Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

Abstract

Purpose:The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening.Methods:Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern.Results:Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000). Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H20; P=0.00). Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7%) successes and 2/24(8.3%) failure and for cLMA, 19/24 (79.16%) successes and 5/24 (16.7%) failure in the first attempt.Conclusion:The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

A systematic review and meta‐analysis of the i‐gel® vs laryngeal mask airway in adults

“…1 and Table 1), five of which were crossover studies [29,39,41,42,44]. All participants underwent elective surgery.…”

“…Fifteen RCTs included paralysed participants. Two RCTs included patients with anticipated or simulated difficult airways [39,41]. The RCTs recruited relatively few participants and were conducted at single centres using different protocols.…”

“…We may have missed studies that were not indexed in the databases we searched, although there was no funnel plot asymmetry that might be caused by publication bias. We were unable to extract from crossover RCTs paired data or data from the first period, which we therefore conservatively analysed as parallel group studies [29,39,41,42,44]. We did not consider the possibility of carry-over effect for the outcomes of interest other than for sore throat.…”

Airway management in a pediatric patient with post-burn neck contracture using i-gel

“…I-gel has a thermoplastic cuff with a soft pliable consistency, and no inflation is necessary (Fig.3). Compatibility with perilaryngeal tissues and stability after application are the advantages of this technique [8]. Using I-gel compared to LMA, Singh et al in terms of ventilation time, airway leakage pressure, and fiberoptic view, They reported significantly greater success with I-gel than with LMA [9].…”

A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

“…Similarly Trivedi et al and Chauhan et al found i-gel airway was easier to insert with less attempt when compared to PLMA. 9,12,16,17 Das et al had observed higher number of manipulations to insert LMA than i-gel. 18 In our study device was placed in first attempt in 88% patients of group i-gel compared to 64% of group LMA.…”