i-gel® from Intersurgical: clinical evidence listing

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.

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.

Michalek P, Donaldson WJ, Hinds JD. Anaesthesia 2009; 64(6): 692-693

This article includes three cases of patient injury caused by the i-gel®. In the first case, a paramedic had difficulty inserting the device. It was removed immediately and it was found that the patient was bleeding from the frenulum. The second patient’s tongue was caught in the bowl of the i-gel® during insertion. Although the i-gel® was repositioned successfully, there was minor swelling and bleeding upon removal. This patient reported soreness for three days. The final case involved an insertion which appeared successful, however the patient reported a sore tongue and loss of taste lasting three weeks. The authors recommend two alternative insertion techniques to avoid mouth injuries – sliding the i-gel® over the thumb into the mouth or rotating the device so the tongue cannot get caught.

Link to abstract.

Park SK, Choi GJ, Choi YS, Ahn EJ, Kang H

During the meta-analysis, 12 studies were evaluated to find no significant differences in first attempt success rate, leak pressure and quality of fibreoptic view between the devices. i-gel had a shorter insertion time and lower blood staining incidence, sore throat reports and dysphagia.

Link to abstract

Beylacq L, Bordes M, Semjen F, Cros AM. Acta Anaesthesiol Scand 2009; 53(3): 376-379

This study evaluated the i-gel® in 50 children above 30kg undergoing short-duration surgery. The parameters measured included: ease of insertion, seal pressure, ease of inserting a gastric tube and post operative complications. The first time insertion success rate was 100%. No laryngeal leak occurred. The mean seal pressure was 24.9cm H20. The authors concluded that i-gel® was very easy to insert and that ‘no learning curve is needed before a high success insertion rate is obtained. The i-gel® appears to be safe for paediatric management’.

Link to abstract.