i-gel® from Intersurgical: clinical evidence listing

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.

Bamgbade OA, Macnab WR, Khalaf WM. Eur J Anaesthesiol 2008; 25(10): 865-6
This letter reported that first time insertion with i-gel® was achieved in <5 seconds in 290/300 patients. Three patients with difficult airway underwent successful fibreoptic endotracheal intubation through i-gel® and all patients underwent adequate pressure mode ventilation with airway pressures of 10-30cm H2O initially and spontaneous breathing subsequently. In addition, lubricated gastric tubes were easily inserted through the gastric channel at the first attempt in all 80 cases where this was performed. The authors concluded that ‘i-gel® is very suitable for peri-operative airway management, positive pressure ventilation and weaning from ventilation. It is also useful as an intubation aid and has a potential role in airway management during resuscitation. It is very easy to use, highly reliable and associated with minimal morbidity. The gastric channel separates the oesophagus from the larynx and provides protection from aspiration. Further studies are required to compare i-gel® with other supraglottic devices.’

Abstract text

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.

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.