Application of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients

A stepwise lung recruitment maneuver using I-gel can improve respiratory parameters: A prospective observational study

I-gel has been used in various clinical situations. The study investigated alterations in respiratory parameters following a stepwise lung recruitment maneuver (LRM) using the i-gel. The research involved 60 patients classified as American Society of Anesthesiologists class I-II, aged 30 to 75 years, undergoing elective urologic surgery. Various respiratory parameters, including lung compliance, airway resistance, leak volume, airway pressure, and oxygen reserve index, were recorded at different time points: before LRM, immediately after LRM, and at 5, 15, and 30 minutes after LRM, as well as at the end of the surgery. The primary outcome was to assess an improvement in lung compliance. Dynamic lung compliance (mean ± SD) was significantly increased from 49.2 ± 1.8 to 70.15 ± 3.2 mL/cmH2O (P < .05) after LRM. Static lung compliance (mean ± SD) was increased considerably from 52.4 ± 1.7 to 65.0 ± 2.5 mL/cmH2O (P < .05) after the LRM. Both parameters maintained a statistically significant increased status for a certain period compared to baseline despite a decreased degree of increment. Airway resistance (mean ± SD) was significantly reduced after the LRM from 12.05 ± 0.56 to 10.41 ± 0.64 L/cmH2O/s (P < .05). Stepwise LRM using i-gel may improve lung compliance and airway resistance. Repeated procedures could lead to prolonged improvements in respiratory parameters.

Should positive end-expiratory pressure be used during elective general anaesthesia with supraglottic airway devices?

Anaesthetists' use of positive end-expiratory pressure during elective general anaesthesia via supraglottic airway devices varies. Positive end-expiratory pressure may help to maintain oxygenation and prevent atelectasis, but could worsen the risk of air leak, gastric insufflation and catastrophic aspiration.

Head elevation and laryngeal mask airway Supreme insertion: A randomized controlled trial

BACKGROUND

A laryngeal mask airway (LMA) is usually inserted by conventional 7 cm head elevation. However, little is known about the association of head elevation degree and LMA insertion. We hypothesized that 14 cm head elevation would increase the first attempt success rate of LMA Supreme insertion compared with conventional 7 cm head elevation in patients undergoing transurethral resection of bladder tumour.

METHODS

Patients were randomly allocated to the high group (n = 55, 14 cm head elevation) or the control group (n = 55, conventional 7 cm head elevation). The primary outcome was the first attempt success rate of LMA Supreme insertion.

RESULTS

The first attempt success rate was significantly higher in the high group than in the control group (53 [96.4%] vs 40 [72.7%], P = .001, relative risk = 1.30, 95% confidence interval [CI] = 1.12-1.57, absolute risk reduction = 23.7%). Fibreoptic bronchoscope grade 4 (ie optimal position of the LMA) was significantly higher in the high group (35 [64.8%] vs 18 [36.7%], P = .004, relative risk = 1.76, 95% CI = 1.16-2.68, absolute risk reduction = 30.9%).

CONCLUSIONS

Head elevation of 14 cm height increased the first attempt success rate of LMA Supreme insertion and fibreoptic bronchoscopic grade in patients undergoing transurethral resection of bladder tumour. High head elevation can be an effective option for successful LMA Supreme insertion. Trial Registry Number: Clinicaltrials.gov (NCT04229862).

I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position

Background

The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients.

Methods

In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period.

Results

In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge.

Conclusions

The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients.

Trial registration

Registered at Clinicaltrials.gov NCT02462915, registered on 1 June 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-016-0291-1) contains supplementary material, which is available to authorized users.

Comparison of I-gel with Classic Laryngeal Mask Airway Regarding the Ease of Use and Clinical Performance

OBJECTIVE

I-gel is a new supraglottic airway device without an inflatable cuff. We aimed to compare I-gel and the classic laryngeal mask airway (LMA) regarding the ease of use and clinical performance in Turkish population.

METHODS

Fifty American Society of Anesthesiologists (ASA) I-II patients were randomly allocated into two groups: Group I-gel and Group LMA. Insertion time and success in first attempt were recorded. Peak, plato and mean airway pressures, EtCO2, airway compliance and leak volume were periodically recorded during the operation. The presence of blood on device removal and postoperative sore throat were also assessed.

RESULTS

The device insertion time in Group I-gel was shorter than that in Group LMA (21.00±4.15 vs. 30.40±12.17 s, p=0.001). The success rate in first attempt, peak, plato and mean airway pressures, EtCO2 and airway compliance did not differ between the groups. The leak volume was lower in Group I-gel 5 and 45 min after insertion (p=0.041 and p=0.027). The presence of blood on device removal and postoperative sore throat were similar in both groups.

CONCLUSION

I-gel may be a more advantageous supraglottic airway device compared with LMA.

Efficacy of laryngeal mask airway I-gel for airway management in patients undergoing laparoscopic cholecystectomy

AIM: To evaluate the efficacy of laryngeal mask airway I-gel for airway management in patients who underwent insertion of a nasogastric tube before laparoscopic cholecystectomy.

METHODS: Eighty-seven patients who would undergo laparoscopic surgery were randomly divided into three groups: Ⅰ, Ⅱ and Ⅲ (n = 29 each). Group Ⅰ underwent insertion of a nasogastric tube through the drain tube of laryngeal mask airway I-gel; group Ⅱ underwent insertion of a nasogastric tube through the nostril before surgery, retained the nasogastric tube during surgery, and then underwent insertion of a nasogastric tube not through the drain tube after placing laryngeal mask airway I-gel; group Ⅲ underwent insertion of a nasogastric tube through the nostril before surgery, retained the nasogastric tube during surgery, and then underwent insertion of a nasogastric tube through the drain tube after placing laryngeal mask airway I-gel. The anesthesia time, operative time, recovery time, laryngeal mask airway placement time, success rate of laryngeal mask airway placement at the first attempt, depth of placement, the time to laryngeal mask airway removal, bloodstains, gastroesophageal reflux and adverse reactions within 24 h after surgery were recorded. The fiberoptic laryngoscopy score, airway sealing pressure, and pH values at the tip of laryngeal mask airway and on the dorsal and ventral sides of the body of laryngeal mask airway were assessed after successful laryngeal mask airway placement.

RESULTS: The laryngeal mask airway placement time, depth of placement, success rate of laryngeal mask airway placement at the first attempt, airway sealing pressure, peak airway pressure, the time to laryngeal mask airway removal, and leakage of laryngeal mask airway showed no significant differences among the three groups (P > 0.05). The peak airway pressures in group Ⅰ (25.3 cmH₂O± 4.7 cmH₂Ovs 28.1 cmH₂O± 5.6 cmH₂O), group Ⅱ (24.6 cmH₂O± 3.8 cmH₂Ovs 29.2 cmH₂O± 5.8 cmH₂O), and group Ⅲ (24.3 cmH₂O± 3.1 cmH₂Ovs 30.4 cmH₂O± 6.2 cmH₂O) were significantly lower than airway sealing pressure (P < 0.05). There were no differences in mean arterial pressure, saturation of pulse oximetry or heart rate before and after placing laryngeal mask airway among the three groups (P > 0.05). The scores of fiberoptic laryngoscopy among the three groups did not differ significantly (P > 0.05). The rates of bloodstains, gastroesophageal reflux, pharyngalgia, and hoarseness among the three groups also showed no significant differences (P > 0.05). The pH values at the tip of laryngeal mask airway and on the dorsal and ventral sides of the body of laryngeal mask airway among the three groups also showed no significant differences (P > 0.05).

CONCLUSION: When patients undergo insertion of a nasogastric tube before laparoscopic cholecystectomy, insertion of laryngeal mask airway I-gel is easy, and laryngeal mask airway I-gel can assure a good airway sealing and adequate ventilation. The airway management using laryngeal mask airway I-gel is secure and efficient.