A clinical evaluation of the i‐gel^TM supraglottic airway device in children

Abstract

Pediatric i-gel(TM) sizes 1.5-2.5 provided a satisfactory airway during anesthesia for spontaneously breathing infants and children. However, to ensure a clear airway, considerable vigilance is required when fixing the device in the mouth and to avoid the negative effects of flexion of the proximal tubing. The i-gel(TM) is more expensive than first-generation devices. Whether this additional cost for the potential benefit of greater airway protection is considered acceptable will depend on longer-time evaluation and surveillance to establish overall safety.

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

“…Additionally, this difference may be related to the greater number of issues associated with the i-gel, as evidenced by spontaneous dislodgement and the need for continuous downward traction on the device, a finding also reported by other investigators. [21][22][23][24] Despite these concerns, both devices had high insertion success rates. The insertion success rates are encouraging given the limited clinical experience of the anesthesia trainees with either device in children prior to this study.…”

A performance comparison of the paediatric i‐gel™ with other supraglottic airway devices

“…In addition, a previously clear airway was lost in two children, one child regurgitated, one child became wheezy, one child moved during insertion of the device, and one child lost a tooth during removal of the i-gel [32]. Hughes et al [19] noted complications in 36 patients: 11 on insertion of the device; 15 during maintenance of anaesthesia; and 24 during emergence. Common problems were coughing, partial airway obstruction and blood-staining of the device.…”

“…Complication rates during insertion, maintenance of anaesthesia and recovery ranged from zero in a study by Gil et al [31] to 23% in a study by Hughes et al [19]. Beringer et al [32] recorded 13 complications in 120 children (11%).…”

“…Eight studies, with a total of 641 children and various sized i-gels, were included. The largest study was performed by Hughes et al [19] who evaluated sizes 1-2.5 over a period of 12 months in 154 children; the smallest study was by Rylov and Bersenev [20] who included 32 patients aged between 4 and 14 years. The median leak pressure ranged between 20 and 27 cmH 2 O.…”

“…Beringer et al [32] Unclear* Low Low Low Hughes et al [19] Unclear* Low Low Low Abukawa et al [23] Unclear* Low Low Low Gil et al [31] Unclear* Low Low Low Rylov et al [20] Low Low Low Low Foucher-Lezla et al [29] Low Low Low Low Franksen et al [30] Low Low Low Low Beylacq et al [21] Low Low Low Low * Decision to use i-gel or conventional supraglottic device left to discretion of senior anaesthetist so selection bias is possible. Das et al [7,8] the authors compared the i-gel with two other airway devices and the results have been separated for ease of comparison.…”