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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. [ABSTRACT FROM AUTHOR]

Background: Supraglottic airways (SGA) are increasingly used in pediatric anesthesia. Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This study was conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. Methods: A total of 140 children aged 1–5 years, who were undergoing elective surgery, were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under general anesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), and secondary objectives were number of attempts of device insertion, success rate, ease of LMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. Results: The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA (27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on the first attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time, ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. Conclusions: The I-gelTM was more efficacious device in term of OPLP than BlockbusterTM LMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia. [ABSTRACT FROM AUTHOR]

Background: The current evidence on the safe use of supraglottic airway for pediatric laparoscopic surgeries is limited. Although i-gel has been successfully used in adult laparoscopic surgeries, to our knowledge, no studies have compared it to the endotracheal tube (ETT) in pediatric laparoscopic surgeries. This study evaluated the effectiveness of i-gel over ETT with regards to the respiratory and hemodynamic parameters during pediatric laparoscopic surgeries. Methods: A total of 60 pediatric patients undergoing elective laparoscopic surgeries were randomly allocated to either the i-gel or ETT groups. Anesthetics used included ketamine, sevoflurane, and rocuronium. The primary outcome measured was the peak airway pressure (PAP) and the secondary outcomes measured were leak fraction, endtidal CO2, respiratory rate, insertion time, heart rate, blood pressure and perioperative complications. Results: The PAP during surgeries was higher in the ETT group than in the i-gel group. There were no statistically significant differences in the leak fraction, end-tidal CO2, and respiratory rate. The i-gel group had a shorter insertion time compared with the ETT group. The changes in heart rate were comparable in both groups. However, systolic and diastolic pressures were higher in the ETT group following intubation, before and after the creation of pneumoperitoneum. The incidence of perioperative complications was similar in both groups. Conclusions: The i-gel provided adequate ventilation with lower PAP compared with ETT. In addition, it provided minimal hemodynamic changes compared with ETT. Therefore, the i-gel may provide a suitable alternative to ETT in pediatric laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Study Objective: Various randomized controlled trials and a meta‑analysis have compared i‑gel™ and laryngeal mask airway Supreme™ (LMA‑S™) in adult patients and found that both the devices provided equivalent oropharyngeal leak pressure (OLP). However, no randomized controlled trial has compared air‑Q™ with i‑gel™ and LMA‑S™ in adult patient. Hence, we designed this study to compare air‑Q™ with LMA‑S™ and i‑gel™ in adult patients. Materials and Methods: A total of 75 adult patients of the American Society of Anesthesiologists physical status I/II of both sexes, between 18 and 60 years, were included in this prospective randomized controlled trial conducted in a tertiary care center. Randomization of patients was done in three equal groups according to the insertion of supraglottic airway device by a computer‑generated random number sequence: group air‑Q™ (n = 25), group i‑gel™ (n = 25), and group LMA‑S™ (n = 25). Primary outcome of this study was OLP. We also recorded time for successful placement of device, ease of device insertion, number of attempts to insert device, and ease of gastric tube insertion along with postoperative complications. Results: The mean ± standard deviation OLP of air‑Q™, i‑gel™, and LMA‑S™ was 26.13 ± 4.957 cm, 23.75 ± 5.439 cm, and 24.80 ± 4.78 cm H2O (P = 0.279). The first insertion success rate for air‑Q™, i‑gel™, and LMA‑S™ was 80%, 76%, and 92%, respectively (P = 0.353). The insertion time of air‑Q™, i‑gel™, and LMA‑S™ was 20.6 ± 4.4, 14.8 ± 5.4, and 15.2 ± 4.7 s, respectively (P = 0.000). Time taken for air‑Q™ insertion was significantly higher than time taken for i‑gel™ (mean difference 5.8 s, P < 0.0001) and LMA‑S™ (mean difference 5.4 s, P = 0.0001) insertion. Postoperative complications were similar with all three devices. Conclusions: We concluded that air‑Q™, i‑gel™, and LMA‑S™ were equally efficacious in terms of routine airway management in adult patients with normal airway anatomy. [ABSTRACT FROM AUTHOR]

Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2-6 years of American Society of Anesthesiologists Physical Status I-II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cm H2O as compared to 26.1 ± 3.8 cmH2O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar. [ABSTRACT FROM AUTHOR]

Objective: I-gel is a noncuff type of laryngeal airway mask. No horizontal line has yet been determined as an ideal position for pediatric sizes because of the variability in length of the oropharyngeal-laryngeal arch in children. We investigated whether there is a correlation between insertion length and patient body weight or height for the pediatric I-gel sizes from 1.5 to 2.5. Methods: With parental informed consent, we planned to maintain the airway of 130 children aged from 7 months to 13 years by using the I-gel device under general anesthesia. The following two parameters were evaluated: (1) distance between the teeth and the connector wing; (2) insertion length (distance from the distal end of the gastric tube to the teeth). Size selection was determined on the basis of patients' body weight. We identified the relationship between each parameter and height or weight. Results: Average insertion length became gradually longer with increasing height and weight. Spearman's R between insertion length and height or weight was 0.8. There was more correlation with height than with weight in pediatric size 2.5. Conclusion: Results suggested that it is possible to draw an ideal line on the I-gel with sizes 1.5 and 2 only. [ABSTRACT FROM AUTHOR]

Almost all supraglottic airways (SGAs) are now available in pediatric sizes. The availability of these smaller sizes, especially in the last five years has brought a marked change in the whole approach to airway management in children. SGAs are now used for laparoscopic surgeries, head and neck surgeries, remote anesthesia; and for ventilation during resuscitation. A large number of reports have described the use of SGAs in difficult airway situations, either as a primary or a rescue airway. Despite this expanded usage, there remains little evidence to support its usage in prolonged surgeries and in the intensive care unit. This article presents an overview of the current options available, suitability of one over the other and reviews the published data relating to each device. In this review, the author also addresses some of the general concerns regarding the use of SGAs and explores newer roles of their use in children. [ABSTRACT FROM AUTHOR]

Purpose: We compared the insertion performance of the pediatric size 1.5-3 i-gel airway device with that of the ProSeal laryngeal mask airway (PLMA) in anesthetized children in a prospective, randomized, controlled manner. Methods: We included 134 children, aged 3 months to 15 years, scheduled for elective surgery under general anesthesia. They were randomly divided into the i-gel and the PLMA groups according to the airway device used. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were ease of insertion, required time for insertion, fiberoptic view, and first-attempt and overall success rates. Results: There were no differences in the ease of insertion, insertion time, or leak pressure between the devices. Fiberoptic view was significantly better with the i-gel than with the PLMA ( P = 0.002). The view was significantly better with the sizes 2, 2.5, and 3 i-gel than with the size 1.5 i-gel ( P = 0.02, 0.004 and 0.002, respectively), and the view was significantly better with the sizes 2.5 and 3 PLMA than with the size 1.5 PLMA ( P = 0.02 and 0.005, respectively). The first-attempt success rates were 94 and 97 % in the i-gel and the PLMA groups, respectively; the success rates including the second attempt were 100 % in both groups. No children developed side effects requiring treatment with either device. Conclusion: Both the pediatric i-gel and the PLMA were successfully inserted in children. The fiberoptic view was better with the i-gel than with the PLMA. [ABSTRACT FROM AUTHOR]

Purpose: Insertion of a laryngeal mask airway (LMA) is occasionally difficult in children because of their anatomical features and variations. A new single-use supraglottic airway device, the i-gel airway, was recently introduced. The objective of this study was to show the initial experience of the i-gel airway device by the residents for pediatric patients. Methods: With approval from the local ethics committee and parental informed consent, 70 children undergoing minor surgery in the supine position, ASA score I-II, were investigated. Exclusion included patients having thoracic, neurosurgical, spine, and otolaryngological procedures. Patients were divided into three groups: group 1 was airway size 1.5 for patients weighing 5-12 kg, group 2 was size 2 for 10-25 kg, and group 3 was size 2.5 for those weighing 25-35 kg. The following seven characteristics were evaluated: (1) ease of the i-gel and gastric tube insertion; (2) leak pressure; (3) tidal volume/body weight at leak pressure point; (4) fiberscope score; (5) insertion time; (6) hypoxia rate (laryngospasm); and (7) coughing and trace of bleeding. Results: The overall insertion success rate and the success rate at first attempt were 99% and 94%, respectively. Gastric tube insertions were easy in all patients. The overall leak pressure was 23 ± 5 cmHO. The tidal volume per body weight was 24 ± 10 ml/kg. A good view of the fiberscope was achieved in 79%. In group 1 (size 1.5), one failed insertion, two dislocations, and one dysphonia were observed. Hypoxia rate was 1%. There was no case with coughing and trace of bleeding. Conclusion: These results show that the i-gel airway is a safe and effective device for use by residents who do not have experience with insertion of a pediatric LMA. However, using size 1.5, special caution should be taken to protect the infant airway, similar to what has been previously reported for other airway devices. [ABSTRACT FROM AUTHOR]

Supraglottic airway devices have been increasingly used because of their several advantages. Previous studies showed that the small-sized i-gel provides effective ventilation for young pediatric patients; however, few studies have reported the use of AuraGain in these patients. Herein, we compared the clinical performance of AuraGain and i-gel in young pediatric patients aged between 6 months and 6 years old and weighing 5–20 kg, who were scheduled to undergo extremity surgery under general anesthesia. In total, 68 patients were enrolled and randomly allocated into two groups: AuraGain group and i-gel group. The primary outcome was the requirement of additional airway maneuvers. We also analyzed insertion parameters, fiberoptic bronchoscopic view, oropharyngeal leak pressure, and peri-operative adverse effects. Compared with the AuraGain group, the i-gel group required more additional airway maneuvers during the placement of the device and maintenance of ventilation. The fiberoptic view was better in the AuraGain group than in the i-gel group. However, the oropharyngeal leak pressure was higher in the i-gel group. AuraGain might be a better choice over i-gel considering the requirement of additional airway maneuvers. However, when a higher oropharyngeal leak pressure is required, the i-gel is more beneficial than AuraGain. [ABSTRACT FROM AUTHOR]