i-gel® from Intersurgical: clinical evidence listing

Janakiraman C, Chethan DB, Wilkes AR, Stacey MR, Goodwin, N. Anaesthesia 2009; 64(6): 674-678

This study compared the performance of i-gel® and cLMA airways in 50 healthy adult patients. The success rate on the first insertion attempt was significantly lower in the i-gel® group. Overall success after two attempts did not show a significant difference, although a change of device size was allowed. Leak pressures and fibreoptic view of the vocal cords were significantly better with the i-gel®, with the two devices producing leak pressures of 20 (i-gel®) and 17cm H2O (cLMA). 14 patients needed a change in i-gel® size.

Link to abstract.

Chapman D. Anaesthesia 2009; 64(2): 228

This letter is a reply to Baxter (2008). Baxter described two incidents where air was ‘entrained through the suction port’ leading to decreased end-tidal sevoflurane and lightened anaesthesia. This response suggests that the devices in question may not have been inserted fully, meaning that the airway and gastric channels were not isolated from each other. To ensure full insertion takes place, users should make sure that the level of anaesthesia, patient position and insertion method are correct.

Abstract text

Baxter, S. Anaesthesia 2008; 63(11): 1265

This correspondence article reports a problem that occurred in two patients ventilated with an i-gel® during anaesthesia. In the first case, anaesthesia started to lighten and end-tidal sevoflurane fell. The user suspected air entrainment through the suction port. In the second case, anaesthesia remained stable but end-tidal sevoflurane still dropped. The user placed a finger over the suction port and sevoflurane levels returned to normal. In both cases, the i-gel® was replaced with a laryngeal mask airway.

Link to abstract.

Gatward JJ, Cook TM, Seller C, Handel J, Simpson T, Vanek V, Kelly F. Anaesthesia 2008; 63(10):1124-1130

A study of i-gel® in 100 elective, anaesthetised patients. Parameters assessed included ease of use, positioning, airway quality, seal pressure and complications. First time insertion success was 86%. Median airway leak pressure was 24cm H2O. On fibreoptic examination via the device, the vocal cords were visible in 91% of patients. The incidence of airway obstruction, airway irritation, oropharyngeal trauma and other complications was low. Insertion of the device into the correct position was rapid and easy. The authors concluded that, ‘these attributes would suggest potential roles in anaesthesia, management of the difficult airway and airway management during CPR’. Further studies are now indicated against i-gel®’s likely clinical competitors.

Link to abstract.

Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. Anaesthesia 2008; 63(9): 991-995

This study evaluated the performance of i-gel® in manikins and anaesthetised patients when used by novices. The i-gel® was deployed with minimal evidence of patient trauma and 100% insertion success. In their summary, the authors concluded that, ‘i-gel® is rapidly inserted in both manikins and patients by novice users and compares favourably to other supraglottic airways available. Further work determining safety and efficacy during cardio-pulmonary resuscitation is required.’

Link to abstract.