Case series: protection from aspiration and failure of protection from aspiration with the i-gel airway †

Abstract

We present three patients of regurgitation while using the i-gel supraglottic airway in 280 patients. In two patients, the i-gel completely protected the airway from aspiration. In one patient, it did not provide complete protection. The i-gel has features designed to separate the airway and gastro-intestinal tracts and as such should offer some protection against aspiration. However, the efficacy of these features has not been confirmed, and further study is required to determine the safety profile of the device.

Evaluation of the size 4 i‐gel™ airway in one hundred non‐paralysed patients*

“…Two other cases of regurgitation whilst using the device have occurred in our hospital (patients not in this trial) in approximately 280 uses. In one case, the i-gel fully protected the airway; in the other case there was evidence of partial aspiration, though the patient made an uneventful recovery [27]. The incidence of regurgitation associated with the device is, however, almost certainly lower than this case series would suggest, as no other case reports have been published despite over 200 000 uses of the device (David Chapman, Intersurgical, personal communication).…”

I-Gel(tm) vs. Auraonce(tm) Laryngeal Mask for General Anaesthesia With Controlled Ventilation in Paralyzed Patients

“…The incidence of soiling on the inner aspect of both devices was low overall, being lower in the i-gel TM group. The phenomenon of visible regurgitation with the i-gel TM is now well documented 25,26 . The gastric channel allows early recognition of regurgitant gastric contents when placed correctly, although Gibbison's case series points out that this may not prevent ingression of gastric contents into the airway.…”

Is it time to revisit tracheal intubation for Cesarean delivery?

“…19 In another report on non-obstetric patients, the authors described two cases of emission of regurgitated fluid from the drainage tube with no airway soiling and a third case in which aspiration occurred with the i-gelÓ, another supraglottic device with a drainage tube. 20 The ''gold standard'' of general anesthesia for CD has been rapid sequence induction with tracheal intubation and cricoid pressure. However, the value of cricoid pressure as part of the rapid sequence induction technique has been challenged and debated.…”

“…19 Dans d'autres comptes rendus chez des patients non obstétricaux, des auteurs ont décrit deux cas d'émission de liquide régurgité par le tube de drainage, sans souillure des voies aériennes, et un troisième cas chez lequel une inhalation est survenue avec l'i-gelÓ, un autre dispositif supraglottique avec tube de drainage. 20 La « référence » pour l'anesthésie générale en cas de césarienne a été l'induction à séquence rapide avec intubation trachéale et pression cricoïdienne. Cependant, la contribution de la pression cricoïdienne dans le cadre de la technique d'induction à séquence rapide a été remise en cause et discutée.…”