European Journal of Cardiovascular Medicine

Background: Securing airway is a vital skill for anaesthesiologists. Difficulty in securing airway can lead to catastrophic results. The cuffed endotracheal tube is considered as gold standard for providing a safe airway. Laryngoscopy and endotracheal intubation produce reflex sympathoadrenal stimulation. The supraglottic airway device is a novel equipment that fills the gap in airway management between tracheal intubation and use of face mask. I-gel (Intersurgical Ltd., Wokingham, UK) is a relatively new supraglottic airway device with a non-inflatable cuff, made up of soft gel like, transparent thermoplastic elastomer. Aim and objectives: To compare standard, reverse and rotational techniques of i-gel placement in terms of insertion characteristics and success rate. Materials and Methods: A randomized prospective study, was undertaken at Government Dharmapuri Medical College and Hospital, Dharmapuri during the academic year from 2020 to October 2022. Ninety patients (N=90), scheduled for various elective surgical procedures undergoing general anaesthesia belonging to ASA class I and II were included in the study. The participants were divided into 3 groups of 30 participants based on the techniques used for i-gel insertion. Results: There was no statistically significant difference in the age, ASA grading, Mallampatti class between the 3 groups. There was no statistically significant difference in the ease of insertion between the groups. The median attempts for insertion in all three groups was 1 attempt. Chin lift manoeuvre had to be performed in 2 participants in the standard insertion group. The mean time taken for insertion (in seconds) was 20.33 ± 4.05 in standard technique group, 19.47 ± 4.67 in reverse technique group and 19.67 ± 4.26 in rotational technique group and the mean difference was not statistically significant. There was no significant difference in the mean leak pressure across the groups. Maximum number (N=7) complications was seen in standard technique group. There was no significant difference in heart rate measured at 1 min, 3min and 5min across the group. There was significant difference in MAP at 1min (p=0.01), 3min (p=0.001) and 5 min (p=0.062) across the groups with highest mean MAP measured in standard technique group. Conclusion: The three insertion techniques are suitable for routine use in maintaining anaesthesia in spontaneously breathing patients under general anaesthesia with normal airways. By all methods I-Gel appear to be effective in providing a clinically patent airway and have a high rate of insertion success, no hemodynamic changes, and low morbidity.