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Insertion of i-gel™ by the reversed technique improves the success rate and reduces the time taken for its placement: A prospective, randomized, controlled, interventional trial.

ABSTRACT: We hypothesized that the i-gel™ supra-glottic airway can be inserted with relative ease in a reversed manner just like a Guedel's airway.A prospective, randomized, controlled interventional trial was conducted on 100 patients to compare reversed insertion of the i-gel™ (Group R) with the conventional insertion (Group C). In Group C, i-gel™ was introduced in a conventional manner, whereas in the Group R, i-gel™ was introduced into the oral cavity with the concavity facing the hard palate. On reaching the oropharynx, the device was rotated 180° and advanced further until it fitted over the larynx. The time of insertion, ease, and placement appropriateness were compared.All patients completed the study. Better success rate of the first attempt insertion was achieved using the reversed technique (96% vs. 86%), but it was not statistically significant. Mean time required for i-gel™ insertion in Group R was 17.5 ± 6.9 s as compared to 20.8 ± 5.9 s in Group C, which was statistically significant. In Group R, it could be inserted within 20 s in 84% of cases, but only in 62% in Group C. The seal of the i-gel™ was similar in both the groups with the leak volumes (inspired - expired tidal volumes) being similar.Reversed insertion technique for the placement of i-gel™ resulted in appropriate placement with easier insertion and lower placement time than that with the conventional technique.

SUBMITTER: Sharda M

PROVIDER: S-EPMC5520597 | biostudies-other | 2017 Apr-Jun

REPOSITORIES: biostudies-other

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Project description:BackgroundProSeal (PLMA) and Supreme (SLMA) laryngeal mask airways are effective ventilator devices with distinctive designs that may require different anaesthetics for insertion. Sevoflurane induction provides acceptable conditions for laryngeal mask insertion, and remifentanil significantly decreases the minimum alveolar concentration of sevoflurane required for that insertion. The study aimed to evaluate the optimal end-tidal (ET) sevoflurane concentration for successful insertion of PLMA versus SLMA in patients receiving a remifentanil infusion without a neuromuscular blocking agent.MethodsAltogether, 45 patients ASA (American Society Anaesthesiologists) physical status I-II, aged 18-60 years were scheduled for elective ambulatory surgery. Exclusion criteria were a difficult airway, recent respiratory infection, reactive airway, obstructive sleep apnoea syndrome, gastric aspiration's risk factors, pregnancy, and lactation. Patients were randomly allocated to receive the SLMA or the PLMA. Sevoflurane induction with co-administration of remifentanil was performed at an effect-site concentration of 4 ng mL- 1. ET50 was calculated with a modified Dixon's up-and-down method (starting at 2.5% in steps of 0.5%). Predetermined sevoflurane concentration was kept constant during the 10 min before LMA insertion. Patient's response to LMA insertion was classified as "movement" or "no movement". Sevoflurane ET50 was determined as the midpoint concentration of all the independent pairs that manifested crossover from "movement" to "no movement".ResultsThe ET50 sevoflurane concentration co-administered with remifentanil required for PLMA insertion was 1.20 ± 0.41% (95% confidence interval 0.76 to 1.63%). For SLMA insertion, it was 0.55 ± 0.38% (95% confidence interval 0.14 to 0.95%) (p = 0.019).ConclusionsThe end-tidal sevoflurane concentration with co-administered remifentanil required to allow insertion of the SLMA was 54% lower than that needed for inserting the PLMA.Trial registrationClinicaltrials.gov identifier: NCT03003377. Retrospectively registered. Date of registration: December 28, 2016.

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Insertion of i-gel™ by the reversed technique improves the success rate and reduces the time taken for its placement: A prospective, randomized, controlled, interventional trial.

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