Randomized controlled trial to compare i-gel guided intubation by two insertion techniques: conventional vs. reverse

Authors: THONGAM SHEITYABALA DEVI, SASWATI DAS, AYESHA PATTNAIK, SHREYASI MALLICK

DOI: 10.18231/j.ijca.11805.1760329284

Keywords: airway management, intubation, supraglottic device, i-gel,difficult airway

Abstract: Background and Aims: Supraglottic airway (SGA) devices have become an integral part of airway management as they can secure the airway and serve as a conduit for tracheal intubation. In this study, we aimed to compare the efficacy of two insertion methods for i-gel placement, namely conventional and reverse techniques, in terms of first-attempt success rate and ease of blind intubation. Methods: The study included 80 patients aged 18- 60 years of American Society of Anesthesiologists class I and II, randomly assigned to two groups. In Group C, i-gel was inserted using the conventional technique, and in Group R, using the reverse technique. Blind tracheal intubation was attempted in both groups after successful i-gel placement, and first attempt success rate of intubation, the number of attempts as well as time taken to intubate the patient through i-gel was compared in both the groups. Results: Insertion of i-gel was easier in Group R, with a higher first attempt success rate (97.5%, p=0.002) with a higher oropharyngeal leak pressure (OLP) (34.25±2.42 vs 28.07±3.68, p=0.003), indicating improved placement using this technique. Group R had 32.5% successful intubations through the i-gel in the first attempt, whereas it was 12.5% in Group C (p=0.005). Mean insertion time for successful intubation was less in Group R (17.97±3.69sec vs. 22.7±9.46 secs, p=0.014). Post-operative complications were minimal in both the groups and was not statistically significant. Conclusion: This study concluded that the reverse technique placement of i-gel facilitates smoother insertion of the i-gel and allows a better chance of first-attempt blind tracheal intubation. Hence it is a superior alternative to the conventional method for i-gel insertion.