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The i-gel® supraglottic airway: a literature update

Christiaan Keijzer
29 July, 2013  
The i-gel system can significantly reduce the incidence of sore throat and dysphagia after surgery and has a number of advantages over other established supraglottal devices
Christiaan Keijzer MD PhD
Department of Anesthesiology and Intensive Care, 
The Netherlands Cancer Institute –
Antoni van Leeuwenhoek Hospital, 
Amsterdam, The Netherlands
The problem of postoperative sore throat for patients after the use of supraglottic device, such as a laryngeal mask for airway management, has been described previously.(1) Keijzer(1) compared the use of the i-gel® supraglotic airway with the disposable LaPremiere® laryngeal mask and found a significant reduction in the incidence of postoperative sore throat and dysphagia. The incidence of sore throat for the i-gel® was between 5 and 6% compared with 24–47% for the disposable laryngeal mask. For other supraglottic devices, incidences were reported in the literature of 16.8% for the ProSeal®, 22.6% for the Classic® laryngeal mask, 14.7% for the SoftSeal® and 7.9% for the LMA-Unique®.
The article hypothesised that the lower number of postoperative complaints in the i-gel® group is due to the smaller size of this device when compared with an inflated laryngeal mask. Also, the absence of an inflatable cuff could prevent possible tissue trauma around this device in the supraglottic area due to high cuff pressures.
A number of studies have been published in which the i-gel® was compared with other supraglottic airway devices. This article presents an overview of the literature from 2009 to 2013.
Paediatric i-gel®
Paediatric sizes of the i-gel® have been introduced and several study groups have compared these with other supraglottic paediatric-sized devices. 
ProSeal®
Three studies(2–4) compared the paediatric i-gel® with the equivalent ProSeal® laryngeal mask. A study by Mitra and colleagues(2) investigating 60 children and size 2.5 devices found the same ease of insertion for both devices but a higher seal pressure for the i-gel®. In a study of 134 children, Fukuhara and colleagues3 found similar insertion time, ease of insertion and similar leak pressures; this study also investigated the fiber optic grade of view, which was better for the i-gel® group. Another study(4) with 51 children found no differences between the groups for these parameters. Goyal and colleagues,(5) in a study of 150 children investigating the i-gel®, ProSeal® and Classic LMA®, demonstrated easier insertion and higher sealing pressure for the i-gel®. 
LMA Supreme®
One study(6) investigated these two devices in 168 children. Higher airway leak pressures were measured for the i-gel®. Other parameters, such as ease and time of insertion and fibre optic grade of view, were similar for both devices.
Classic LMA® and the AuraOnce® 
A study(7) in 99 children comparing the i-gel® with the Classic LMA® revealed similar leak pressure but a shorter insertion time and better glottic view in the i-gel® group. A study by Theiler and colleagues(8) in 208 children comparing AuraOnce® with i-gel® demonstrated shorter insertion time for the AuraOnce® but a higher seal pressure for the i-gel®.
Conclusions 
From these studies, it can be concluded that the paediatric i-gel® is a good alternative for other supraglottic devices. An advantage demonstrated in most studies is the higher seal pressure of the i-gel®.
Studies with the adult device
Several studies have been published comparing the i-gel® with other types of adult supraglottic device. A study with the Supreme® demonstrated similar results for ease of insertion and leak pressures.(9) Another study investigated the actual mucosal pressure through pressure sensors within the devices.(10) Pressures were comparable for both devices but pressures were higher in the hypopharynx than in the distal oropharynx and base of the tongue with the LMA Supreme®, whereas these pressures were equal for the i-gel®. 
This could explain why the i-gel® results in less postoperative throat complaints.  Studies(11–13) with the ProSeal®, Classic LMA® and the i-gel® demonstrated higher leak pressures for the i-gel® and overall easier insertion. Also, in one study,(11) a high incidence (28.5%) of postoperative sore throat was found for the Classic LMA®, whereas i-gel®® and ProSeal® had a comparable incidence of 7.8 and 9.4%, respectively. Studies(14–16) with the AuraOnce® and LMA Unique® compared with the i-gel® revealed higher leak pressures for the i-gel® and a lower incidence of postoperative sore throat when compared with the AuraOnce®.
Conclusions 
From the literature, it can be concluded that the i-gel® is a good alternative for other supraglottic devices and is often easier to use and results in higher leak/seal pressures. Studies have confirmed the previous findings of the NKI-AVL research group(17) in that the i-gel® results in fewer complaints of postoperative sore throat. 
References
  1. Keijzer C. Reducing postsurgical sore throat and dysphagia. Hosp Healthcare Eur 2012:257–8.
  2. Mitra S et al. Comparison of Size 2.5 i-gel™ with Proseal LMA™ in anaesthetised, paralyzed children undergoing elective surgery. N Am J Med Sci. 2012;4(10):453–7.
  3. Fukuhara A et al. A randomized comparison of the i-gel and the ProSeal laryngeal mask airway inpediatric patients: performance and fiberoptic findings. J Anesth 2012;Sep 11 [Epub ahead of print].
  4. Gasteiger L et al. LMA ProSeal(TM) vs. i-Gel(TM) in ventilated children: a randomised, crossover study using the size 2 mask. Acta Anaesthesiol Scand 2012;56(10):1321–4.
  5. Goyal R et al. Comparison of size 2 i-gel supraglottic airway with LMA-ProSeal™ and LMA-Classic™ in spontaneously breathing children undergoing elective surgery. Paediatr Anaesth 2012;22(4):355–9.
  6. Jagannathan N et al. A randomized equivalence trial comparing the i-gel and laryngeal mask airway Supreme in children. Paediatr Anaesth 2012;Nov 27 [Epub ahead of print].
  7. Lee JR et al. A randomised trial comparing the i-gel (TM) with the LMA Classic (TM) in children. Anaesthesia 2012 Jun;67(6):606–11.
  8. Theiler LG et al. Performance of the pediatric-sized i-gel compared with the Ambu AuraOnce laryngeal mask in anesthetized and ventilated children. Anesthesiology 2011;115(1):102–10.
  9. Eschertzhuber S et al. Directly measured mucosal pressures produced by the i-gel™ and Laryngeal Mask Airway Supreme™ in paralysed anaesthetised patients. Anaesthesia. 2012;67(4):407–10.
  10. Teoh WH et al. Comparison of the LMA Supreme vs the i-gel in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia 2010;65(12):1173–9.
  11. Shin WJ et al. The supraglottic airway I-gel in comparison with ProSeal laryngeal mask airway and classic laryngeal mask airway in anaesthetized patients. Eur J Anaesthesiol 2010;27(7):598–601.
  12. Singh J et al. 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. Indian J Anaesth 2012;56(4):348–52.
  13. Helmy AM et al. Comparative study between I-gel, a new supraglottic airway device, and classical laryngeal mask airway in anesthetized spontaneously ventilated patients. Saudi J Anaesth 2010;4(3):131–6.
  14. Donaldson W et al. i-gel™ vs. AuraOnce™ laryngeal mask for general anaesthesia with controlledventilation in paralyzed patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011;155(2):155–63.
  15. Weber U et al. Comparison of the i-gel and the LMA-Unique laryngeal mask airway in patients with mild to moderate obesity during elective short-term surgery. Anaesthesia 2011;66(6):481–7.
  16. Francksen H et al. A comparison of the i-gel with the LMA-Unique in non-paralysed anaesthetised adult patients. Anaesthesia 2009;64(10):1118–24.
  17. Keijzer C et al. A comparison of postoperative throat and neck complaints after the use of the i-gel and the La Premiere disposable laryngeal mask: a double-blinded, randomized, controlled trial. Anesth Analg 2009;109(4):1092–5.