Evaluation of a new supraglottic airway device in ambulatory surgery: The I-gel

##plugins.themes.academic_pro.article.sidebar##

Published Aug 8, 2014
Download
pdf
Vol. 92 No. 4 (2014): Issue Apr 2014

##plugins.themes.academic_pro.article.main##

H. Jaoua
L. Djaziri
J. Bousselmi
H. Belhouane
R. Skander
A. Ben Maamer
A. Cherif
K. Ben Fadhel

Abstract

Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Its tube is profiled to facilitate and stabilize its insertion.
aim : The aim of our study is to state the efficiency and the place of I-gel® in airway management in adult anaesthetic practice.
methods: One hundred patients, ASA I-II, scheduled for shortduration elective surgery under general anaesthesia were included in this prospective study. Patients with neck pathology, previous or anticipated airway problems, increased risk of regurgitation or aspiration, ASA III and above and undergoing emergency surgery were not included in the study. We collected the following data: adequacy of the size recommended to the patient, ease in inserting the I-gel®, leak fraction, gastric leak, complications during insertion and removal, ease in inserting the gastric tube, haemodynamic and ventilatory parameters, stability during patient movement and satisfaction of the anaesthetists.
results: The success rate of insertion and the use of the I-gel was respectively 99% and 96%. The device was inserted at the first attempt in 92% of cases. The introduction of the I-gel® was rated easy in 99% of cases taking a median of 13 seconds. Complications of insertion were restricted to coughing in 5 patients and hiccups in 7 patients. There were no significant increase in heart rate and mean arterial blood pressure compared to pre-insertion values. An audible leak was recorded in 14.6% of cases. The need for additional manoeuvres was less than or equal to 2 in 96.9 % of patients. The mean of the recorded peak airway pressure values was 18 cmH2O.
After a fibreoptic exam via the airway tube, the glottis was completely seen in 74% of cases and partially seen in 14.6%. Two cases of gastric inflation were recorded. There was no case of regurgitation or hypoxemic episode during this trial. Post-operatively sore-throat was reported by one patient in recovery. After I-gel withdrawal, trace of blood was observed in 5 devices. One case of dental trauma was noted. 95% of the anaesthetists were satisfied with the use of the I-gel in their pratice.
Conclusion: This study showed that I-gel® can be used safely and effectively in patients undergoing short-duration elective surgery because the I-gel® has a very good insertion success rate and few complications. The fibreoptic position of the device was correct and the ventilation was highly effective. These elements must be corroborated in larger series.

Keywords:

Airways, Laryngeal mask airway, Supraglottic device, General anaesthesia, Ambulatory surgery.

##plugins.themes.academic_pro.article.details##

References

  1. Dhonneur G, Combes X, Bouleau B. Gestion des voies aériennes en dehors du patient intubé. In: SFAR éditeur. Conférence d'actualisation. Paris: Elsevier, 2000: 111-25.
  2. Gabbott DA, Berlinger R. The I-gel supraglottic airway: a potential role for resuscitation? Resuscitation 2007;73:161-2.
  3. Gatward JJ, Thomas MJC, Nolan JP, Cook TM. Effect of chest compressions on the time taken to insert airway devices in a manikin. Br J Anaesth 2008;100:351-6.
  4. Jackson KM, Cook TM. A comparison of four different advanced airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia 2007;62:388-93.
  5. Levitan RM, KinkleWC. Initial anatomic investigations of the Igel airway: a novel supraglottic airway device without inflatable cuff. Anaesthesia 2005;60:1022-6.
  6. Intersurgical. I-gel Users Guide. www.intersurgical.com, 01.05.2008. (accessed January 2008).
  7. Gatward JJ, Cook TM, Seller C, et al. Evaluation of the size 4 igel trade mark airway in one hundred non-paralysed patients. Anaesthesia 2008; 63: 1124-30
  8. Wharton NM, Gibbison B, Gabbott D, Haslam GM, Cook TM. Igel insertion by novices in manikins and patients. Anaesthesia 2008; 63 :991-5.
  9. Richez B, Saltel L, Banchereau F, Torrielli R, Cros AM. A new single use supraglottic airway device with a noninflatable cuff and an esophageal vent: an observational study of the i-gel. Anesth Analg 2008; 106: 1137-9
  10. MassaH. Comparaison du masque laryngé LMA unique® et du igel ® : étude clinique et tomodensitométrique. Thèse faculté de médecine de Nice,2008.
  11. Wiese CHR, Bahr J, Popov AF et al. Influence of airway management strategy on “no-flow-time” in a standardized single rescuer manikin scenario (a comparison between LTS-DTM and I-gel). Resuscitation2009;80:100-3.
  12. Langlois C, Péan D, Testa S, Béliard C, Moreau D, Lejus C. The LTD laryngeal tube: a new single-use airway device. Ann Fr Anesth Reanim 2007;26:197-201.
  13. Tan MG, Chin ER, Kong CS et al. Comparison of the re-usable LMA Classic and two single-use laryngeal masks in airway management by novice personnel. Anaesthesia and intensive care 2005; 33:739-43.
  14. Klaver NS, Kuizenga K, Ballast A et al. A comparison of the clinical use of the Laryngeal Tube S® and the ProSeal® Laryngeal Mask Airway by first-month anaesthesia residents in anaesthetized patients. Anaesthesia 2007;62:723-7.
  15. Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth 1999;82:286-7.
  16. Soar J. The I-gel supraglottic airway and resuscitation—some initial thoughts. Resuscitation 2007; 74: 197
  17. Brimacombe J, Keller C, Fullekrug B, et al. A multicenter study comparing the ProSeal and Classic laryngeal mask airway in anesthetized, non paralyzed patients. Anesthesiology 2002; 96:289-95
  18. Uppal V, Fletcher G, Kinsella J et al. Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. British Journal of Anaesthesia 2009;102:264-8.
  19. Devitt JH, Wenstone R, Noel AG, O'Donnell MP. The laryngeal mask airway and positive-pressure ventilation. Anesthesiology 1994; 80: 550-5
  20. Natalini G, Franceschetti ME, Pantelidi MT et al. Comparison of the standard laryngeal mask airwayand the ProSeal laryngeal mask airway in obese patients. Br J Anaesth 2003; 90: 323-6
  21. Dorges V, Ocker H, Wenzel V, Schmucker P. The laryngeal tube: a new simple airway device. Anesth Analg 2000;90:1220-2.
  22. Keller C, Brimacombe J. The influence of head and neck position on oropharyngeal leak pressure and cuff position with the flexible and the standard laryngeal mask airway. Anesth Analg 1999;88:913-6.
  23. Goudsouzian NG, Denman W, Cleveland R et al. Radiologic localization of the laryngeal mask airway in children. Anesthesiology. 1992;77:1085-9.
  24. Miller DM, Light D. Laboratory and clinical comparison of the Streamlined Liner of the Pharynx Airway (SLIPATM) with the laryngeal mask airway. Anaesthesia 2003; 58: 136-42
  25. Keller C, Brimacombe J, Kleinsasser A et al. Does the ProSeal laryngeal mask airway prevent aspiration of regurgitated fluid? Anesth Analg 2000; 91: 1017-20.
  26. Gibbison B, Cook TM, Seller C. Case series: protection from aspiration and failure of protection from aspiration with the i-gel airway. British Journal of Anaesthesia 2008; 100:415-7.
  27. Parker MR, Day CJ. Visible and occult blood contamination of laryngeal mask airways and tracheal tubes used in adult anaesthesia. Anaesthesia 2000; 55: 388-90
  28. Tordoff SG, Scott S. Blood contamination of the laryngeal mask airways and laryngoscopes—what do we tell our patients? Anaesthesia 2002; 57: 505-6
  29. Greenberg RS, Brimacombe J, Berry A et al. A randomised controlled trial comparing the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anaesthetized adults. Anesthesiology 1998; 88: 970-7.
  30. Cook TM, Lee G, Nolan JP. The ProSeal laryngeal mask airway: a review of the literature: [Le masque laryngeProSeal : un examen des publications]. Canadian Journal of Anesthesia 2005; 52: 739-60.
  31. Figuerdo E, Vivar-Diago M, Munoz-Blanco F.Laryngopharyngeal complaints after use of the laryngeal mask airway. Canadian Journal of Anesthesia 1999; 46: 220-5.
  32. Oczenski W, Krenn H, Dahaba AA, et al. Complications following the use of the Combitube, tracheal tube and laryngeal mask airway. Anaesthesia 1999; 54: 1161-5.
  33. Brimacombe J, Keller C, Puhringer F.Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized patients with a modified cuffed oropharyngeal airway. Anesthesiology. 1999;91:1661-5.
  34. Gaitini LA, Vaida SJ, Mostafa S, Yanovski B. The effect of nitrous oxide on the cuff pressure of the laryngeal tube. Anaesthesia 2002;57:506-9.
  35. Ouellette RG. The effect of nitrous oxide on laryngeal mask cuff pressure. American Association of Nurse Anesthetists Journal 2000; 68: 411-4.
  36. Vollmer T, Genzwuerker HV, Ellinger K. Fibreoptic control of the laryngeal tube position. Eur J Anaesthesiol 2002;19:306-7.
  37. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002; 88: 582-4
  38. Dyer RA, Llewellyn RL, James MF. Total i.v. anaesthesia with propofol and the laryngeal mask for orthopaedic surgery. Br J Anaesth 1995; 74: 123-8
  39. Cork R, Depa R, Standen J. Prospective comparison of use of the laryngeal mask and endotracheal tube for ambulatory surgery. Anesth Analg 1994;79:719-27.
  40. Brimacombe J, Berry A. A simple method of ventilation via the laryngeal mask d0000uring transportation and recovery from anaesthesia. Acta Anaesthesiol Scand 1996; 40: 1258-63
  41. Kanefield J, Munro J, JH. E. Incidence of bleeding after oral endotrachéal intubation. Anesthesiology 1990;17:43-5.
  42. Clery G, Brimacombe J, Stone T et al. Routine cleaning and autoclaving does not remove protein deposits from reusable laryngeal mask devices. Anesth Analg 2003;97:1189-91, table of contents.
  43. Miller D, Youkhana I, Karunaratne W, Pearce A. Presence of protein deposits on cleaned re-usable anaesthetic equipment. Anaesthesia 2001;56:1069-72.
  44. Hill A, Butterworth R, Joiner S, coll e. Investigation of variant Creutzfeldt- Jakob disease and other human prion diseases with tonsil biopsy samples. Lancet 1999;353:183-9.
  45. Forewaker J. The laryngoscope as a potential source of cross infection. J Hosp Inf 1995;29:315-6.