i-gel airway device provides reliable anesthesia ventilation

By Andrew Czyzewski

The i-gel supraglottic airway device provides reliable ventilation in patients under anesthesia, results of a prospective multicentre observational study show.

Corrective minor airway manoeuvres were necessary in about one-fifth of all cases, although adverse events were rare.

"Importantly, the study provides a large retrospective data on i-gel usage in the everyday clinical setting," Lorenz Theiler (University Hospital Bern, Switzerland) and colleagues comment in the British Journal of Anaesthesia.

The successful use of i-gel (Intersurgical Ltd, Wokingham, UK) has been previously described in randomized controlled studies, including studies showing the possibility to intubate through the i-gel. However, large prospective data about the application in daily clinical practice, side effects, and possible predictors of i-gel failure are lacking.

In the current study Theiler et al analyzed data from 2049 i-gel uses in variety of patients and surgical indications to obtain data about the i-gel's clinical performance, risk factors for failure, and adverse events in an everyday clinical setting.

Theiler et al report that a total of 1914 (93.4%) i-gel devices were successfully inserted without changing the size of the device (defined as the primary success rate), while 135 devices failed initially.

In 52 (2.5%) of these failures, changing the size of the i-gel was sufficient to achieve a patent airway. Successful ventilation was therefore established by an i-gel device of some size in 1966 (95.9%) cases (defined as the overall success rate).

The mean airway leak pressure was 26 cm H₂O and the allowed maximum of 40 cm H₂O was reached in 213 (10%) cases).

The number of adverse events was low but included 25 (1.2%) cases of laryngeal spasms, 79 (3.9%) cases of blood stained airway devices, two (0.1%) cases transient nerve damage, one case of transient vasovagal asystole, and one glottic hematoma.

Notably, in the one case of vagal reflex bradycardia followed by asystole, cardiopulmonary resuscitation was initiated and atropine administered, with return of spontaneous circulation after around 1 minute. Despite chest compressions, ventilation was successfully maintained with the i-gel in place throughout the episode. The patient was young and healthy and showed no signs of neurologic or cardiac sequelae after emergence from anesthesia.

"In order to minimize pressure presumably caused by the i-gel, we would recommend using the smallest sized i-gel that provides enough airway seal pressure, especially in overweight patients and for prolonged procedures," Theiler et al comment.

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