i-gel – News & Events

Exciting news! Today we are launching the new range of paediatric sizes at the Association of Anaesthetists Winter Meeting in London. If you’re going to this event please come along and see us and get a first look at the four new sizes. You can also see what Professor Diemunsch of Strasbourg University Hospital said about the trials of paediatric i-gel. The video is now online. If you would like to try the paediatric sizes please fill in the quick enquiry form and we’ll be in contact with you.

An interview with eminent consultant and Chairman of the EAMS (European Airway Management Society) Professor Pierre Diemunsch, has recently been published in the journal Capital Medical Equipment. An initial global study, involving the first 50 children undergoing ventilation using the i-gel paediatric device, was carried out over two months. In the article Professor Diemunsch describes the paediatric i-gel as ‘…the most successful device to be used in place of the traditional laryngeal mask’.
You can download the article in full here

This case report, published in Paediatric Anesthesia, highlighted the case of a 10 year old child, weighing 30kg, scheduled for an elective pyeloplasty. A size 3 i-gel was inserted and secured after confirming correct placement and a suction catheter inserted down the gastric channel. The child was positioned prone and the correct positioning of i-gel reconfirmed by appropraite CO2 wave form, absence of audible leak and chest auscultation. At the end of the procedure, the child was returned to a supine position and i-gel removed after reversal. The patient recovered without any complications.

Reference:
Link to abstract
 Successful use of the i-gel airway in prone position surgery.
Senthil Kumar M, Pandey R, Khanna P. Paediatric Anaesthesia. 2009 Feb; 19(2): 176-7.

This interesting paper, published in Resuscitation, compared i-gel to another supraglottic airway in a manikin cardiac arrest scenario. The study evaluated the effect use of these devices had on No-flow time (NFT). The authors stated that ‘an ideal supraglotic airway should be inserted rapidly with minimal training and it should enable controlled ventilation’. i-gel met these criteria during resuscitation in a manikin and NFT was kept as low as possible, consistent with ERC guidelines.

Reference
Link to abstract
Influence of airway management strategy on ‘no-flow-time’ in a standardized single rescuer manikin scenario (a comparison between LTS-D and i-gel: Wiese CHR, Bahr J, Popov AF, Hinz JM, Graf BM. Resuscitation 80 (2009) 100-103.

A study recently published in Acta Anaesthesiologica Scandinavica, evaluated i-gel in 50 children above 30kg undergoing short-duration surgery. The parameters measured included; ease of insertion, seal pressure, ease of inserting a gastric tube and post operative complications. The first time insertion success rate was 100%. No laryngeal leak occurred. The mean seal pressure was 24.9cm H₂0. The authors concluded that i-gel was very easy to insert and that ‘no learning curve is needed before a high success insertion rate is obtained’. ‘The i-gel appears to be safe for paediatric management.

Reference:
Link to abstract
The i-gel, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: An observational study in children: Beylacq L, Bordes M, Semjen F, Cros AM. Acta Anaesthesiol Scand 2009; 53: 376-379

Customers spoke and we listened. We’ve reduced the material content by 50%, so i-gel now has a significantly lower environmental impact than before. The new cradle (replacing the old ‘cage pack’) still retains the i-gel shape and offers a base for pre-insertion lubrication.

A number of studies, case reports and correspondence relating to the use of i-gel has already been published, but this is the first study to make a comparison of the device to cuffed tracheal tubes during pressure-controlled ventilation. In this study, published in the BJA, twenty-five patients were given a standard anaesthetic, followed by insertion of an i-gel. The lungs were ventilated at three different pressures and the difference between the inspired and expired tidal volumes used to calculate the leak volume and leak fraction. The i-gel was then removed and replaced with a conventional tracheal tube, for which similar readings were taken. The results were then compared. From the data taken, the authors concluded that, ‘compared with a tracheal tube there is no significant difference in the gas leak when using an i-gel during PCV with moderate airway pressures’. The complete study can be obtained at http://bja.oxfordjournals.org/cgi/content/abstract/102/2/264. Ref: Uppal V, Fletcher G, Kinsella J: Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. BJA 2009 102(2):264-268.

An interesting paper has been published in ‘Diving & Hyperbaric Medicine’, entitled, ‘Extraglottic airway devices for use in diving medicine – part 3. The i-gel’. This study looked at the use of i-gel in airway management of a patient in a diving bell or deck decompression chamber. The study highlighted the potential limitations of some supraglottic airways used in Hyperbaric Medicine, such as possible cuff expansion with a decrease in pressure on decompression and change in cuff volume due to gas diffusion as the gas mixtures breathed change, problems not associated with i-gel.  It showed that, subjectively, there was no change in the consistency of the i-gel at 203 and 283kPa pressure and that no bubbles were detected following decompression from 203, 283 or 608kPa. The i-gel was also preferred by the Diver Medical Technician’s (DMT’s) to the alternative device included in the manikin section of the study because it ‘lacked a cuff and was easier to insert from any position’. For further details we would recommend contacting the South Pacific Underwater Medicine Society at http://www.spums.org.au/.
Ref: Acott CJ: Extraglottic airway devices for use in diving medicine – part 3: The i-gel: Diving and Hyperbaric Medicine. 2008;38: 124-7.

Two new clinical papers have been published on the i-gel, links to the abstracts are here: ‘The i-gel airway for Difficult Intubation’ and ‘Observational Study of a Newly Developed Supraglottic Airway’

i-gel was showcased at the recent SFAR (Societe Francaise d’Anesthesie et de Reanimation) conference in Paris. A team of 12 individuals from Intersurgical were in attendance. The stand was inundated with delegates, as you can see by the picture, eager to take a look at the i-gel and see it in action on a mannikin. The inventor of the i-gel, Dr. Mohammed Nasir, was in attendance and was happy to answer questions about the product. Take a look at the events calendar to see where you can see i-gel in the future.

The correspondence section of the September edition of ‘Anaesthesia’, includes a letter from three anaesthetists at the Royal United Hospital Bath, UK, describing successful airway rescue with an i-gel in a case of failed ventilation and predicted difficult intubation, after two other well known competitor brands of supraglottic airway had failed.

The patient, a middle-aged obese female, scheduled for an elective hand operation, had a Mallampati score of 3 and mouth opening of 3cm. Following induction of anaesthesia, facemask ventilation with an oropharyngeal airway was found to be extremely difficult and oxygenation saturation fell rapidly. Two other well known brands of supraglottic airway were initially tried, but although insertion with both was performed easily, ventilation was not possible with either device. Rescue facemask ventilation again proved difficult and a size 4 i-gel was easily inserted. i-gel, ‘immediately provided unobstructed ventilation and stable oxygen saturation  of 98%’. IPPV produced ‘good ventilation and peak airway pressures of 25cm H2O for the remainder of the case’.

The authors comment on the potential role of the device in airway rescue where other more established supraglottic airway devices have failed. They also report that discussion with colleagues revealed that two other anaesthetists had also experienced cases where i-gel had been used successfully after the failure of other supraglottic airways. They concluded that, ‘the i-gel’s role in difficult airway management remains to be established’, but certain features of the device make it a, ‘potentially useful airway device in cases of difficult mask ventilation’. The complete correspondence can be obtained from the following link; http://www3.interscience.wiley.com/journal/121371462/abstract