A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

Abstract

INTRODUCTIONThe approach of airway has evolved greatly in recent times since development of endotracheal intubation by Mc Evan in 1880 to present day use of modern supraglottic airway. The tracheal intubation requires skill and continuous training and practice and usually requires direct laryngoscopy, which may cause laryngopharyngeal lesions. It also produces reflex sympathetic stimulation and is associated with raised levels of plasma catecholamine, hypertension, tachycardia and myocardial ischemia, depression of myocardial contractility, ventricular arrhythmias and intracranial hypertension. Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anaesthesia both in adults and children. The first successful supraglottic airway device -laryngeal mask airway (LMA) classic, an inflatable supraglottic airway device became available in 1981.2 I-gel is the most recent development in supraglottic airway devices. It is made of ABSTRACT Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO 2 and SPO 2 , perioperative hemodynamic parameters and intra operative and postoperative complication. Methods: This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In "sniffing air" position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO 2 >95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications. Results: No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO 2 and ETCO 2 . Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel. Conclusions: I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO 2 and ETCO 2 were maintained in both the groups.

Comparison of I-gel versus endotracheal tube in patients undergoing elective cesarean section: A prospective randomized control study

“…Literatures have shown that incidence of postextubation sore throat, mucociliary dysfunction, laryngeal edema, and hoarseness of voice were less with the use of SGAD when compared with ET tube. [ 15 16 17 18 ] Furthermore, SGAD with an inflatable cuff has the potential to cause tissue distortion, venous compression, and nerve injury. Trauma during insertion, multiple insertion attempts, cuff volume, and pressure exerted by the cuff against the pharyngeal mucosa have all been implicated for postoperative complications.…”

I-Gel and LMA classic in the hands of novice: A comparative study

“…14 The adverse events such as cough, sore throat, dysphagia/dysphonia and blood stain on device were reported to be lower with the use of I-Gel compared with cLMA in many other studies. 12,13,19,20,27 The study has a few limitations. Here, a second-generation SAD (I-gel) is compared with a first-generation SAD (cLMA).…”

“…The performance of I-Gel has been compared with the LMA Proseal [6][7][8] or with LMA Supreme. 9 Several studies have been reported comparing I-Gel and LMA classic (cLMA) in adult, 1,[10][11][12][13][14][15][16] in child [17][18][19] and in mixed age group 20 population. Some of these studies report the comparative performance of I-Gel and cLMA in the hands of experienced or skilled anaesthesiologists.…”

A comparative study on the perfomance between I-gel® and Classic laryngeal mask airway in anaesthetized spontaneously breathing patients

“…The laryngeal mask airway has been well-established for more than three decades and is often used when endotracheal intubation is not necessary. 1,2 Nevertheless, utility of the LMA is limited by the potential risk of aspiration. 1,3,4 The I-gel supraglottic airway is a 2 nd generation supraglottic airway device with a soft anatomically preformed non-inflatable stuff made of a gel like thermoplastic elastomer, containing a gastric port.…”

“…Jee-Eun Chang, Hyerim Kim et al in (2019), 1 Smita R. Engineer, Digant B. Jansari, Saumya Saxena et al (2016). 2 Vinuth Krishna Murthy, Krishna Prasad Patla et al (2020) 5 concluded that I-gel is effective airway which is easier to insert and provides a better airway maintenance even in the scene of a difficult airway. In many studies ease of insertion becomes an important factor when these devices are used by relatively untrained personnel.…”