I-gel Airway Research Articles

Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube

We hypothesised that the effects of insertion of an i-gel supraglottic airway management device on intraocular pressure (IOP) and haemodynamic variables would be milder than those associated with insertion of a laryngeal mask airway (LMA) or an endotracheal tube. This study evaluated IOP and haemodynamic responses following insertion of an i-gel airway, LMA or endotracheal tube. This was a randomised controlled study in a tertiary care centre in which 60 adults scheduled for elective non-ophthalmic procedures under general anaesthesia were allocated to one of three groups. Patients with pre-existing glaucoma, cardiovascular, pulmonary or metabolic diseases or anticipated difficult intubation were excluded. Following induction of general anaesthesia, an endotracheal tube, LMA or i-gel device was inserted. IOP, SBP, DBP, heart rate (HR) and perfusion index were measured before induction of anaesthesia and before and after insertion of the airway device. Insertion of the i-gel did not increase IOP. Insertion of an endotracheal tube increased IOP from 11.6 ± 1.6 to 16.5 ± 1.7 mmHg (P < 0.001). The post-insertion IOP exceeded the pre-induction value (P < 0.05). Insertion of the LMA increased IOP from 13.0 ± 1.5 to 14.7 ± 1.8 mmHg (P < 0.01), but this did not exceed the pre-induction value. Tracheal intubation significantly increased HR, SBP and DBP. Insertion of the LMA significantly increased HR and SBP. These increases were significantly higher than those which followed insertion of the i-gel device. Insertion of the endotracheal tube or LMA resulted in a significant decrease in perfusion index which was maintained for 5 min following tracheal intubation and for 2 min after insertion of the LMA. Insertion of the i-gel device did not change perfusion index significantly. Insertion of the i-gel device provides better stability of IOP and the haemodynamic system compared with insertion of an endotracheal tube or LMA in patients undergoing elective non-ophthalmic surgery.

Failure of Double-Lumen Tube Positioning in a Patient With Lingual Tonsil Hypertrophy

A 59-year-old man (weight, 93 kg; height, 172 cm) was scheduled for left video-assisted thoracoscopy. The preoperative airway assessment revealed a Mallampati grade 2, an interdental distance of 5 cm, a wide mouth and limited cervical spine movement. After preoxygenation, general anesthesia was induced with intravenous fentanyl (2 g/kg), propofol (2 mg/ kg), and succinylcholine (0.8 mg/kg). The direct laryngoscopy with a Macintosh 3 blade revealed a Cormack/Lehane (C/L) grade 4 view; no glottic structures were visible at all. A second attempt was performed using the GlideScope videolaryngoscope, and the best view of the larynx achieved was C/L grade 3; direct vision of the tongue revealed a lingual tonsil hypertrophy. Ventilation and oxygenation with a bag and mask continued to be effective, and anesthesia was continued with a mixture of sevoflurane 2% and oxygen 100%. The previous sniffing position was changed, the patient was placed in simple head extension, and a further attempt with the GlideScope was tried (C/L grade 3). A blind technique of tracheal intubation failed, and the right tonsil began bleeding, probably because of direct contact with the blade and the endotracheal tube. A size 5 supraglottic airway i-gel device (Intersurgical Ltd, Berkshire, UK) was inserted without further drugs, and spontaneous ventilation was achieved. Afterwards, fiberoptic endotracheal intubation through the supraglottic device was attempted unsuccessfully. The anesthesia was stopped, and consciousness returned. The fiberoptic view showed an anterior and small glottis perpendicular to the axis of the trachea with a small space between the glottis and arytenoids. The airway was secured by awake nasal fiberoptic intubation under topical anesthesia, and surgery took place as scheduled without any problem for the patient; one-lung ventilation was achieved using a Cohen endobronchial blocker, and tonsillar bleeding stopped before the end of surgery. The supraglottic airway i-gel device permitted us to achieve spontaneous ventilation by maintaining airway patency and preventing collapse of laryngeal structures; this device was also

Efficacy of laryngeal mask airway i-gel in patients undergoing laparoscopic gynecological surgery

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery. Key words: Laryngeal mask; Respiration,artificial; Laparoscopy

Modified i-gel Airway for Oral Surgery

The i-gel (Intersurgical Ltd, Wokingham, UK) is a relatively new, single-use supraglottic airway device for use during general anesthesia. The main components of this device are a noninflatable gel-like cuff that is claimed to achieve a perfect fit to the pharyngeal and laryngeal structure and a thick airway tube with a gastric drain tube orifice.1 We often use the i-gel during dental procedures and minor oral surgery. However, its thick airway tube occasionally interferes with surgical access. We describe a modified i-gel airway for use during oral surgeries. Our idea was to use a reinforced tracheal tube, also called a coiled-wire reinforced tracheal tube, along with the i-gel airway to avoid interference with the surgical field. A size number 4 i-gel airway was cut to an airway tube length of 5.5 cm (Figure 1A). A reinforced tracheal tube (inner diameter 7.5 mm, outer diameter 10.2 mm, Rusch, Kernen, Germany) was then passed into the i-gel's airway tube. The distal end of the reinforced tracheal tube just fits into the i-gel so that the tip does not protrude through its ventilation hole (Figure 1B). To fix the i-gel even more tightly, the cuff of the reinforced tracheal tube was inflated with approximately 2.5 mL of air. Figure 1. A. Cut i-gel airway and reinforced tracheal tube. B. Cut i-gel airway with reinforced tracheal tube in it. To fix the i-gel tightly, the cuff of the reinforced tracheal tube was inflated with air. Insertion of the i-gel into the airway can be readily achieved by gripping its thick airway tube part and using the index and middle fingers to position it into the hypopharynx in the usual manner. However, removal should only be performed by gripping the thick airway tube part of the i-gel using Magill forceps under direct laryngoscopy so that the reinforced tracheal tube does not separate from the i-gel and leave it lodged in the oropharyngeal cavity. Using this modified i-gel airway, we successfully administered general anesthesia to more than 15 outpatients presenting for dental treatment and minor oral surgery. We believe that this modified i-gel airway is a useful device for these surgeries, provided that it is only removed by pulling on the i-gel base and not on the reinforced tracheal tube.

Efficacy of fiberopfic bronchoscope-guidcd tracheal intubation with laryngeal mask airway iogel in patients undergoing cervical spine surgery

Objective To evaluate the efficacy of fiberoptic bronchoscope （FOB）-guided tracheal intubation with laryngeal mask airway i-gel （LMA i-gel） in patients undergoing cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients, aged 36-62 yr, weighing 57-78 kg, scheduled for cervical spine surgery under general anesthesia, were randomly divided into 2 groups （n = 20 each）： FOB-guided tracheal intubation with oropharynx ventilation tube group （group O） and FOB-guided tracheal intubation with LMA i-gel （group I）. Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 2-3 μg/kg and rocuronium 0.9 mg/kg. The intubation time, fiberoptic bronchoscope score, the number of successful intubation, hypertension, tachycardia and hypoxemia were recorded. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness, etc. Results The rate of successful LMA i-gel placement at first attempt was 100%, placement time was （10 ＋ 3） s, and the rate of successful intubation in the two groups was 100%. The intubation time was significantly shorter, the rate of successful intubation at first attempt and fiberoptic bronchoscope score were significantly higher in group I than in group O （P 〈 0.05）. Hypertension, tachycardia and hypoxemia were not found in the two groups. There was no significant difference in the incidence of adverse effects between the two groups （P 〉0.05）. Conclusion FOB-guided tracheal intubation with LMA i-gel can provide adequate ventilation during operation, improve the success rate of FOB-guided intubation and shorten the intubation time in patients undergoing cervical spine surgery. Key words: Laryngeal masks; Intubatiun,intratracheal; Bronchoscopy

Phenomenon with I‐Gel airway: a reply

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.

Oesophageal seal of the novel supralaryngeal airway device I-Gel™ in comparison with the laryngeal mask airways Classic™ and ProSeal™ using a cadaver model

BackgroundSupraglottic airway devices are increasingly used in anaesthesia and emergency medicine. This study was designed to investigate the oesophageal seal of the novel supralaryngeal airway device, I-Gel™ (I-Gel), in comparison with two of the laryngeal mask airways, Classic™ (cLMA) and ProSeal™ (pLMA), in a model of elevated oesophageal pressure. MethodsThe three supralaryngeal airway devices were inserted into eight unfixed cadaver models with exposed oesophagi that had been connected to a water column producing both a slow and a fast oesophageal pressure increase. The pressure applied until the loss of oesophageal seal during a slow and fast pressure increase was measured. ResultsDuring the slow increase of pressure, the pLMA withstood an oesophageal pressure up to a median of 58 cm H2O, while the cLMA was able to block the oesophagus up to a median of 37 cm H2O, and I-Gel already lost its seal at 13 cm H2O. One minute after maximum pressure had been applied, the pLMA withstood an oesophageal pressure of 59 cm H2O, the cLMA of 46 cm H2O, and I-Gel airway of 21 cm H2O. A fast release of oesophageal fluid was accomplished through the oesophageal lumen of both the pLMA and I-Gel. ConclusionsBoth the pLMA and cLMA provided a better seal of the oesophagus than the novel I-Gel airway. The pLMA and I-Gel drain off gastrointestinal fluid fast through the oesophageal lumen. Thus, tracheal aspiration may be prevented with their use. Further study is necessary.

A cohort evaluation of the i-gel airway in 100 elective patients

A cohort evaluation of the i-gel airway in 100 elective patients

Phenomenon with I‐gel airway?

Phenomenon with I‐gel airway?

Aspiration recognition with an i‐gel airway

Aspiration recognition with an i‐gel airway

Evaluation of the i-gel airway in 300 patients

Evaluation of the i-gel airway in 300 patients O. Bamgbade;W. Macnab;W. Khalaf; European Journal of Anaesthesiology

Fiberoptic Intubation Through an I-Gel Supraglottic Airway in Two Patients with Predicted Difficult Airway and Intellectual Disability

We describe successful fiberoptic-guided tracheal intubation through the novel supraglottic "I-gel" airway in two uncooperative adult patients with genetic syndromes, learning disability, and predicted difficult airway, scheduled for complex dental treatment under general anesthesia. The I-gel maintained the airway immediately after induction, allowing oxygenation and ventilation. Location of the laryngeal inlet was successful on the first attempt with a fiberscope, and the tracheal tube was inserted into the trachea over the endoscope without complication in both patients. This report suggests another option for management of predicted difficult airways.

Case series: protection from aspiration and failure of protection from aspiration with the i-gel airway

We present three patients of regurgitation while using the i-gel supraglottic airway in 280 patients. In two patients, the i-gel completely protected the airway from aspiration. In one patient, it did not provide complete protection. The i-gel has features designed to separate the airway and gastro-intestinal tracts and as such should offer some protection against aspiration. However, the efficacy of these features has not been confirmed, and further study is required to determine the safety profile of the device.

Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff

Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff

Initial anatomic investigations of the I‐gel airway: a novel supraglottic airway without inflatable cuff*

The I-gel airway is a novel supraglottic airway that uses an anatomically designed mask made of a gel-like thermoplastic elastomer. We studied the positioning and mechanics of this new device in 65 non-embalmed cadavers with 73 endoscopies (eight had repeat insertion), 16 neck dissections, and six neck radiographs. A full view of the glottis (percentage of glottic opening score 100%) occurred in 44/73 insertions, whereas only 3/73 insertions had epiglottis-only views. Including the eight repeat insertions with a different size, a glottic opening score of > 50% was obtained in all 65 cadavers. The mean percentage of glottic opening score for the 73 insertions was 82% (95% confidence interval 75-89%). In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. We found that the I-gel effectively conformed to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.