An audit of the i-gel supraglottic airway for general anaesthesia with spontaneous and controlled ventilation – the effect of ventilation mode and operator experience on device performance

Summary

Objective:
The i-gel supraglottic airway has features that may confer advantage over the standard laryngeal mask in terms of performance and postoperative complications.

Design:
Prospective observational study (clinical audit).

Setting:
Anaesthetic department of district general teaching hospital.

Material and methods:
We carried out a prospective audit of 96 i-gel insertions in order to assess insertion success rate, airway leak associated with a mode of ventilation and postoperative complications. The i-gel was inserted in theatre settings for general surgery, gynaecology, urology and vascular surgical procedures. Data collected included patient and operator demographics, information about device insertion, the presence of blood or gastric fluid on the device after removal and postoperative complications: sore throat, sore tongue, difficulty speaking, difficulty swallowing, nausea and vomiting. The performances of experienced and inexperienced operators were compared.

Results:
The i-gel was used with spontaneous ventilation in 35 (36.5%) of patients, while 61 (63.5%) of patients were ventilated with assisted or controlled mode. The device was inserted at the first attempt in 86.5% cases, at the second attempt in 9.4% and in 4.2% of patients three or more attempts were necessary. A minor leak was noted in 15.6% while in 17.7% of cases repositioning was required after insertion. The presence of blood on the device was noted in 5.2% of the patients and 9.4% of patients described sore throat postoperatively. No patients complained of sore throat at 48 hrs. There was no statistical difference between any variables between experienced and inexperienced operators. A leak was more often seen with controlled ventilation (P = 0.03).

Conclusion:
The device proved relatively easy to insert, performed well under both spontaneous and controlled ventilation and was well tolerated by patients.

Keywords:
i-gel supraglottic airway – laryngeal mask airway – complications