Clinical Studies
A comparison of postoperative sore throat and neck complaints after the use of the i-gel and the La Premiere® laryngeal mask: A double-blinded, randomized, controlled trial
This study from the department of Anesthesiology and Intensive Care at the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital and the VU University Medical Center in Amsterdam compared the rate of postoperative sore throat and neck complaints with i-gel to a well known brand of laryngeal mask. Patients were interviewed postoperatively as 1hr, 24hrs and 48 hrs. The authors found significantly lower levels of sore throat with i-gel, as well as lower levels of dysphagia.
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Read articleCrossover comparison of the Laryngeal Mask Supreme and the i-gel in simulated difficult airway scenario in anesthetized patients
This study looked at a simulated difficult airway scenario by using a neck collar to limit both mouth opening and neck movement. Both devices were placed in random order in each of 60 patient. The primary outcome was overall success rate. Other measurements included time to successful ventilation, seal pressure, fibreoptic view and adverse events.The authors concluded the two devices tested had a 'similar insertion success and clinical performance in the simulated difficult airway situation'. The i-gel enabled better fibreoptic laryngeal view and less epiglottic downfolding.
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Read articleIs i-gel a new revolution among supraglottic airway devices? - a comparative evaluation
This study compared i-gel to two other supraglottic airways in respect of hemodynamic changes, including heart rate, systolic and diastolic blood pressure, mean arterial pressure and rate pressure product. The authors concluded that 'i-gel effectively conforms to the perilaryngeal anatomy despite the lack of an inflatable cuff, it consistently achieves proper positioning for supraglottic ventilation and causes less hemodynamic changes as compared to other supraglottic airway devices.'
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Read articleInfluence of airway management strategy on 'no-flow-time' in a standardized single rescuer manikin scenario - a comparison between LTS-D and i-gel
This paper, compared i-gel to another supraglottic airway in a manikin cardiac arrest scenario. The study evaluated the effect use of these devices had on No-flow time (NFT). The authors stated that 'an ideal supraglottic airway should be inserted rapidly with minimal training and it should enable controlled ventilation'. i-gel met those criteria during resuscitation in a manikin and NFT was kept as low as possible, consistent with ERC guidelines.
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Read articleThe i-gel, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: An observational study in children
This study evaluated 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'.
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Read articleEffect of chest compressions on the time taken to insert airway devices in a manikin
In this study, forty volunteer doctors regularly involved in CPR, were timed inserting four different airway devices, including i-gel and a tracheal tube, with and without stopping chest compressions. Comparison of the speed of insertion of the different devices during CPR allowed ranking of the devices. The i-gel was inserted approximately 50% faster than the other devices tested.
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Read articleOesophageal seal of the novel supralaryngeal airway device i-gel in comparison with the laryngeal mask airways Classic and ProSeal using a cadaver model
The three supraglottic devices were inserted into eight unfixed cadaver models with exposed oesophagi, connected to a water column producing both a slow and fast oesophageal pressure increase. During a fast increase of oesophageal pressure (simulated vomiting procedure) with the oesophageal lumen of the i-gel and pLMA open, the authors reported that 'the entire oesophageal liquid was drained to the outside without any tracheal aspiration occurring.'
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Read articleA new single use supraglottic airway with a noninflatable cuff and an esophageal vent: An observational study of the i-gel
This study on 71 ASA I-II women scheduled for gynaecological surgery, reported a 97% insertion success rate with i-gel. mean seal pressure was 30cm H2O. A gastric tube was inserted in 100% of cases. Only one case of courghing and sore throat occurred. The authors concluded that 'The i-gel is a reliable, easily inserted airway device that provides an adequate seal with a low morbidity rate.'
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Read articleExtraglottic airway devices for use in diving medicine - part 3: the i-gel
This study looked at the use of i-gel in airway management of a patient in a diving bell or deck decompression chamber. The study highlighted the potential limitations of some supraglottic airways used in Hyperbaric Medicine, such as possible cuff expansion with a decrease in pressure on decompression and change in cuff volume due to gas diffusion as the gas mixtures breathed change, problems not associated with i-gel. It showed that, subjectively, there was no change in the consistency of the i-gel at 203 and 283kPa pressure and that no bubbles were detected following decompression from 203, 283 or 608kPa. The i-gel was also preferred by the Diver Medical Technician’s (DMT’s) to the alternative device included in the manikin section of the study because it ‘lacked a cuff and was easier to insert from any position’.
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Read articlei-gel insertion by novices in manikins and patients
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.'
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Read articleComparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation
In this study, published in the BJA, twenty-five patients were given a standard anaesthetic, followed by insertion of an i-gel. The lungs were ventilated at three different pressures and the difference between the inspired and expired tidal volumes used to calculate the leak volume and leak fraction. The i-gel was then removed and replaced with a conventional tracheal tube, for which similar readings were taken. The results were then compared. From the data taken, the authors concluded that, ‘compared with a tracheal tube there is no significant difference in the gas leak when using an i-gel during PCV with moderate airway pressures’.
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Read articleComparison of clinical performance of i-gel with LMA-ProSeal in Elective surgeries
This clinical investigation into performance of i-gel compared to another supraglottic airway with gastric access, concluded that i-gel was easier to insert, required less attempts at insertion, had easier gastric tube placement and was less traumatic than the other device tested. Sixty patients were randomly assigned into two groups Group 1 (n=30) for i-gel and Group P (n=30). Assessment was made of sealing pressure, ease of insertion, success rate of insertion, ease of gastric tube placement, airway trauma by post operative blood staining of the device, tongue, lip and dental trauma, hoarseness, regurgitation/aspiration and cost effectiveness.
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Read articleEvaluation of the size 4 i-gel airway in one hundred non-paralysed patients
A study of i-gel in 100 elective, anaesthetied 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.
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Read articleInitial anatomic investigations of the i-gel airway: a novel supraglottic airway without inflatable cuff
A study of the positioning and mechanics of the i-gel in 65 non-embalmed cadavers, with 73 endoscopies, 16 neck dissections and 6 neck radiographs. The mean percentage of glottic opening score for the 73 insertions was 82%. In each of the neck dissections and radiographs the bowl of the device covered the laryngeal inlet. In their summary, the authors concluded that the i-gel was consistently positioned over the laryngeal inlet and that the unique gel-like material of the device performed as intended, conforming to the perilaryngeal anatomy.
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Read articleCase reports
i-gel supraglottic airway for rescue airway management and as a conduit for intubation in a patient with acute respiratory failure
This case report details the case of a 54 year old man with acute respiratory failure, who had a grade 4 view at laryngoscopy. He was difficult to bag-mask ventilate and a laryngeal mask was inserted as an airway rescue technique. As ventilation was not possible with this device, it was removed and a size 4 i-gel inserted. This allowed good ventilation. A fibrescope was passed down the airway channel and a 7.0mm endotracheal tube passed over the fibrescope and through the i-gel. The i-gel was then removed, leaving the airway secure.
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Read articleSuccessful use of the i-gel airway in prone position surgery
This case report, published in 'Pediatric Anesthesia', highlighted the case of a 10 year old child, weighing 30kg, scheduled for an elective pyeloplasty. A size 3 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.
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Read articleFibreoptic intubation through an i-gel supraglottic airway in two patients with predicted difficult airway and intellectual disability
This case study describes successful fibre-optic guided tracheal intubation through the i-gel in two uncooperative adult patients with learning disability and predicted difficult airway. The i-gel maintained the airway immediately after induction, allowing oxygenation and ventilation. Fibreoptic identification of the laryngeal inlet was successful on the first attempt and a tracheal tube inserted into the trachea, without complication, in both patients.
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Read articleUse of an i-gel for airway rescue
This case report concerns a middle-aged female patient scheduled for an elective operation on the hand. She had undergone several general anesthetics in the past when a cLMA had been used without documented problems. She had a Mallampatis score of three and a thyromental distance of 6cm. Face mask ventialtion with an oropharyngeal airway was extremely difficult. A pLMA was inserted, but ventilation was not possible. A size 4 cLMA was also tried with the same result. A size 4 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.'
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Read articleThe i-gel supraglottic airway and resuscitation - some initial thoughts
This case report detailed use of a size 4 i-gel during a cardiac arrest. The i-gel was inserted in <10 seconds from opening the packet. The author was able to ventilate the patients lungs easily using a self-inflating bag-valve device connected to the i-gel. The patients lungs were ventilated asynchronously during chest compressions with no leak. There was no evidence of aspiration. In addition, this case report confirmed the training of five non-anaesthetic trainee doctors to insert the i-gel and ventilate an anaesthetised patient after minimal instruction. All these trainees rated i-gel easier to insert than a laryngeal mask airway.
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Read articleAspiration recognition with an i-gel airway
A report on a case of a young male patient undergoing surgery where i-gel helped with the recognition and management of regurgitation. During this case, gastric contents were noticed to be coming out of the gastric channel. No secretions were evident in the airway channel. As regurgitation continued, surgery was paused and and the patients airway secured following rapid sequence induction. ‘Laryngoscopy revealed a clear view of the trachea (Cormack & Lehane grade 1) with no evidence of gastric contents’. The patient remained stable throughout the remainder of the operation. There was no clinical evidence of aspiration and a post-op chest X-ray revealed clear lung fields. It transpired the patient had consumed a can of Coca-Cola a few hours prior to the operation, something he failed to mention during a pre-operative visit.
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Read articleThe i-gel airway for ventilation and rescue ventilation
This case report concerns use of an i-gel on a teenage patient scheduled for closure of colostomy. Two year previously he had a grade 3 (Cormack & Lehane) view at laryngoscopy. On this occasion there were no clinical features to predict difficult intubation. laryngoscopy revealed a grade 4 view. Two attempts at tracheal intubation with a gum elastic bougie failed. A cLMA was inserted. Despite providing satisfactory ventilation, two attempts at fibreoptic intubation through the device failed. A size 4 i-gel was inserted and satisfactory ventilation achieved. After fibreoptic confirmation of a good view of the vocal cords, a size 6.5mm cuffed tracheal tube was successfully passed through the i-gel blindly into the trachea at the first attempt. he i-gel was left in place until extubation.
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Read articleOthers
The i-gel supraglottic airway: A potential role for resuscitation?
A letter on initial findings following clinical use of i-gel in 100 patients. In order to evaluate its potential use in a resuscitation setting, the investigators confined their use to a size 4 device. They used i-gel on 100 patients undergoing elective surgery under general anaesthesia. The device was used in patients with a weight range of 40-100kg. In 98/100 cases, the i-gel was adequately positioned on the first or second attempt. The mean and median leak on sustained pressure was 24cmH2O. Airway trauma, demonstrated by visible blood on the device on removal, was only detected on one occasion.There was one case regurgitation. The gastric fluid was successfully vented through the oesophageal drainage port without any evidence of aspiration.
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Read articleEvaluation of the i-gel airway in 300 patients
This letter, published in the European Journal of Anaesthesiology, reported 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 an 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.'
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Read articleAirway techniques and ventilation strategies
This review, published in 'Current opinion in Critical Care', by Jerry Nolan and Jasmeet Soar, discussed the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation. It also discussed the role of ventilation during out-of-hospital CPR. In the section on supraglottic airways, i-gel was one of a number of devices mentioned. It confirmed that the ease of insertion of the i-gel and its favourable leak pressure make it 'theoretically very attractive as a resuscitation device for those inexperienced in tracheal intubation'. It also confirmed further study was required.
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Read articleAirway management in the outpatient setting: new devices and techniques
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'.
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