Endotracheal intubation using i-gel® and lightwand in a patient with difficult airway: a case report

Abstract

This case report involves tracheal intubation using i-gel® in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel® was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel® and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel® and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…525 Case reports also observed intubation success for unanticipated and emergency airway patients when combination techniques were used (Category B4-B evidence). [526][527][528][529][530][531][532][533][534][535][536] The literature is insufficient to evaluate which of the above devices are most effective when attempted first after failed intubation, nor is the literature sufficient to evaluate the most effective order of devices to be used for attempted intubation of an unanticipated or emergency difficult airway.…”

Optimal propofol dosage for i-gel® insertion in healthy paralyzed patients

“…Supraglottic airway devices (SADs) such as laryngeal mask airway (LMA) Classic™, LMA ProSeal™, LMA Supreme®, and i-gel® can be used for emergency situations with failed tracheal intubation, as well as for elective inpatient or outpatient surgery under general anesthesia [ 1 2 3 ]. Despite the risk of gastric insufflation and regurgitation, SADs have advantages over tracheal intubation, including a decreased incidence of postoperative sore throat and coughing, improved hemodynamic stability, and reduced anesthetic requirements [ 4 ].…”

Use of an Airway Exchange Catheter for Removal of an I-Gel Airway

“…They can be easily placed without direct visualisation of the larynx and usually enable adequate ventilation. Endotracheal intubation through the i-gel has been found to be reasonably successful, and the success rate can be increased further by facilitating endotracheal tube (ETT) placement using a fibreoptic bronchoscope or light wand ( 1 , 2 ). In addition, the i-gel has a rapid insertion time and is a reliable device to quickly establish the airway allowing for oxygenation and ventilation.…”

“…The use of a silicone pusher from the ILMA set ( 5 ) and a nasopharyngeal airway ( 6 ) may help facilitate i-gel removal. Other anaesthesiologists have placed a ventilating bougie or airway exchange catheter (AEC) through the i-gel and then removed the i-gel, after which an appropriate size and type of ETT can be railroaded over the bougie or catheter ( 2 ). However, reintubation over an AEC is not always easy because a relatively large and stiff adult ETT, with its sharp leading edge, can get caught on either the corniculate or arytenoid cartilages or on the glottic structures.…”