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

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.

Amer GF, Abdeldayem OT, Lahloub FMF. Anesth Essays Res 2019 Apr-Jun; 13(2): 209-213

This investigation assessed the use of the i-gel as an alternative to local anaesthesia (LA) in insulin dependents diabetic patients undergoing cataract surgery. 60 diabetic patients were randomly assigned to receive either LA or general anaesthesia (n = 30) in combination with the i-gel (n = 30). Several parameters were monitored including mean arterial blood pressure (MBP), heart rate (HR), as well as blood glucose levels and plasma cortisol levels. Results have shown no significant difference in either blood glucose or cortisol levels in both groups. However, blood glucose level increased in both groups after induction of anaesthesia. In addition, HR and MBP increased in the LA group but not in the i-gel group. In conclusion, these results show that both LA and general anaesthesia using the i-gel are safe and do not produce a marked impact in hemodynamics, blood glucose, or cortisol levels in diabetic patients.

Link to abstract.

Choudhary N, Kumar A, Kohli A, Wadhawan S, Bhadoria P. Indian J Anaesth. 2019 Mar;63(3):218-224

This investigation aimed to compare the successful intubation rate of the i-gel using three types of endotracheal tubes (ETTs). 75 ASA I and II patients (age 18-60 years) undergoing elective surgery under general anaesthesia were randomly assigned into three groups based on the type of endotracheal ETT, which included polyvinyl chloride ETT (Group P), intubating laryngeal mask airway ETT (Group I) and flexometallic ETT (Group F). Recorded parameters included time taken for successful intubation, success rate, number of attemps, manoeuvres, and complications. Results demonstrated that Group P had the lowest time and mean time for intubation, as well as the highest first attempt and overall intubation success rate. Therefore, the combination of polyvinyl chloride ETT with i-gel to intubate patients with difficult airways represents the most successful approach compared to other combinations. However, additional studies are needed to validate these results.

Link to abstract.