i-gel® from Intersurgical: clinical evidence listing

Ye Q, Wu D, Fang W, Wong GTC, Lu Y.  BMC Anesthesiol. 2020;20(1):136. Published 2020 Jun 3.

This randomised observational study set out to evaluate and compare the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynaecological surgery when managed with different supraglottic airway devices (SAD). One hundred ASA I and II female patients were assessed for the study enrolment and subsequently randomly allocated into three groups of different ventilation devices, which included LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). Several parameters were measured including antral cross-sectional area (primary outcome), haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting (secondary outcomes). Findings have demonstrated that the antral CSA was not significantly different among three groups before induction after induction and at the end of surgery. On the other hand, the haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion and after removal. Interestingly, sore throat was detected in none in the I-gel group compare to two patients in the LMA-Supreme group and fifteen patients in the tracheal tube group. Moreover, hoarseness was detected in one in the I-gel group, whereas two patients in the LMA-Supreme group and eleven patients in the tracheal tube group suffered from this postoperative adverse event.

Conclusions: The SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynaecological surgery.

Link to abstract

Featuring all known evidence on the use of i-gel in a resuscitation and pre-hospital setting, the booklet includes even more adult, paediatric and manikin studies, case reports and a section on cardiocerebral resuscitation and passive oxygenation.

During the current COVID-19 pandemic, i-gel remains an important option for managing the airway in the emergency and pre-hospital setting, so the opportunity to review the published evidence for the device at this time is particularly valuable.

You can now download the PDF from the i-gel website and through the Education page.

Clinical evidence on the i-gel is also available to view on our evidence database, which includes all studies mentioned in both this bibliography and the standard version.

We hope you find the bibliography and clinical database useful in reviewing evidence published on the i-gel device.

Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Anaesthesia 2020 Jun; 75(6): 785-799

Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.

Link to abstract

Luthra A, Chauhan R, Jain A, Bhukal I, Mahajan S, Bala I. Anesth Essays Res. 2019 Oct-Dec;13(4):669-675

This prospective randomized observational study was carried out to evaluate the efficacy of the i-gel as compared to the ProSeal laryngeal mask airway (PLMA) in non-paralysed anaesthetised patients. 40 ASA I-II patients, between 18 and 65 years of age, undergoing elective surgery were randomly allocated to either the i-gel or the PLMA. Observed parameters included insertion time, ease of insertion, number of attempts, failed insertion, airway reaction during insertion, oropharyngeal leak pressure (OLP), and gastric insufflation. Additionally, fibreoptic view of the channels of the devices and ease of insertion of Ryle's tube through the gastric drain channel and complications were also assessed. Results showed that both devices had a similar performance in terms of first attempt, overall insertion success rates and insertion times. On the other hand, the Ryle's tube passage was easier through the i-gel. Full view of the vocal cords was achieved in 17 patients intubated using the i-gel and 9 using the PLMA. In addition, the incidence and severity of postoperative sore throat and hoarseness was higher in the PLMA group. Thus, the i-gel provides superior approach in this type of patient as it is able to achieve a better positioning over the laryngeal framework and oesophagus while allowing an easier passage of the Ryle's tube through its drain channel as compared to the PLMA.

Link to abstract.

Choi HY, Kim W, Jang YS, Kang GH, Kim JG, Kim H. Emerg Med Int. 2019 Oct 31;2019:8913093

This prospective randomized crossover manikin study investigated the intubation performance of I-gel blind intubation (IGI) in comparison to I-gel bronchoscopic intubation (IBRI) and intubation using Macintosh Laryngoscope (MCL). 23 emergency physicians carried out intubations with two different types of ET tubes while performing chest compressions. Assessed outcomes included intubation time (primary) cumulative success rate for each intubation time was significantly shorter as compared to the IBRI and MCL using both ET tubes. On the other hand, the performance of polyvinyl chloride and wire reinforced silicon tubes were comparable for each intubation technique. Moreover, the IGI approach reached 100% intubation success rate in a significantly shorter amount of time as compared to the other techniques. Therefore, the IGI technique is a safe and effective approach when carrying out intubations in emergency scenarios that can be used by experienced intubators when administering chest compressions.

Link to abstract.