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

Abstract

The classic Laryngeal Mask Airway (c-LMA) is a first generation supraglottic airway device with an inflatable cuff forming a low pressure seal around the laryngeal inlet and permitting ventilation. I-gel is a supraglottic airway device made of thermoplastic elastomer which is soft gel-like and transparent. Unlike the classic LMA(c-LMA), I-gel does not have an inflatable cuff. In view of this, the present study was undertaken to compare the performance of the two supraglottic airway devices in spontaneously breathing adult patients posted for elective surgeries under general anesthesia.To compare the ease of insertion, number of insertion attempts, time for insertion, airway leak pressure, hemodynamic changes as well as perioperative complications such as cough sore throat between patients using the two devices.Sixty patients admitted in SRM medical college and research center scheduled for various elective surgical procedures under general anesthesia belonging to ASA class I and II were included in the study. They were randomly divided into two groups of 30 each using a random number generator. In group I, I-gel supraglottic airway device was used and in Group 2 classic laryngeal mask airway was used. Data was collected using a questionair containing socio-demographic details, details regarding performance of the device as well as hemodynamic changes and perioperative complications.The insertion was easy in 25 patients (83.3%) in group I, while in group II 15 patients (50%) had easy insertion. P=0.0 1781. The mean time of insertion for I-gel was (20. 17± 3 .91 seconds) which was significantly shorter compared to c-LMA (26.80 ±7.24 seconds) (P<0.001).There was no statistically significant difference between the devices with respect to number of attempts of insertion. Even though the airway leak pressure is not statically significant, the mean oropharyngeal leak pressure for I-gel was 20.40±5.68 (mm Hg), which was higher than c-LMA 18.73±5.06 (mm Hg), which is well within the normal limits to prevent aspiration. There were no statistically significant differences in hemodynamic changes. No Blood staining was seen after removal of device in I-gel group where it was observed in 2 (7%) patients in c- LMA group. Post removal cough was more in c -LMA (13 .3%) than l-gel (P= 0.04 SS*). Pharyngo-Laryngeal morbidity was more with classic LMA. Sore throat was more with the classic LMA (13 .3%) when compared to I-gel group (3%).We conclude that I-gel is a better airway when compared to c-LMA with respect to ease of insertion, shorter duration for insertion, adequate oropharyngeal seal with lesser pharyngo-laryngeal morbidity and less incidence of airway trauma.

Comparison of I-gel and laryngeal mask airway classic in terms of ease of insertion and hemodynamic response: a randomised observational study

“…Jacob et al observed I-gel had a lower incidence of complications such as cough, sore throat, blood staining, etc. 9 Similarly, we found sore throat and hoarseness of voice after 24 hours of surgery was more in C-LMA than I-gel, but was statistically non-significant (p>0.05).…”

“…It was highly significant, with a p value of <0.001. 9 In study by Gupta et al the mean inserting time was shorter for I-gel (11.07±1.93 seconds) than LMA (12.50±2.35 seconds) and the difference was statistically significant. 4 We found mean number of attempts of successful insertion was 1.11±0.32 times in C-LMA group and 1.03±0.17 times in I-gel group, which was statistically non-significant (p>0.05).…”

“…Successful insertion was achieved in first attempt in 87.5 and 77.5% of patients of the I-gel and LMA groups, respectively, but was not statistically significant (p=0.986). 9 Prateeba et al observed that both the devices were easy to insert <two attempts, but the success rate in the first attempt was 100% with I-gel and 84% with LMA C, which is statistically significant (p=0.003). 8 Kalra et al the ease of insertion was more with the I-gel (41/50 patients required single attempt with no resistance at insertion than with the LMA (39/50 patients required single attempt with no resistance at insertion, which was statistically comparable.…”

“…The observations of sex and ASA parameters by Gupta et al and Jacob et al were in concordance of present study. 4,9 In study by 8,[11][12][13] Since no cuff inflation is required in the I-gel, time required to achieve an effective airway was shorter, and does not require an introducer, the device can be simply pushed into place. The mean insertion time observed by Durrani et al was statistically insignificant.…”