The I-gel is a useful supraglottic device and can replace the need of tracheal intubation in elective cesarean section with no reported serious complications and low incidences of pharyngolaryngeal morbidity when compared to tracheal intubation.

Supraglottic airway devices have become a standard in airway management. These devices sit outside trachea but provide a hands free means of achieving a gas tight airway.

About I-Gel

  • The I-gel is a supraglottic airway device.
  • The soft non inflatable cuff fits closely on to the perilaryngeal frame work, mirroring the shape of the epiglottis, aeryepiglottic folds, piriform fossae, perithyroid, pericricoid, posterior cartilages and spaces.
  • The seal created is sufficient for both spontaneously breathing patients and for intermittent positive pressure ventilation.
  • It provides a better seal for positive pressure ventilation, separation of the respiratory from the alimentary tract.
  • The drain tube prevents gastric insufflations, allows easy placement of gastric tube it has been shown that the i-gel airway is better alternative device compared to proseal laryngeal mask airway (PLMA) for ease of insertion and maintenance of anesthesia.

Study design:

  • This study was conducted on 1000 cases scheduled for elective CS under general (because of patients and obstetricians preference) in the obstetric department.
  • All patients underwent preoperative assessment by history taking, Physical examination and laboratory investigations.
  • All patients received 150 mg ranitidine and 30 ml of sodium citrate (non particulate antacid), and 10 mg of metclopramide one hour before anesthesia.
  • All patients received preoxygenation for 3 min, anesthesia was induced by propofol 2 mg/kg, rocuronium 0.6 mg/kg, assisted positive pressure ventilation was done, the size 4 i-gel for 50-90 kg or size 5 for more than 90 kg was inserted after lubricating the device with a water-based lubricant according to manufacturer’s recommendations.

Findings:

  • The I-gel supraglottic airway provides an acceptable means of ventilation and oxygenation during elective Cesarean delivery.
  • No episode of hypercapnia or desaturation was observed.
  • I gel was useful in preventing the pressor response to laryngoscopy and tracheal intubation, which had particular importance in cardiac, hypertensive and pre-eclamptic patients.
  • Requires less time for insertion with minimal hemodynamic changes when compared to ETT.
  • Provides adequate positive-pressure ventilation, comparable with ETT.
  • Provides protection against aspiration.
  • Postoperative sore throat is a common adverse outcome in patients underwent surgeries.
  • The method used for airway management has the strongest influence on the incidence of sore throat.
  • The association between postoperative stay and sore throat could result from the discomfort of a sore throat early in the postoperative period making patients reluctant to go home.
  • The incidence of sore throat in this study was low, this could be explained by the ease of insertion, proper anatomic fit; no manipulations were required to adjust the device, with no inflatable cuff. Where postoperative sore throat is reported to be in excess of 25% with tracheal tube placement.

In conclusion, I-gel is a useful supraglottic device and can replace the need of tracheal intubation in elective cesarean section with no reported serious complications and low incidences of pharyngolaryngeal morbidity when compared to tracheal intubation.

Citation
Amin S, Fathy S (2016) Can I-Gel Replace Endotracheal Tube During Elective Cesarean Section? . J Anesth Clin Res 7: 605. doi: 10.4172/2155-6148.1000605

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