i-gel® from Intersurgical: clinical evidence listing

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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De Lloyd L, Hodzovic I, Voisey S, Wilkes AR, Latto IP. Anaesthesia 2010; 65(1): 36-43

This randomised crossover study compared the cLMA® to the i-gel® during endotracheal intubation of a manikin. 32 anaesthetists took part in the study. For each device, two intubations took place with the tracheal tube directly over the fibrescope and two used an Aintree Intubation Catheter. Intubation took significantly less time with the i-gel® using both methods. Five oesophageal intubations occurred with the cLMA. Anaesthetists stated a preference for the i-gel® due to the ease of use. The authors conclude that the i-gel® is a more appropriate choice for intubation than the cLMA.

Link to abstract.