European Journal of Molecular & Clinical Medicine

Title: A comparison of I-gel with Baska mask airway for controlled ventilation in patients undergoing General Anaesthesia for surgeries less than three hours duration- A randomized prospective study
 
Background: Supraglottic airway devices (SADs) offer an alternative airway to traditional tracheal intubation or a face mask. The recently introduced Baska mask is a third generation SAD. The ideal SAD must have a high airway sealing pressure during spontaneous and positive pressure ventilation and low resistance to the flow of gases.
Aim: To compare I-gel with Baska mask in terms of insertion characteristics, efficacy haemodynamic response and safety in patients receiving controlled mechanical ventilation during elective surgical procedures.
Materials and Methods: The present randomized, double-blinded study was conducted on 60 patients of either sex and age of 18 years and above belonging to American Society of Anesthesiology (ASA) grade I and II with normal body mass index (BMI) randomly allocated to receive Baska mask (Group A -30) or I-gel (Group B-30) for airway management. Demographic data recorded. Various parameters measured were airway sealing pressure, insertion time, ease of insertion, number of insertion attempts, overall success rate and the incidence of airway trauma and complications were also recorded. Patient vitals including heart rate, systolic/diastolic blood pressures and peripheral capillary oxygen saturation were measured along with ventilatory parameters including inspiratory and expiratory tidal volume, end-tidal carbon dioxide, leak volume and airway pressures at various intervals. Paired and unpaired t-test were used to analyse numerical data and chi-square test for non-parametric data.
Results: Both groups were comparable in terms of demographic and clinical characteristics. Overall success rate was comparable in both groups. The insertion time was comparable for both groups (p value≥0.05). Oropharyngeal leak pressure was significantly higher for Baska mask (28.6±1.03 cm H₂O) than I-gel (25.1±1.34 cm H₂O; p value < 0.005). Ryle’s tube insertion was easy via I-gel than Baska mask. Hemodynamic parameters and post operative complications were comparable in both groups.
Conclusion: Both airways are suitable for elective surgeries under general anaesthesia. The sealing pressures of the Baska mask are superior to those of the I-gel and can serve as an exemplary, alternative airway device for the surgeries under controlled ventilation with minimum complications.

Extraglottic airway devices (EGD) like the laryngeal mask airway (LMA) and the Baska mask are commonly used for minor surgical procedures under general anaesthesia. These devices are intended to be used as an alternative to traditional endotracheal intubation, which can be difficult and time-consuming, as well as risky, such as airway trauma, bleeding, and infection. EGDs have the advantage of being relatively easy to insert and requiring less training than traditional intubation techniques. As a result, they may be useful for less experienced anaesthetists or in emergency situations. The LMA is a well-known EGD that has been in use for more than 20 years. It consists of a mask-like device that sits over the larynx and is sealed by an inflatable cuff

Background:Supraglottic-airway devices (SAD) are divided into first-generation and second-generation devices. Baska Mask and i-gel device are the two commonly used second-generation SADs in anaesthetic practice. This study compares the i-gel and Baska Mask in terms of efficacy and safety as a ventilatory device in anaesthetized patients undergoing elective surgeries.
Materials and Methods: The study was carried out in Department of Anaesthesiology, Government Medical College and Dr.Sushila Tiwari Hospital, Haldwani. Patients were allocated into 2 groups: Group A (i-gel, n=35) and Group B (Baska Mask, n=35). All patients were pre-oxygenated for 3-minutes and anaesthesia was induced. Successful insertion of the device was confirmed by chest wall movement, auscultation of breath sounds and square wave capnographic tracing. At the end of the surgical procedure, anaesthesia was discontinued and patients were reversed with the standard dose of neostigmine and glycopyrrolate after proper suctioning. Complications, if any were noted after 2 hours and 24 hours period.
Results: The mean age of the study population was 35.83±9.50 years. Among i-gel group, there were 24 (68.6%) males and 11 (31.4%) females. Among Baska Mask group, there were 20 (57.1%) males and 15 (42.9%) females. The percentage of patients with easy insertion was 80% and 68.6% for i-gel and Baska Mask respectively. The mean time taken for SAD was significantly more among Baska Mask (24.49±4.39) in comparison to i-gel (16.19±2.38). Sore throat at 2 hours was seen in 3 (8.6%) and 2 (5.7%) patients of i-gel and Baska Mask group respectively. Dysphagia at 2 hours was seen in 2 (5.7%) and 1 (2.9%) patient of i-gel and Baska Mask group respectively, while dysphagia at 24 hours was seen in 1(2.9%) patient of i-gel group only, also hoarseness at 2 hours was seen in 1(2.9%) patient of i-gel group. Incidence of all the complications reported with i-gel and Baska Mask group were comparable.
Conclusion: This study demonstrated that both Baska Mask and i-gel provided a similar performance in airway management. In terms of the total time taken for insertion, i-gel has a lesser time of insertion than the Baska mask. The success rate of insertion of Baska Mask and i-gel was comparable and ease of insertion was also comparable. Complications observed in both devices were minimal.

Supraglottic Airway devices (SAD) have now become a fundamental tool for ventilation, oxygenation and delivery of anaesthetic gases in modern anaesthesiology. The advent of newer generation of SADs has resulted in their extended use. Baska mask and I Gel being newer generation SADs are vastly being used due to their specific designs for ease of securing the airway, better ventilation and higher patient safety. After institutional ethical committee clearance, a prospective randomized comparative study was conducted. 60 patients of age group 18-60 years of ASA grade I and II undergoing elective surgeries under GA were included. Patients were randomized into 2 groups, Group B (Baska mask group) and Group I (I Gel group) with 30 patients in each group. The ease of insertion (p value 0.035), insertion attempts (p value 0.04) and the time taken for insertion (p value <0.001) were significantly better with I Gel compared to Baska mask. Both the groups were comparable in terms of postoperative pharyngolaryngeal morbidities.

Laryngeal mask airways are supraglottic airway devices designed to provide and maintain a
seal around the laryngeal inlet and are effective alternatives to endotracheal tubes. The
relatively newer second generation supraglottic airway devices, LMA-ProSeal, I-Gel & Baska
mask have been safely used in children during spontaneous or controlled ventilation without
complications. A total number of 90 paediatric patients of ASA grade I and II, weighing 10-
25 kg, of either sex, posted for elective surgeries under general anaesthesia and satisfying the
inclusion criteria were enrolled in the study after obtaining informed, written, valid consent
from their parents/guardian. According to our observations, mean insertion time taken for
group B was 15.8 seconds with a standard deviation of 0.9, 10.6 seconds with a standard
deviation of 1.1 for group I and 13.5 seconds with a standard deviation of 0.9 for group P. On
analysis by ANOVA test, p value obtained is 0.001 (significant, <0.05) which implies that
insertion time taken for group B is significantly greater than that of group P and group I.

The novel features of the Baska mask are its integrated bite-block, which prevents airway
block due to patients biting the device and an extended hand-tab attached to the cuff which
helps the operator to manipulate its degree of flexion while inserting the device. Last but not
the least, the device can be inserted in neutral head position. The Baska mask is available in
four sizes, paediatric and adult, in single use and reusable types. Pre-anaesthetic evaluation of
all patients were done on the previous day of surgery by an anaesthesiologist. All patients
under the above-said inclusion criteria, were randomly allocated into following groups after
taking informed, written and valid consent from their parents/guardian:Group B(n=30):
patients receiving Baska mask Group I (n=30): patients receiving I-Gel,Group P (n=30):
patients receiving LMA-ProSeal.Post-operative blood-staining of device on removal was seen
in only one patient (3.3%) in group P and cough in one patient in group B (3.3%) which were
insignificant with a p value of 0.36. Other complications (desaturation, laryngospasm,
aspiration, mucosal/lip trauma, dysphagia, hoarseness) were not observed in any patient.