i-gel® from Intersurgical: clinical evidence listing

Wiese CHR, Bahr J, Popov AF, Hinz JM, Graf BM. Resuscitation 2009; 80(1): 100-103

This paper compared i-gel® to another supraglottic airway in a manikin cardiac arrest scenario. The study evaluated the effect use of these devices had on No-Flow Time (NFT). The authors stated that ‘an ideal supraglottic airway should be inserted rapidly with minimal training and it should enable controlled ventilation’. i-gel® met those criteria during resuscitation in a manikin and NFT was kept as low as possible, consistent with ERC guidelines.

Link to abstract.

Schmidbauer W, Bercker S, Volk T, Bogusch G, Mager G, Kerner T. Br J Anaesth 2009; 102(1): 135-139

The three supraglottic devices were inserted into eight unfixed cadaver models with exposed oesophagi, connected to a water column producing both a slow and fast oesophageal pressure increase. During a fast increase of oesophageal pressure (simulated vomiting procedure) with the oesophageal lumen of the i-gel® and pLMA open, the authors reported that ‘the entire oesophageal liquid was drained to the outside without any tracheal aspiration occurring.’

Link to abstract.

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.

Joshi NA, Baird M, Cook TM. Anaesthesia 2008; 63(9): 1010-1026

A middle-aged female patient was scheduled for an elective operation on her hand. She had undergone several general anaesthetics in the past when a cLMA had been used without documented problems. She had a Mallampati score of three and a thyromental distance of 6cm. Face mask ventilation with an oropharyngeal airway was extremely difficult. A pLMA was inserted, but ventilation was not possible. A size four cLMA was also tried with the same result. A size four i-gel® was then inserted. This immediately provided unobstructed ventilation and stable oxygenation saturation of 98%. The authors commented that ‘the i-gel®’s role in difficult airway management remains to be established, but its ease of insertion, short wide airway tube and good airway leak pressures make it a potentially useful airway device in cases of difficult mask ventilation.’

Link to abstract.