Abstract
Background: General anesthesia with endotracheal tube and rapid sequence induction remain the gold standard for caesarean section. The I-gel is supraglottic airway devices it provides a better seal for positive pressure ventilation, separation of the respiratory from the alimentary tract and the venting of gas or liquid via its unique drain port. The aim of our study was to evaluate the efficacy of I-gel as rescue device in rapid establishment of airway and protect against pulmonary aspiration during elective CS under general anesthesia. Patients and Methods: This study was conducted on 1000 parturients with at least eight hours of fasting scheduled for elective Cesarean delivery. We recorded the number of insertion attempts of the i-gel, the time to effective ventilation, incidence of aspiration, the presence of blood on the I gel, postoperative sore throat, and patients and obstetricians satisfaction. Result: 1000 parturients, were included, mean body mass index was 28.5±3.4 (kg/m²). All i-gel insertions were successful on first attempt in (99%) of the cases and a time to effective airway of 11.3±2.4 sec. There was no evidence of regurge or aspiration. 25 parturients (2.5%) had visible blood on the i-gel upon removal, 20 (2%) had sore throat, one patients (0.1%) had tingling in the tongue and patients and obstetricians satisfaction was 98%. Conclusion: The i-gel is useful supraglottic device and can replace the need of tracheal intubation in elective cesarean section with no reported serious complications and low incidences of pharyngolaryngeal morbidity when compared to tracheal intubation.
Highlights
Patients and MethodsIt has been established that inability to successfully manage very difficult airway was been responsible for as many as 30% of death totally attributable to anesthesia [1].The routine use of endotracheal tube is to secure the airway and prevent the aspiration of gastric content in case of regurge or vomiting but there is a case series demonstrated that the routine use of the endotracheal tube did not reduce maternal death due to aspiration [2].Supraglottic airway devices have become a standard in airway management
All patients received preoxygenation for 3 min, anesthesia was induced by propofol 2 mg/kg, rocuronium 0.6 mg/kg, assisted positive pressure ventilation was done, the size 4 i-gel for 50-90 kg or size 5 for more than 90 kg was inserted after lubricating the device with a water-based lubricant according to manufacturer's recommendations [5]
In our study in a large numbers of parturients, and somewhat over weight, we found that, the i-gel supraglottic airway provided an acceptable means of ventilation and oxygenation during elective Cesarean delivery
Summary
It has been established that inability to successfully manage very difficult airway was been responsible for as many as 30% of death totally attributable to anesthesia [1]. The aim of our study was to evaluate the efficacy of i-gel as rescue device in rapid establishment of airway and protect against pulmonary aspiration during elective CS under general anesthesia. All patients received preoxygenation for 3 min, anesthesia was induced by propofol 2 mg/kg, rocuronium 0.6 mg/kg, assisted positive pressure ventilation was done, the size 4 i-gel for 50-90 kg or size 5 for more than 90 kg was inserted after lubricating the device with a water-based lubricant according to manufacturer's recommendations [5]. The absence of square wave ETCO2 trace denoted failure of establishment of effective ventilation, the device was completely removed for another insertion attempt. The primary outcome was defined as the number of patients developed respiratory adverse events as oxygen desaturation, Partial or Complete upper airway obstruction, Laryngospasm and /or Clinically apparent pulmonary aspiration
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
