i-gel® from Intersurgical: clinical evidence listing

Campbell J, Michalek P, Deighan M. Resuscitation 2009; 80(8): 963

This case report details the case of a 54-year-old man with acute respiratory failure, who had a grade four view at laryngoscopy. He was difficult to bag-mask ventilate and a laryngeal mask was inserted as an airway rescue technique. As ventilation was not possible with this device, it was removed and a size four i-gel® inserted. This allowed good ventilation. A fibrescope was passed down the airway channel and a 7.0mm endotracheal tube passed over the fibrescope and through the i-gel®. The i-gel® was then removed, leaving the airway secure.

Link to abstract.

Thomas M, Benger J. Resuscitation 2009; 80(12): 1437

This correspondence article describes 12 attempts to ventilate patients in cardiac arrest using the i-gel®. The device could usually be inserted on the first attempt; however, on seven out of 12 occasions ventilation was then found to be inadequate. The i-gel®s were correctly positioned, but there were large leaks. The authors state that the reason for this is unclear, but that the device may be harder to position correctly when patients are not in the most appropriate position for insertion. An alternative explanation is that higher pressure is needed to ventilate the lungs after cardiac arrest, in which case other supraglottic airways should have the same problem.

Link to abstract.

Shin W, Cheong Y, Yang H, Nishiyama T. European Journal Of Anaesthesiology 2009; 26: 000-000

167 patients were randomly assigned to device groups. Haemodynamic data, airway leak pressure, leak volume, success rates and postoperative complications were assessed.

Link to abstract.

Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler MD, Luyet C, Vogt A, Greig R, Unibe MME. Anesthesiology 2009; 111(1): 55-62

This study looked at a simulated difficult airway scenario by using a neck collar to limit both mouth opening and neck movement. Both devices were placed in random order in each of 60 patients. The primary outcome was overall success rate. Other measurements included time to successful ventilation, seal pressure, fibreoptic view and adverse events.The authors concluded the two devices tested had a ‘similar insertion success and clinical performance in the simulated difficult airway situation’. The i-gel® enabled better fibreoptic laryngeal view and less epiglottic downfolding.

Link to abstract.

Cook TM, Gatward JJ. Anaesthesia 2009; 64(11): 1262-1263

This letter is a response to Kushakovsky and Ahmad (2009 - see above) regarding the performance of the LMA Supreme®, LMA ProSealTM and i-gel® devices. The letter states that the i-gel® and ProSeal® have both been shown to vent gastric contents when they have good placement and oesophageal seal, but that this has not been studied in the LMA Supreme®. Only small studies comparing the LMA Supreme®, ProSeal and i-gel® are available, although these generally show comparable performance. The authors recommend further research with larger study populations.

Link to abstract.