APPARATUS The Laryngeal Mask Airway SupremeTM – a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the Laryngeal Mask Airway ProSealTM in paralysed, anaesthetised patients

The LMA SupremeTM is a new extraglottic airway device which brings together features of the LMA ProSealTM, FastrachTM and UniqueTM. We test the hypothesis that ease of insertion, oro-pharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSealTM and the LMA SupremeTM in paralysed anesthetised patients. Ninety-three females aged 19–71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSealTM, 92 % and 100%; LMA SupremeTM 95 % and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4–8 ml higher for the LMA ProSealTM over the inflation range (p < 0.001). Intracuff pressure was 16–35 cm higher for the LMA ProSealTM when the cuff volume was 20–40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30–40 ml. There were no differences in the fibreoptic position o