i-gel® from Intersurgical: clinical evidence listing

Donaldson W, Michalek P. Minerva Anestesiol 2010; 76(5): 369-372

This report details the case of a 47-year-old woman with subglottic stenosis. During preoperative screening she stated that there had been difficulty inserting an endotracheal tube during an earlier procedure. During anaesthesia, a size four i-gel® was inserted on the first attempt. A fibrescope was passed down the i-gel® and into the trachea, where subglottic stenosis could be seen. The i-gel® showed no signs of leaking and did not cause any trauma. The authors note that this is the first case report where an i-gel® has been used in a patient with subglottic stenosis, and state that preoperative tests should be carried out before choosing to use the device in this situation.

Link to abstract.

Taxak S, Gopinath A. Minerva Anestesiol 2010; 76(5): 381

This case study describes the use of the i-gel® while the patient was in a prone position for surgery. A 45kg 16-year-old boy laid in a prone position with his head turned laterally. After induction of anaesthesia, a size three i-gel® was inserted on the first attempt. There were no adverse events either during or after surgery and the i-gel® was removed while the patient was still prone. Previous research has shown that the cLMA and ProSealTM airways can be inserted in the prone position, and i-gel®s have successfully ventilated prone patients who were turned over after insertion. However, this is the first reported case of i-gel® insertion while the patient is already prone. Routine use of this technique should only occur after further research has taken place.

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Ali A, Sheikh NA, Ali L, Siddique SA. Professional Med J 2010; 17(4): 643-647

100 patients received ventilation via the i-gel® or cLMA during elective surgery. The devices were compared for ease of insertion, insertion time, number of airway manipulations needed and post-operative complications. The devices were generally comparable. More airway manipulations were required with the i-gel®, however this was not a statistically significant increase compared to the cLMA. The incidence of complications was very low, with one case of blood on an i-gel® and one incident of laryngospasm with each device.

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Taxak S, Gopinath A. Anaesthesiology 2010; 112(2): 500-501

This correspondence article responds to Theiler et al’s comments on the design of the i-gel® and subsequent effects of tongue size. The authors state that they have noticed a similar issue where the patient’s tongue is carried towards the back of the mouth by the i-gel®, which then cannot be inserted fully. The i-gel® had to be removed and re-inserted. The authors recommend stabilising the tongue before attempting to insert the device. A reply from the authors of the original report says that a tongue retractor should be used for this rather than fingers. This response also points out that although the tongue may also get caught between the teeth and the i-gel® bite block, this could happen with any supraglottic airway.

Link to abstract.

Chapman D. Anaesthesia 2010; 65(1): 89

This letter is a response to the 2009 study by Janakiraman (see page 7) et al. which compared the i-gel® to the LMA Classic®. In that study, the authors stated that the devices were lubricated along the tip and the posterior surface. However, the correct lubrication procedure for the i-gel® is different; the thermoplastic material used to make the device is tacky until lubricated and requires lubrication on all four sides of the cuff.

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