Abstract
PurposeThis prospective, randomized trial was designed to assess whether the i-gel supraglottic airway device is suitable for volume-controlled ventilation while applying positive end-expiratory pressure (PEEP) of 5 cmH2O under general anesthesia. It was believed that this device might improve arterial oxygenation.MethodsForty adult patients (aged 20–60 years) scheduled for elective orthopedic surgery were enrolled in this study. Twenty patients were ventilated without external PEEP [zero positive end-expiratory pressure (ZEEP) group], and the other 20 were ventilated with PEEP 5 cmH2O (PEEP group) after placing an i-gel device. Volume-controlled ventilation at a tidal volume (TV) of 8 ml/kg of ideal body weight, leak volume, and arterial blood gas analysis were investigated.ResultsThe incidences of a significant leak were similar in the ZEEP and PEEP groups (3/20 and 1/20, respectively; P = 0.605), as were leak volumes. No significant PaO2 difference was observed between the two groups at 1 h after satisfactory i-gel insertion (215 ± 38 vs. 222 ± 54; P = 0.502).ConclusionsThe use of an i-gel during PEEP application at 5 cmH2O did not increase the incidence of a significant air leak, and a PEEP of 5 cmH2O failed to improve arterial oxygenation during controlled ventilation in healthy adult patients.
Highlights
The i-gel (Intersurgical, Wokingham, Berkshire, UK) was introduced into clinical practice in 2007
The use of an i-gel during positive end-expiratory pressure (PEEP) application at 5 cmH2O did not increase the incidence of a significant air leak, and a PEEP of 5 cmH2O failed to improve arterial oxygenation during controlled ventilation in healthy adult patients
There were no differences in the amount of atelectasis in the patients undergoing general anesthesia without lung injury between a tidal volume of 10 and 6 ml/kg [5], in patients with acute lung injury, changes in tidal volume from 10 to 6 ml/kg increase the alveolar collapse, which can reversed by positive end-expiratory pressure (PEEP) application [6]
Summary
The i-gel (Intersurgical, Wokingham, Berkshire, UK) was introduced into clinical practice in 2007. It is made of a thermoplastic elastomer, a soft gel-like substance [1]. This disposable device is designed to fit the perilaryngeal and hypopharyngeal structures without the use of an inflatable cuff, in contrast to other supraglottic airway devices [2], and has the advantages of easier insertion, minimal tissue compression, and fewer positional changes after cuff inflation. Applying PEEP in addition to controlled ventilation has been suggested to increase functional residual capacity and
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