Ye Q, Wu D, Fang W, Wong GTC, Lu Y. BMC Anesthesiol. 2020;20(1):136. Published 2020 Jun 3.
This randomised observational study set out to evaluate and compare the antral cross-sectional area (CSA) in patients undergoing laparoscopic gynaecological surgery when managed with different supraglottic airway devices (SAD). One hundred ASA I and II female patients were assessed for the study enrolment and subsequently randomly allocated into three groups of different ventilation devices, which included LMA-Supreme (Group S), I-gel (Group I) or tracheal tube (Group T). Several parameters were measured including antral cross-sectional area (primary outcome), haemodynamic parameters and postoperative morbidity such as sore throat, hoarseness, dry throat, nausea and vomiting (secondary outcomes). Findings have demonstrated that the antral CSA was not significantly different among three groups before induction after induction and at the end of surgery. On the other hand, the haemodynamic variables were significantly higher in the tracheal tube group than in the LMA-Supreme and I-gel groups after insertion and after removal. Interestingly, sore throat was detected in none in the I-gel group compare to two patients in the LMA-Supreme group and fifteen patients in the tracheal tube group. Moreover, hoarseness was detected in one in the I-gel group, whereas two patients in the LMA-Supreme group and eleven patients in the tracheal tube group suffered from this postoperative adverse event.
Conclusions: The SADs do not cause obvious gastric insufflation. Thus, LMA-Supreme and I-gel can be widely used as alternative to endotracheal intubation for the short laparoscopic gynaecological surgery.
Link to abstract
Luthra A, Chauhan R, Jain A, Bhukal I, Mahajan S, Bala I. Anesth Essays Res. 2019 Oct-Dec;13(4):669-675
This prospective randomized observational study was carried out to evaluate the efficacy of the i-gel as compared to the ProSeal laryngeal mask airway (PLMA) in non-paralysed anaesthetised patients. 40 ASA I-II patients, between 18 and 65 years of age, undergoing elective surgery were randomly allocated to either the i-gel or the PLMA. Observed parameters included insertion time, ease of insertion, number of attempts, failed insertion, airway reaction during insertion, oropharyngeal leak pressure (OLP), and gastric insufflation. Additionally, fibreoptic view of the channels of the devices and ease of insertion of Ryle's tube through the gastric drain channel and complications were also assessed. Results showed that both devices had a similar performance in terms of first attempt, overall insertion success rates and insertion times. On the other hand, the Ryle's tube passage was easier through the i-gel. Full view of the vocal cords was achieved in 17 patients intubated using the i-gel and 9 using the PLMA. In addition, the incidence and severity of postoperative sore throat and hoarseness was higher in the PLMA group. Thus, the i-gel provides superior approach in this type of patient as it is able to achieve a better positioning over the laryngeal framework and oesophagus while allowing an easier passage of the Ryle's tube through its drain channel as compared to the PLMA.
Link to abstract.
Choi HY, Kim W, Jang YS, Kang GH, Kim JG, Kim H. Emerg Med Int. 2019 Oct 31;2019:8913093
This prospective randomized crossover manikin study investigated the intubation performance of I-gel blind intubation (IGI) in comparison to I-gel bronchoscopic intubation (IBRI) and intubation using Macintosh Laryngoscope (MCL). 23 emergency physicians carried out intubations with two different types of ET tubes while performing chest compressions. Assessed outcomes included intubation time (primary) cumulative success rate for each intubation time was significantly shorter as compared to the IBRI and MCL using both ET tubes. On the other hand, the performance of polyvinyl chloride and wire reinforced silicon tubes were comparable for each intubation technique. Moreover, the IGI approach reached 100% intubation success rate in a significantly shorter amount of time as compared to the other techniques. Therefore, the IGI technique is a safe and effective approach when carrying out intubations in emergency scenarios that can be used by experienced intubators when administering chest compressions.
Link to abstract.
Sood S, Saxena A, Thakur A, Chahar S. Saudi J Anaesth. 2019 Oct-Dec; 13(4): 290–294.
This prospective randomised study aimed to compare the performance of two supraglottic airway devices (SADs) the i-gel and LMA Fastrach when performing fiberoptic-guided intubation in adult paralysed patients. 60 patients were randomly assigned to either i-gel or LMA Fastrach. Several parameters were assessed, which included ease and time taken for fiberoptic-guided intubation (primary outcome), time taken for successful SAD placement, ease of insertion, ease and time of removal, as well as haemodynamic parameters and postoperative complication (secondary outcomes). Findings demonstrated that the Fastrach had a faster tracheal intubation and higher airway sealing pressure. On the other hand, the ETT was easier to insert when using the i-gel as compared to the Fastrach. Haemodynamic parameters were comparable between both devices. In addition, post removal complications were observed in either devices. Therefore, both devices are comparable in terms of performance and efficacy facilitating fiberoptic-guided intubation in adult paralysed patients.
Link to abstract.
Kohli M, Wadhawan S, Bhadoria P, Ratan SK. J Anaesthesiol Clin Pharmacol. 2019 Jan-Mar;35(1):30-35
This study aimed to determine the efficacy of the i-gel as compared to the ETT in terms of adequacy of ventilation in 80 children (2-8 years of age) undergoing paediatric laparoscopic surgeries. Several parameters were evaluated including peak airway pressure, end-tidal CO2, minute ventilation, SpO2, as well as desufflation of the peritoneal cavity. These variables were recorded after securing the airway, after carboperitoneum (CP) and after desufflation of the peritoneal cavity. Results showed a significant increase in the partial pressure of mean expired CO2 (PeCo2), peak airway pressure, as well as minute ventilation in both groups after creation of CP. On the other hand, no difference was observed in heart rate or mean arterial pressure. Moreover, the i-gel showed a smaller increase in peak airway pressure and fewer post-operative complications. Thus, both devices were comparable in terms of adequacy of ventilation, but the i-gel was able to provide a safe alternative to the ETT.
Link to abstract.