flow Diagram

Flow diagram of study inclusion and exclusions. LMA indicates laryngeal mask airway; ASA, American Society of Anesthesiologists; and RCT, randomized controlled trial.

Figure 4.  ; Final positioning of supraglottic airway. (A) Laryngeal mask airway (LMA) slightly moved down to show direct seal over glottis, permitting pressures of 20–40 cm H2O without pressurizing the stomach. Note that the practitioner must always verify that the device is past the base of the tongue to have adequate depth for creating a seal over the glottis. (B) Bronchoscope visualization of LMA centered over and sealing patient's glottis.
M. B Rosenberg,
J. C Phero, and
D. E Becker
<bold>Figure 4. </bold>
Figure 4. 

Final positioning of supraglottic airway. (A) Laryngeal mask airway (LMA) slightly moved down to show direct seal over glottis, permitting pressures of 20–40 cm H2O without pressurizing the stomach. Note that the practitioner must always verify that the device is past the base of the tongue to have adequate depth for creating a seal over the glottis. (B) Bronchoscope visualization of LMA centered over and sealing patient's glottis.

Anesthetic Management Using a Laryngeal Mask Airway for a Patient With Ankylosing Spondylitis: A Case Report
Masaharu YamadaDDS,
Masataka TamuraDDS, PhD,
Yoko NunotaniDDS,
Nobumasa MinamiDDS, and
Kikuo FujiDDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 69: Issue 3
Online Publication Date: Oct 06, 2022
DOI: 10.2344/anpr-69-02-03
Page Range: 36 – 37

patient was seated in a dental chair and asked to place his head in the most comfortable position possible to reduce excessive strain on his cervical spine during the procedure. After securing peripheral intravenous (IV) access, general anesthesia was induced using IV midazolam 5 mg and propofol 160 mg. A laryngeal mask airway (LMA; LMA Flexible #4) was then inserted with minimal backward tilt of his head. Anesthesia was maintained with a propofol infusion 7 mg/kg/h (116 mcg/kg/min) and 33/67% nitrous oxide/oxygen under spontaneous ventilation. Ampicillin 1 g and

Figure 5.  ; Comparison of classic LMA (left side) versus i-gel (right side). Four beneficial features of i-gel not found in the classic LMA: (a) does not require air inflation to seal over the glottis; (b) tip does not flex forward or backward preventing seal over the glottis; (c) vents gastric pressure if prior bag mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if patient bites down during return to consciousness while still needing airway management and ventilation assistance.
M. B Rosenberg,
J. C Phero, and
D. E Becker
<bold>Figure 5. </bold>
Figure 5. 

Comparison of classic LMA (left side) versus i-gel (right side). Four beneficial features of i-gel not found in the classic LMA: (a) does not require air inflation to seal over the glottis; (b) tip does not flex forward or backward preventing seal over the glottis; (c) vents gastric pressure if prior bag mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if patient bites down during return to consciousness while still needing airway management and ventilation assistance.

Figure 2.; Time to successful intubation with the LMA Flexible and modified i-gel airway. The x-axis represents the number of intubation attempts, and the y-axis represents the intubation time (seconds). Data represent mean (SD). * P < .05 versus the first attempt.
Takuro Sanuki,
Shingo Sugioka,
Nobuyasu Komasawa,
Ryusuke Ueki,
Yoshiroh Kaminoh, and
Junichiro Kotani
Figure 2.
Figure 2.

Time to successful intubation with the LMA Flexible and modified i-gel airway. The x-axis represents the number of intubation attempts, and the y-axis represents the intubation time (seconds). Data represent mean (SD). * P < .05 versus the first attempt.

Modified Retrograde Nasal Intubation: A New Airway Technique and Devices
Vernon H. VivianMBChB,
Dip Anaes(SA),
Tyson L. PardonMD, and
Andre A. J. Van ZundertMD, PhD, EDRA
Article Category: Research Article
Volume/Issue: Volume 68: Issue 2
Online Publication Date: Jun 29, 2021
DOI: 10.2344/anpr-68-02-03
Page Range: 107 – 113

cause several complications including epistaxis, which has a reported incidence as high as 86%. 2 Piepho et al 3 elaborated on this in a case report involving an adult male patient undergoing NTI who developed severe epistaxis after the tube had passed through the nasopharynx. Laryngoscopy revealed a Cormack-Lehane grade 4 airway, and as a result of this combination, NTI failed. Attempts with a laryngeal mask airway (LMA)–Fastrach (Teleflex, Westmeath, Ireland) and Bonfils Optical Stylet (Karl Storz, Tuttlingen, Germany) for orotracheal intubation also failed, and

Figure 2.; Network Geometries of the Adverse Outcomes The network geometry of the primary, (A) apnea incidence and (B) apnea time, and secondary, (C) airway adverse events, (D) insertion failure, and (E) inadequate depth of anesthesia, outcomes during LMA placement. Gray connecting lines between circles indicate the direct comparison of interventions and the circle width is proportional to the number of studies evaluating the comparison. The circle volume is proportional to the number of patients who received the intervention. PPF indicates propofol; MDZ, midazolam; AA, agonist-antagonist; IV, intravenous; NMBA, neuromuscular blocking agent; and THIO, thiopentone.
Cameron Goertzen,
Erin Goertzen,
Maryam Zanjir,
Christopher Dare,
Amir Azarpazhooh, and
Michelle Wong
Figure 2.
Figure 2.

Network Geometries of the Adverse Outcomes

The network geometry of the primary, (A) apnea incidence and (B) apnea time, and secondary, (C) airway adverse events, (D) insertion failure, and (E) inadequate depth of anesthesia, outcomes during LMA placement. Gray connecting lines between circles indicate the direct comparison of interventions and the circle width is proportional to the number of studies evaluating the comparison. The circle volume is proportional to the number of patients who received the intervention. PPF indicates propofol; MDZ, midazolam; AA, agonist-antagonist; IV, intravenous; NMBA, neuromuscular blocking agent; and THIO, thiopentone.