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

Abstract

Background and Aim:Physiological changes during pregnancy and the sympatho adrenalstimulation during larynoscopy and intubation leads to evaluation of safe devices to secure airway during cesarean section under general anesthesia. I-gel, recently emerging effective supra glottic device found safe during general anesthesia in cesarean section. Aim of the study is to compare the hemodynamic disturbances and airway related complications of I-gel and Endotracheal tube in patients undergoing cesarean section under general anesthesia.Material and Methods:Eighty ASA II pregnant patients posted for elective LSCS were randomly divided into two groups of 40 each (n = 40). According to the group they were inserted either I-gel (Group I) or ETT (Group E). Insertion time, ease of intubation, hemodynamics during insertion and Extubation, airway related complications like sore throat, blood on the device, dysphagia, regurgitation, nausea, vomiting, aspiration and laryngospasm were noted and compared. Statistical analysis was done by using unpaired t test, chi square test and fisher's test. P value of <0.05 was considered as significant.Results:The demographic parameters, ease of insertion, insertion times and adequacy of ventilation were comparable between the groups (P > 0.05). 8 out of 40 patients in Group E had difficult intubation (P < 0.01). More than 20% of rise in MAP and HR were found during intubation and Extubation in Group E (40 out of 40 patients) which was statistically significant when compared to Group I (P < 0.001). Post operative sore throat significantly high in Group E (30 out of 40) (P < 0.001) when compared to Group I (4 out of 40).Conclusion:Easier insertion with less hemodynamic disturbances and very low incidence of sore throat I-gel found to be safer device to secure the airway in patients undergoing LSCS under general anesthesia.

Comparison of Endotracheal Intubation Versus Supraglottic Airway Device in Patients Undergoing Corneal Transplantation Under General Anaesthesia

“…They observed that approximately 20% rise in mean arterial pressure and heart rate seen in endotracheal group when compared with I-Gel group (p<0.001) thus providing greater hemodynamic stability. They concluded remarkable sore throat after endotracheal intubation (p<0.001), however in our study, no obvious incidence of sore throat in recovery was seen in endotracheal group (p=0.500).They compared both groups in terms of postoperative complication of blood on the device, which was not conspicuous in either of the groups consistent with findings of our study 12 .…”

The role of supraglottic airway devices in obstetric anaesthesia

“…The use of SGA in emergency situations such as rescue airway device is easily justifiable as the risks of aspiration outweigh the potential of hypoxaemia and death. However, since 2001, the use of SGA as primary airway device during GA for CD has been demonstrated in several studies and been reviewed on several occasions [8][9][10][11][12][13][14][15][16][17]19,43 && ,44,45 && ,46]. To date, there are at least twelve peer reviewed studies describing the use of SGA as primary airway device (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19].…”

“…In obstetric practice, SGA are confined to use as a rescue airway device when failed intubation occurs [1,7 & ]. More recently, SGAs have been used as the primary airway device for elective and emergency caesarean delivery (CDs) in carefully selected patient cohorts [8][9][10][11][12][13][14][15][16][17][18][19]. This review aims to discuss the place of SGAs in obstetric anaesthetic practice and review the available literature.…”

Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some?

“…27 It provides a more stable haemodynamic profile at insertion with lower mean arterial pressure and heart rate than tracheal intubation in patients undergoing elective Caesarean delivery. 5 Its use in elective Caesarean deliveries has been shown to provide comparable control of the airway (in 9 vs 10 s), 6 but was associated with fewer airway complications, such as bronchospasm, sore throat, regurgitation, and dysphagia. 5,6 Most of the aforementioned studies included fasted nonobese patients and excluded patients with gastrooesophageal reflux or anticipated difficult airway.…”

“…5 Its use in elective Caesarean deliveries has been shown to provide comparable control of the airway (in 9 vs 10 s), 6 but was associated with fewer airway complications, such as bronchospasm, sore throat, regurgitation, and dysphagia. 5,6 Most of the aforementioned studies included fasted nonobese patients and excluded patients with gastrooesophageal reflux or anticipated difficult airway. Such stringent patient selection criteria were not universal amongst the 11 studies (Table 1).…”