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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A1077
October 20, 2009 9:00 AM - 11:00 AM Room Area E |
| Gum Elastic Bougie Guided I-Gel Airway Insertion Is More Efficient Compared to Standard Technique |
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Rashid M. Khan, M.D., G. Nikhil, M.D., N. Kaul, M.D., Sameer M. Maroof, B.S., Med. Student, A. Sumant, M.D. Anesthesiology & ICU, Nova Southeasthern University & National Trauma Centre, Muscat, Oman |
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Introduction
: I-gel
Tm
airway (IGA) is a cuffless supraglottic device introduced by Intersurgical Ltd, Wokingham, Berkshire, UK. When correctly placed, the distal end of the gastric channel should be located in the upper oesophageal opening and the cuffless bowl should surround the perilaryngeal structure. However on occasions, the device fails to provide adequate ventilation or entry of the nasogastric tube into the oesophagus via its gastric channel. We hypothesize that placing the IGA over a preplaced gum elastic bougie (figure 1) should not only aid its insertion but also assure best approximation of the distal end of the gastric channel.[figure1]
Methods:
After approval by the IRB and informed consent, 50 adult patients of ASA grade I and II scheduled for elective surgical procedures were selected for this prospective, randomized, double blind study. Anesthesia was induced with propofol 2-3 mg/kg. Patients were randomly assigned to one of the 2 groups. In Group I patients, IGA was placed unaided as per manufacturer's instructions [1]; while in Group II patients, IGA was railroaded over a preplaced gum elastic bougie using the gastric channel as the conduit.
Ease of IGA placement was judged by the time and attempts taken to place the device. Placement time was recorded in seconds from entry of the distal device tip between the incisors to the first recording of capnographic curve. Failure to insert the device correctly within 60 seconds was to be considered as an attempt. Maximum of three attempts were allowed. Approximation of distal end of gastric channel of IGA to the upper end of the oesophagus was noted by the ease of nasogastric tube passage via the gastric channel [Grade 1= smooth passage in the first attempt, Grade 2= passed with some resistance, Grade 3= failed placement]. Percentage Of Glottic Opening [POGO] recorded as viewed by flexible fiberscope [Grade 1= POGO score 100%, Grade 2= POGO score >50%, Grade 3= POGO <50%, Grade 4= POGO score 0], the leak test as noted by movement of cotton wisp held near the proximal end of the drain channel [negative or positive]. Results : In one of the Group I patients, POGO score of Grade 4 was noted versus none in Group II. In all patients of Group II, Igel could be successfully placed in the first attempt. In contrast, one patient in Group I needed three attempts for its successful placement. Time needed to place the device successfully in both the groups was nearly identical and showed no significant difference [p>0.05], Ieak was observed in 4 patients [16%] of Group 1. In three of these patients, Ryle's tube needed more than one attempt for successful placement [p<0.05]. References : 1. I-gel User Guide. Intersurgical Ltd, Berkshire RG41 2RZ. From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists. |
Figure 1
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