A prospective randomised trial to compare three insertion techniques for i-gel™ placement: Standard, reverse, and rotation

Mamta Bhardwaj, Suresh K Singhal, Rashmi, Amit Dahiya, Mamta Bhardwaj, Suresh K Singhal, Rashmi, Amit Dahiya

Abstract

Background and aims: This prospective randomised study was done to compare standard, reverse, and rotation techniques of i-gel™ placement in terms of insertion characteristics and success rate.

Material and methods: After institutional ethics committee approval, 135 patients aged 18-50 years, ASA I and II undergoing elective surgery under general anesthesia were included. After induction of anesthesia, i-gel™ was inserted by standard, reverse, and rotation technique in Groups I, II, and III, respectively. The primary objective was mean time of insertion. Secondary variables included ease of insertion, first attempt success rate, manoeuvres required, fiberoptic view of placement, oropharyngeal leak pressure, ease of placement of nasogastric tube, and complications if any.

Results: Mean time of insertion was 18.04 ± 5.65 s, 15.00 ± 5.72 s and 16.12 ± 5.84 s for groups I, II, and III, respectively. Time taken for insertion was shortest and significantly lower (P = 0.048) for group II compared to group I. Insertion time was comparable between rest of groups. The overall success rate in groups I, II, and III were 91.1%, 95.6%, and 93.3% respectively (P = 0.7). The first attempt success rate was 82.2%, 89%, and 84.4% in groups I, II and III, respectively (P = 0.07). Manoeuvres were required in five (12.19%) patients in group I, four (9.30%) patients in group II, and three (7.14%) patients in group III (P = 0.602). Complications occurred in eight, three, and three patients in groups I, II, and III, respectively.

Conclusion: All techniques of i-gel insertion are equally good and choice of technique depends upon the experience and comfort of the investigator with the particular technique.

Keywords: Airway management; fiberoptic; general anesthesia; rotation; supraglottic airway.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Indian Journal of Anaesthesia.

Figures

Figure 1
Figure 1
The CONSORT flow diagram

References

    1. Duckett J, Fell P, Han K, Kimber C, Taylor C. Introduction of the i-gel supraglottic airway device for prehospital airway management in a UK ambulance service. Emerg Med J. 2014;31:505–7.
    1. Emmerich M, Tiesmeier J. The I-gel supraglottic airway: A useful tool in case of difficult fiberoptic intubation. Minerva Anestesiologica. 2012;78:1169–70.
    1. Rustagi PS, Nellore SS, Kudalkar AG, Sawant R. Comparative evaluation of i-gel™ insertion conditions using dexmedetomidine-propofol versus fentanyl-propofol - A randomised double-blind study. Indian J Anaesth. 2019;63:900–7.
    1. Theiler L, Gutzmann M, Kleine-Brueggeney M, Urwyler N, Kaempfen B, Greif R. i-gel™ supraglottic airway in clinical practice: A prospective observational multicentre study. Br J Anaesth. 2012;109:990–5.
    1. Taxak S, Gopinath A. Insertion of the i-gel™ airway obstructed by the tongue. Anesthesiology. 2010;112:500–1.
    1. Kim HC, Yoo DH, Kim HJ, Jeon YT, Hwang JW, Park HP. A prospective randomised comparison of two insertion methods for i-gel ™ placement in anaesthetised paralysed patients: Standard vs rotational technique. Anaesthesia. 2014;69:729–34.
    1. Sharda M, Kapoor MC, Atray R, Garg S. Insertion of i-gel™ by the reversed technique improves the success rate and reduces the time taken for its placement: A prospective, randomized, controlled, interventional trial. J Anaesthesiol Clin Pharmacol. 2017;33:226–30.
    1. Singh J, Yadav MK, Marahatta SB, Shrestha BL. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients. Indian J Anaesth. 2012;56:348–52.
    1. Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of the single use laryngeal mask airway – The LMA-Unique. Br J Anaesth. 1998;80:677–9.
    1. Hwang JW, Park HP, Lim YJ, Do SH, Lee SC, Jeon YT. Comparison of two insertion techniques of ProSeal laryngeal mask airway: Standard versus 90-degree rotation. Anesthesiology. 2009;110:905–7.
    1. Sen I, Bhardwaj N, Latha YS. Reverse technique for i-gel supraglottic airway insertion. J Anaesthesiol Clin Pharmacol. 2013;29:128–9.
    1. Park JH, Lee JS, Nam SB, Ju JW, Kim MS. Standard versus rotation technique for insertion of supraglottic airway devices: Systematic review and meta-analysis. Yonsei Med J. 2016;57:987–97.
    1. Muneer MN, Malik S, Kumar N. Comparison of ease of i-gel™ insertion with standard and rotational techniques in adults. J Surg Pakistan. 2016;21:122–5.
    1. Liew GH, Yu ED, Shah SS, Koyhandan H. Comparision of the clinical performance of i-gel™, LMA Supreme and LMA ProSeal in elective surgery. Singapore Med J. 2016;57:432–7.
    1. Singh A, Bhalotra AR, Anand R. A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial. Indian J Anaesth. 2018;62:858–64.

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