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.

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.

Senthil Kumar M, Pandey R, Khanna P. Pediatr Anaesth 2009; 19(2): 176-7

This report highlighted the case of a 10-year-old child, weighing 30kg, scheduled for an elective pyeloplasty. A size three i-gel® was inserted and secured after confirming correct placement and a suction catheter inserted down the gastric channel. The child was positioned prone and the correct positioning of i-gel® reconfirmed by appropriate CO2 wave form, absence of audible leak and chest auscultation. At the end of the procedure, the child was returned to a supine position and i-gel® removed after reversal. The patient recovered without any complications.

Link to abstract.

Chapman D. Anaesthesia 2009; 64(2): 228

This letter is a reply to Baxter (2008). Baxter described two incidents where air was ‘entrained through the suction port’ leading to decreased end-tidal sevoflurane and lightened anaesthesia. This response suggests that the devices in question may not have been inserted fully, meaning that the airway and gastric channels were not isolated from each other. To ensure full insertion takes place, users should make sure that the level of anaesthesia, patient position and insertion method are correct.

Abstract text

Jolliffe L, Jackson I. Curr Opin Anaesthesiol. 2008; 21(6): 719- 722

This review highlighted the potential benefits of the current supraglottic airway devices available and their suitability for ambulatory surgery. With regard to i-gel®, it was commented that it was designed to ‘anatomically fit the perilaryngeal and hypolaryngeal structures without the need for an inflatable cuff. This offers the potential for easier insertion, reduced tissue compression and increased stability after insertion.’ They further reported that, ‘Higher mean seal pressures help to facilitate ventilation in laparoscopic work’.

Link to abstract.