I-Gel: The New Supraglottic Device. Will It Get To be Recomemnded As One of the Alternatives Airway in the Next Resus Guidelines?

The above image is linked from http://www.hospital-int.net/images/companies/1702/igel-airway-management-2b.jpg

We are seeing a promising new supraglottic device joining in the armamentarium of airway devices designed to be inserted as easy as possible, in the shortest possible time, and in a manner as secure and as good as endotracheal intubation in terms of its ability for prevention of aspiration.

I-gel is the new supraglottic device that is seeing positive results from clinical trials so far, and might even be advocated as one of the alternative option in advanced life support.

One study has shown that Pro-Seal LMA and igel were both faster to insert than the cLMA and offer additional benefits.

In another study, insertion success rate was shown to be 97%. Insertion was easy and performed at the first attempt in every patient. Mean seal pressure was 30 ± 7 cm H2O, and average peak pressure was 11 ± 3 cm H2O. The gastric tube was inserted in 100% of cases. Only one case of coughing and one mild sore throat occurred.

I-gel can be rapidly inserted in both manikins and patients by novice users and compares favourably to other supraglottic airways available.

In yet another study, median airway seal was 20 cmH2O (range 13–40) [another study shows that it is 30 cm H2O]. One case of regurgitation and partial aspiration occurred.

I-gel effectively conforms to the perilaryngeal anatomy despite the lack of an inflatable cuff and it consistently achieved proper positioning for supraglottic ventilation.

Click here for a list of the studies on I-gel.

Athough I-gel is currently not widely used, and not available in Malaysia, it has shown promising results, and agents may soon be swarming in promoting the device especially if this device really gets to be listed as a recommendation in the next resuscitation guidelines.

Disclaimer: I have no part in the company that sells I-gel, InterSurgical Ltd; neither am I affiliated to them but you can visit their homepage to download a copy of the I-gel instruction manual to better understand the simplicity and their features (also to watch a video on insertion).

Airway Management in Maxillofacial Injuries

This patient, involved in motor-vehicle accident was referred from a district hospital with an oral airway in situ. His upper lip was badly lacerated and swollen.

His initial GCS when admitted to us was 5/15.
His breathing was stridorous.

I would have preferred that this patient's airway be secured properly through endotracheal intubation before transfer.

Airway management is of paramount importance in cases of maxillofacial injuries such as this case.

This is because
1. The maxillofacial injuries causes swelling and distortion of the face, thus obstructing the airway for the patient and making access to airway difficult to the emergency physician

2. The bleeding can be profuse, like in this case and coupled with the fact that patient may sustain head injuries together, his conscious level is poor (in this case, the GCS on admission was 5/15) and a very high chance of aspiration

3. In the case that the patient sustain mandibular fracture resulting in a flail mandible, resulting in the loss of support for the tongue. The tongue can fall backwards and obstruct the airway.

4. Other loose structures, like loose dentures or teeth can also obstruct the airway.

Cases like this, almost always, or should I say, all of these cases require aggressive airway management including early endotracheal intubation. Of course, at the same time this should alert us of difficult airways.

For further reading:
An excellent, short and sweet article can be downloaded free (in *.pdf) from EMJ online (past issues). Click here