PAEDIATRIC ANAESTHESIA AND CRITICAL CARE / ORIGINAL ARTICLE
Comparison of LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia: a randomized trial
1
Department of Anesthesia, Bnai Zion Medical Center, Haifa, Israel
2
Faculty of Medicine, D’Annunzio University of Chieti–Pescara, Italy
3
Department of Anesthesiology and Perioperative Medicine, University Hospital Complex of A Coruña, A Coruña, Galicia, Spain
Submission date: 2025-06-03
Final revision date: 2025-07-29
Acceptance date: 2025-08-03
Publication date: 2025-09-25
Corresponding author
Manuel Ángel Gómez-Ríos
Department of Anaesthesiology and Perioperative Medicine, University Hospital Complex of A Coruña, A Coruña, Galicia, Spain
Department of Anaesthesiology and Perioperative Medicine, University Hospital Complex of A Coruña, A Coruña, Galicia, Spain
Anaesthesiol Intensive Ther 2025;57(1):248-256
KEYWORDS
supraglottic airway devicespediatric anesthesiaairway managementlaryngeal tube suction disposablei-gelrandomized controlled trial
TOPICS
ABSTRACT
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.
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.
REFERENCES (35)
1.
Kumar A, Sinha C, Kumar N, Kumar B, Kumar R. Comparison of the oropharyngeal leak pressure between three second generation supraglottic airway devices during laparoscopic surgery in pediatric patients. Paediatr Anaesth 2022; 32: 843-850. DOI: 10.1111/pan.14447.
2.
Somri M, Gaitini L, Matter I, Hawash N, Falcucci O, Fornari GG, et al. A comparison between the supreme laryngeal mask airway and the laryngeal tube suction during spontaneous ventilation: A randomized prospective study. J Anaesthesiol Clin Pharmacol 2018; 34: 182-187. DOI: 10.4103/joacp.JOACP_24_17.
3.
Barbieri E, Giordano M, Sorgente G, Borgia G, Improta M, Colonna M, et al. Use and efficacy of i-gel in complicated intubations in newborn infants: a review of case reports in the literature. Curr Pediatr Rev 2024; 21: 51-55. DOI: 10.2174/0115733963295361240426064436.
4.
Schalk R, Scheller B, Peter N, Rosskopf W, Byhahn C, Zacharowski K, Meininger D. Laryngeal tube II: alternative airway for children? Anaesthesist 2011; 60: 525-533. DOI: 10.1007/s00101-010-1845-0 [Article in German].
5.
Maitra S, Baidya DK, Bhattacharjee S, Khanna P. Evaluation of i-gel(™) airway in children: a meta-analysis. Paediatr Anaesth 2014; 24: 1072-1079. DOI: 10.1111/pan.12483.
6.
Zimmermann L, Maiellare F, Veyckemans F, Fuchs A, Scquizzato T, Riva T, Disma N. Airway management in pediatrics: improving safety. J Anesth 2025; 39: 123-133. DOI: 10.1007/s00540-024-03428-z.
7.
Cook TM, Kelly FE. Time to abandon the ‘vintage’ laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth 2015; 115: 497-499. DOI: 10.1093/bja/aev156.
8.
Brooks Peterson M, Szolnoki J. Modes of ventilation for pediatric patients under anesthesia: a pro/con conversation. Paediatr Anaesth 2022; 32: 295-301. DOI: 10.1111/pan.14368.
9.
Shih MC, Elvis PR, Nguyen SA, Brennan E, Clemmens CS. Parental presence at induction of anesthesia to reduce anxiety: a systematic research and meta-analysis. J Perianesth Nurs 2023; 38: 12-20. DOI: 10.1016/j.jopan.2022.03.008.
10.
Brimacombe J, Berry A. A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position. Anesth Analg 1993; 76: 457.
11.
Likert R. A technique for the measurement of attitudes. Arch Psychol 1932; 22: 5-55.
12.
Jain RA, Parikh DA, Malde AD, Balasubramanium B. Current practice patterns of supraglottic airway device usage in paediatric patients amongst anaesthesiologists: a nationwide survey. Indian J Anaesth 2018; 62: 269-279. DOI: 10.4103/ija.IJA_65_18.
13.
Lai CJ, Liu CM, Wu CY, Tsai FF, Tseng PH, Fan SZ. I-gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position. BMC Anesthesiol 2017; 17: 3. DOI: 10.1186/s12871-016-0291-1.
14.
Park SK, Ko G, Choi GJ, Ahn EJ, Kang H. Comparison between supraglottic airway devices and endotracheal tubes in patients undergoing laparoscopic surgery: a systematic review and meta-analysis. Medicine (Baltimore) 2016; 95: e4598. DOI: 10.1097/MD.0000000000004598.
15.
Nair A, Borkar N, Murke SS, Dudhedia U. Safety and efficacy of the use of supraglottic airway devices in children and adolescents undergoing adenotonsillectomy-a systematic review and meta-analysis. J Pers Med 2024; 14. DOI: 10.3390/jpm14030311.
16.
Bandyopadhyay A, Puri S, Ashok V. Supraglottic airway device versus tracheal tube for pediatric laparoscopic surgery – a systematic review and meta-analysis. Paediatr Anaesth 2023; 33: 905-912. DOI: 10.1111/pan.14725.
17.
Kanakaraj M, Bhat AD, Singh NP, Balasubramanian S, Tyagi A, Aathreya R, Singh PM. Choice of supraglottic airway devices: a network meta-analysis of randomised controlled trials. Br J Anaesth 2024; 133: 1284-1306. DOI: 10.1016/j.bja.2024.09.001.
18.
Halwagi AE, Massicotte N, Lallo A, Gauthier A, Boudreault D, Ruel M, Girard F, et al. Tracheal intubation through the i-gel supraglottic airway versus the lma fastrach: a randomized controlled trial. Anesth Analg 2012; 114: 152-156. DOI: 10.1213/ANE.0b013e318236f438.
19.
Theiler LG, Kleine-Brueggeney M, Luepold B, Stucki F, Seiler S, Urwyler N, Greif R. Performance of the pediatric-sized i-gel compared with the ambu auraonce laryngeal mask in anesthetized and ventilated children. Anesthesiology 2011; 115: 102-110. DOI: 10.1097/ALN.0b013e318219d619.
20.
Shiveshi P, Anandaswamy TC. Comparison of proseal lma with i-gel in children under controlled ventilation: a prospective randomised clinical study. Braz J Anesthesiol 2022; 72: 247-252. DOI: 10.1016/j.bjane.2021.02.042.
21.
Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, et al. Airway management in neonates and infants: European society of anaesthesiology and intensive care and british journal of anaesthesia joint guidelines. Eur J Anaesthesiol 2024; 41: 3-23. DOI: 10.1097/EJA.0000000000001928.
22.
Schalk R, Engel S, Meininger D, Zacharowski K, Holzer L, Scheller B, et al. Disposable laryngeal tube suction: standard insertion technique versus two modified insertion techniques for patients with a simulated difficult airway. Resuscitation 2011; 82: 199-202. DOI: 10.1016/j.resuscitation.2010.09.474.
23.
Gaitini LA, Vaida SJ, Somri M, Yanovski B, Ben-David B, Hagberg CA. A randomized controlled trial comparing the proseal laryngeal mask airway with the laryngeal tube suction in mechanically ventilated patients. Anesthesiology 2004; 101: 316-320. DOI: 10.1097/00000542-200408000-00011.
24.
Somri M, Vaida S, Garcia Fornari G, Mendoza GR, Charco-Mora P, Hawash N, et al. A randomized prospective controlled trial comparing the laryngeal tube suction disposable and the supreme laryngeal mask airway: the influence of head and neck position on oropharyngeal seal pressure. BMC Anesthesiol 2016; 16: 87. DOI: 10.1186/s12871-016-0237-7.
25.
Gaitini L, Yanovski B, Somri M, Vaida S, Riad T, Alfery D. A comparison between the pla cobra and the laryngeal mask airway unique during spontaneous ventilation: a randomized prospective study. Anesth Analg 2006; 102: 631-636. DOI: 10.1213/01.ane.0000189098.57662.d6.
26.
Brimacombe J, Berry A, Brain AI. Optimal intracuff pressures with the laryngeal mask. Br J Anaesth 1996; 77: 295-296. DOI: 10.1093/bja/77.2.295-a.
27.
Mihai R, Knottenbelt G, Cook TM. Evaluation of the revised laryngeal tube suction: the laryngeal tube suction II in 100 patients. Br J Anaesth 2007; 99: 734-739. DOI: 10.1093/bja/aem260.
28.
Theiler L, Gutzmann M, Kleine-Brueggeney M, Urwyler N, Kaempfen B, Greif R. I-gel™ supraglottic airway in clinical practice: a prospective observational multicentre study. Br J Anaesth 2012; 109: 990-995. DOI: 10.1093/bja/aes309.
29.
Somri M, Gaitini LA, Safadi A, Hossein J, Ebraheem N, Gat M, Gómez-Ríos MÁ. A prospective evaluation of the new laryngeal tube suction-disposable in paralyzed, anesthetized pediatric patients under pressure-controlled ventilation. Minerva Anestesiol 2020; 86: 997-998. DOI: 10.23736/S0375-9393.20.14594-2.
30.
Das B, Varshney R, Mitra S. A randomised controlled trial comparing proseal laryngeal mask airway, i-gel and laryngeal tube suction-D under general anaesthesia for elective surgical patients requiring controlled ventilation. Indian J Anaesth 2017; 61: 972-977. DOI: 10.4103/ija.IJA_339_17.
31.
Russo SG, Cremer S, Galli T, Eich C, Bräuer A, Crozier TA, et al. Randomized comparison of the i-gel™, the lma supreme™, and the laryngeal tube suction-d using clinical and fibreoptic assessments in elective patients. BMC Anesthesiol 2012; 12: 18. DOI: 10.1186/1471-2253-12-18.
32.
Lønvik MP, Elden OE, Lunde MJ, Nordseth T, Bakkelund KE, Ule-berg O. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 2021; 21: 51. DOI: 10.1186/s12873-021-00444-0.
33.
Bedolla C, Zilevicius D, Copeland G, Guerra M, Salazar S, April MD, et al. Military standard testing of commercially available supraglottic airway devices for use in a military combat setting. J Spec Oper Med 2023; 23: 19-32. DOI: 10.55460/B4KU-GB0V.
34.
Price P, Laurie A, Plant E, Chandra K, Pishe T, Brunt K. Comparing the first-pass success rate of the king lts-d and the i-gel airway devices in out-of-hospital cardiac arrest. Cureus 2022; 14: e30987. DOI: 10.7759/cureus.30987.
35.
Sun G, Wojcik S, Noce J, Cochran-Caggiano N, DeSantis T, Friedman S, et al. Are pediatric manual resuscitators only fit for pediatric use? A comparison of ventilation volumes in a moving ambulance. Prehosp Emerg Care 2023; 27: 501-505. DOI: 10.1080/10903127.2022.2066235.
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