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Comparison of four different techniques of i-gel insertion by anaesthesia trainees in children undergoing daycare
Priya Priyadarshi1, Bikram Kishore Behera1, Satyajeet Misra1
1Department of Anesthesiology and Critical Care, AIIMS Bhubaneswar, Odisha, India.
Insights
The 180° rotation technique for pediatric i-gel insertion resulted in the lowest malposition rates and highest oropharyngeal leak pressure. While effective, this method showed no clear advantage in overall clinical performance or ventilation compared to standard techniques.
Area of Science:
- Pediatric Anesthesiology
- Airway Management Devices
- Medical Device Insertion Techniques
Background:
- i-gel supraglottic airway device insertion techniques vary, impacting success rates.
- Assessing i-gel malposition is crucial for patient safety during pediatric anesthesia.
Purpose of the Study:
- To evaluate the incidence of i-gel malposition using 90° rotation, 180° rotation, and jaw thrust-assisted techniques compared to standard insertion in children.
- To compare oropharyngeal leak pressure (OLP) and insertion time across different i-gel insertion techniques.
Main Methods:
- A randomized study involving 132 children undergoing elective surgery.
- i-gel insertion was performed by anesthesia trainees using four techniques: standard, 90° rotation, 180° rotation, and jaw thrust-assisted.
- Device malposition was assessed via flexible video bronchoscopy.
Main Results:
- The 180° rotation technique demonstrated the lowest malposition incidence (27%) compared to standard (39%), 90° rotation (39%), and jaw thrust-assisted (70%) techniques (P=0.004).
- Highest oropharyngeal leak pressure (OLP) was observed with the 180° rotation technique (27.1 cm H2O) (P=0.006).
- Standard insertion technique was fastest (16.9 s), while the 180° rotation technique took longer (19.5 s) (P<0.001).
Conclusions:
- The 180° rotation technique for pediatric i-gel placement by trainees yields the lowest malposition rates and optimal OLP.
- Despite improved metrics, the 180° rotation technique does not offer a clear clinical performance or ventilation advantage over other methods.
Background And Aims:
Different techniques of i-gel insertion have been described with variable success rates. This study aimed to assess the incidence of malposition of i-gel in children with 90° rotation, 180° rotation, jaw thrust-assisted and standard insertion techniques.
Methods:
The study included 132 children undergoing elective surgery under general anaesthesia without neuromuscular blockade after approval from the Institutional Ethics Committee. The i-gel was inserted using one of the four randomised techniques (90° rotation, 180° rotation, jaw thrust-assisted insertion or standard insertion technique) by anaesthesia trainees. The primary objective of this study was to assess device malposition using three alternative techniques compared to the standard insertion technique by flexible video bronchoscopy.
Results:
The incidence of malposition was the least in the 180° rotation technique group (27%) versus 39% in the standard and 90° rotation technique groups and 70% in the jaw thrust technique group (P = 0.004). Oropharyngeal leak pressure (OLP) was highest in the 180° rotation technique group, that is, 27.1 (5.3) cm H2O in the 180° rotation technique group versus 23 (4.3), 25.8 (4.1) and 24.7 (5.6) cm H2O in the standard, 90° rotation and assisted jaw thrust groups, respectively (P = 0.006). The time to i-gel insertion was the least with the standard insertion technique, that is, 16.9 (3.3) s, compared to 18.4 (3.1) s in the 90° rotation group, 19.5 (3.2) s in the180° rotation group and 20.1 (3.4) s in the assisted jaw thrust technique group (P < 0.001).
Conclusion:
The 180° rotation technique for i-gel placement in children by anaesthesia trainees has the lowest incidence of malposition and the best OLP versus other techniques but lacks any clear advantage in clinical performance and ventilation.
