Phenomenon with I‐Gel airway: a reply

Abstract

We would like to thank Dr Baxter for her letter [1], describing two incidents with the i-gel airway. In the first, anaesthesia appeared to lighten and the end-tidal sevoflurane concentration fell. In the second case, end-tidal sevoflurane fell quite rapidly but there was no clinical lightening of anaesthesia. In the first case, Dr Baxter speculated that air might have been ‘entrained through the suction port’ and in the second confirmed that placing a finger over the suction port led to a rapid increase in end-tidal sevoflurane towards inspired levels. Both cases are consistent with sub-optimal insertion, where the device has not been fully inserted to a definitive resistance with the tip of the airway located into the upper oesophageal opening and the non-inflatable cuff located against the laryngeal framework. In such circumstances, the airway and gastric channels will not be isolated from each other, protection against aspiration will be compromised and an excessive air leak up the gastric channel may become evident. The i-gel should be removed and reinserted. In general, sub-optimal insertion can be avoided by ensuring an appropriate level of anaesthesia, adequate lubrication, that the patient is in the ‘sniffing the morning air’ position and the device inserted backwards and downwards along the hard palate until a definitive resistance is felt. If there is early resistance during insertion, then a jaw thrust, deep rotation or triple manoeuvre is recommended. We would also highlight the importance of ensuring complete familiarity with our Instructions For Use [2] and i-gel User Guide [3] prior to use.