Comparison of fiberoptic intubation using i-gel® Plus and standard i-gel® : A Thiel-embalmed cadaveric study

Abstract

Purpose The supraglottic airway (SGA) is widely used. I-gel® Plus is a next-generation i-gel® with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel® Plus and standard i-gel® as a guide for FOI, a Thiel-embalmed cadaveric study was conducted. Methods Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel® Plus and standard i-gel® were inserted into one cadaver, and FOI was performed through each SGA. In Experiment 2, fiberoptic views of the vocal cords in each SGA were assessed using nine cadavers. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, time, number of attempts, VAS for difficulty of SGA insertion and gastric tube placement, and fiberoptic view of the vocal cords were evaluated as secondary outcomes. Results The time for FOI through i-gel® Plus was significantly shorter than that through standard i-gel® (median (IQR), i-gel® Plus: 30.5 (21.8–34.3) sec, vs standard i-gel®: 45.0 (28.0–89.0) sec; median of differences, 11.2 sec; 95% confidence interval, 7.1–41.3; P < 0.001). The number of attempts for successful FOI and the VAS for difficulty in the i-gel® Plus group were significantly lower than those in the standard i-gel® group. Moreover, i-gel® Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% percentage of glottic opening score. Conclusion FOI can be performed more easily using i-gel® Plus than using standard i-gel®.