I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position

Chih-Jun Lai, Chih-Min Liu, Chun-Yu Wu, Feng-Fang Tsai, Ping-Huei Tseng, Shou-Zen Fan, Chih-Jun Lai, Chih-Min Liu, Chun-Yu Wu, Feng-Fang Tsai, Ping-Huei Tseng, Shou-Zen Fan

Abstract

Background: The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients.

Methods: In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period.

Results: In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge.

Conclusions: The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients.

Trial registration: Registered at Clinicaltrials.gov NCT02462915 , registered on 1 June 2015.

Keywords: Endotracheal tube; Laparoscopic surgery; Leak fraction; Pneumoperitoneum; Respiratory parameters; Trendelenburg position; i-gel.

Figures

Fig. 1
Fig. 1
Illustration of experimental settings. a GE S/5 compact anesthesia monitor (GE Healthcare, Helsinki, Finland). b spirometry tube (GE Healthcare, Helsinki, Finland). c D-lite sensor (GE Healthcare, Helsinki, Finland)
Fig. 2
Fig. 2
Study flow diagram. ETT: endotracheal tube
Fig. 3
Fig. 3
Boxplot of leak fraction for i-gel and ETT groups. Data are median [IQR]. ETT: endotracheal tube
Fig. 4
Fig. 4
The force causes less leak fraction in the LPT position than in the supine position. a Body weight force. b Component of body weight and cephalic shifting pressure due to LPT position. c LPT position induced force on the diaphragm. d Force caused by pneumoperitoneum. e LPT position induced pressure on the stomach. LPT: Laparoscopic pneumoperitoneum and Trendelenburg

References

    1. Bardoczky GI, Engelman E, Levarlet M, Simon P. Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia. 1993;48:309–11. doi: 10.1111/j.1365-2044.1993.tb06949.x.
    1. Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001;93:494–513.
    1. Asai T. Editorial II: Who is at increased risk of pulmonary aspiration? Br J Anaesth. 2004;93:497–500. doi: 10.1093/bja/aeh234.
    1. Castle N, Owen R, Hann M, Naidoo R, Reeves D. Assessment of the speed and ease of insertion of three supraglottic airway devices by paramedics: a manikin study. Emerg Med J. 2010;27:860–3. doi: 10.1136/emj.2009.084343.
    1. Cork RC, Depa RM, Standen JR. Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. Anes Analg. 1994;79:719–27. doi: 10.1213/00000539-199410000-00018.
    1. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth. 2002;88:582–4. doi: 10.1093/bja/88.4.582.
    1. Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH. LMA-Classic and LMA-ProSeal are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anaesth. 2003;50:71–7. doi: 10.1007/BF03020191.
    1. Abdi W, Amathieu R, Adhoum A, Poncelet C, Slavov V, Kamoun W, Combes X, Dhonneur G. Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme and the ETT. Acta Anaesthesiol Scand. 2010;54:141–6. doi: 10.1111/j.1399-6576.2009.02095.x.
    1. Teoh WH, Lee KM, Suhitharan T, Yahaya Z, Teo MM, Sia AT. Comparison of the LMA Supreme vs the i-gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia. 2010;65:1173–9. doi: 10.1111/j.1365-2044.2010.06534.x.
    1. Ali A, Canturk S, Turkmen A, Turgut N, Altan A. Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. Eur J Anaesthesiol. 2009;26:1010–4. doi: 10.1097/EJA.0b013e3283313fdd.
    1. Cook TM, Lee G, Nolan JP. The ProSeal laryngeal mask airway: a review of the literature. Can J Anaesth. 2005;52:739–60. doi: 10.1007/BF03016565.
    1. de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel((R)) vs laryngeal mask airway in adults. Anaesthesia. 2014;69:1151–62. doi: 10.1111/anae.12772.
    1. Wong DT, Yang JJ, Jagannathan N. Brief review: The LMA Supreme supraglottic airway. Can J Anaesth. 2012;59:483–93. doi: 10.1007/s12630-012-9673-0.
    1. Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. I-gel insertion by novices in manikins and patients. Anaesthesia. 2008;63:991–5. doi: 10.1111/j.1365-2044.2008.05542.x.
    1. Theiler LG, Kleine-Brueggeney M, Luepold B, Stucki F, Seiler S, Urwyler N, Greif R. Performance of the pediatric-sized i-gel compared with the Ambu AuraOnce laryngeal mask in anesthetized and ventilated children. Anesthesiology. 2011;115:102–10. doi: 10.1097/ALN.0b013e318219d619.
    1. Levitan RM, Kinkle WC. Initial anatomic investigations of the I-gel airway: a novel supraglottic airway without inflatable cuff. Anaesthesia. 2005;60:1022–6. doi: 10.1111/j.1365-2044.2005.04258.x.
    1. Komasawa N, Nishihara I, Tatsumi S, Minami T. Prewarming of the i-gel facilitates successful insertion and ventilation efficacy with muscle relaxation: a randomized study. J Clin Anesth. 2014;26:663–7. doi: 10.1016/j.jclinane.2014.08.009.
    1. Kim YB, Chang YJ, Jung WS, Byen SH, Jo YY. Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients. J Anesthesia. 2013;27:827–31. doi: 10.1007/s00540-013-1628-2.
    1. Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth. 1999;82:286–7. doi: 10.1093/bja/82.2.286.
    1. Tobias JD, Schwartz L, Rice J, Jatana K, Kang DR. Cuffed endotracheal tubes in infants and children: should we routinely measure the cuff pressure? Int J Pediatr Otorhinolaryngol. 2012;76:61–3. doi: 10.1016/j.ijporl.2011.09.033.
    1. Wu CY, Yeh YC, Wang MC, Lai CH, Fan SZ. Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position. BMC Anesthesiol. 2014;14:75. doi: 10.1186/1471-2253-14-75.
    1. Kluger MT, Visvanathan T, Myburgh JA, Westhorpe RN. Crisis management during anaesthesia: regurgitation, vomiting, and aspiration. Qual Saf Health Care. 2005;14:e4. doi: 10.1136/qshc.2002.004259.
    1. Uppal V, Fletcher G, Kinsella J. Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. Br J Anaesth. 2009;102:264–8. doi: 10.1093/bja/aen366.
    1. Devitt JH, Wenstone R, Noel AG, O’Donnell MP. The laryngeal mask airway and positive-pressure ventilation. Anesthesiology. 1994;80:550–5. doi: 10.1097/00000542-199403000-00011.
    1. Carron MDM, Veronese MDS, Gomiero PDW, Foletto MDM, Nitti MDD, Ori MDC, Freo MDU. Hemodynamic and hormonal stress responses to endotracheal tube and ProSeal laryngeal mask AirwayTMfor laparoscopic gastric banding. Anesthesiology. 2012;117:309–20. doi: 10.1097/ALN.0b013ef31825b6a80.
    1. Greenland KB, Edwards MJ, Hutton NJ, Challis VJ, Irwin MG, Sleigh JW. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth. 2010;105:683–90. doi: 10.1093/bja/aeq239.
    1. de Lloyd L, Hodzovic I, Voisey S, Wilkes AR, Latto IP. Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin. Anaesthesia. 2010;65:36–43. doi: 10.1111/j.1365-2044.2009.06155.x.
    1. William Henderson PAP, Najib T. AYAS. Respiratory System Mechanics and Energetics. In: Broaddus VC, editor. Nadel’s Textbook of Respiratory Medicine. Canada: Saunders imprint of Elsevier; 2016. p. 85.
    1. Heuer JF, Stiller M, Rathgeber J, Eich C, Züchner K, Bauer M, Timmermann A. Evaluation of the new supraglottic airway devices Ambu AuraOnce™ and Intersurgical i-gel™. Anaesthesist. 2009;58:813–20. doi: 10.1007/s00101-009-1600-6.
    1. Eschertzhuber S, Brimacombe J, Kaufmann M, Keller C, Tiefenthaler W. Directly measured mucosal pressures produced by the i-gelTM and laryngeal mask airway SupremeTM in paralysed anaesthetised patients. Anaesthesia. 2012;67:407–10. doi: 10.1111/j.1365-2044.2011.07024.x.
    1. Maino P, Dullenkopf A, Bernet V, Weiss M. Nitrous oxide diffusion into the cuffs of disposable laryngeal mask airways. Anaesthesia. 2005;60:278–82. doi: 10.1111/j.1365-2044.2004.04072.x.
    1. Park SK, Choi GJ, Choi YS, Ahn EJ, Kang H. Comparison of the i-gel and the laryngeal mask airway proseal during general anesthesia: a systematic review and meta-analysis. PLoS One. 2015;10:e0119469. doi: 10.1371/journal.pone.0119469.
    1. Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: A meta-analysis of published literature. J Clin Anesth. 1995;7:297–305. doi: 10.1016/0952-8180(95)00026-E.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren