Efficiency of I-gel supraglottic airway device during mechanical ventilation in supine and lateral decubitus position in obese patient; prospective observational study

ABSTRACT

Background

I-gel supraglottic airway device has been widely used recently in anesthesia practice as an alternative to endotracheal intubation. However, its safety and feasibility in obese patients are still under investigations. The aim of this work was to evaluate the efficiency of I-gel in supine and lateral position in adult obese (BMI 30–40) mechanically ventilated patients undergoing short surgical procedures (60 − 120 min).

Methods

Prospective observational study was conducted at Kasr Alainy Hospital. A total of 40 obese patients with body mass index 30–40 aged between 20 and 60 years, American Society of Anesthesiologists class II & III scheduled for elective surgeries were enrolled in one group. We used the I-gel in supine position and lateral position in the same patient.

The primary outcome was comparison between Oropharyngeal leak airway pressure during controlled ventilation in supine position after insertion of I-gel by 1 min and in lateral position. The secondary outcomes were fiberoptic view , insertion attempts and postoperative upper airway complications

Results

The leakage pressure required for I-gel did not show statistically significant difference between both supine and lateral positions (33.88 ± 7.34 cmH₂O versus 33.10 ± 7.58 cmH₂O) respectively. Fiberoptic view ranged between score 2 (8 patients) and score 3 (32 patients) in both supine and lateral position. I-gel was inserted in the first trial in 37 patients, the second trial in two patients and the third trial in one patient. None of the patients experienced postoperative swallowing difficulties, throat pain, hoarseness or postoperative nausea and vomiting. Only two patients (5%) showed blood on I-gel after removal.

Conclusion

The use of I-gel supraglottic airway device is safe and effective in both supine and lateral position in obese patients under mechanical ventilation with reliable ventilation and no postoperative airway complications.

Clinical trial registration

clinicaltrial.gov. ID: NCT04119245

KEYWORDS:

• I-gel supraglottic airway device
• obese patient
• oropharyngeal leak airway pressure
• fiberoptic view

Acknowledgments

We would like to thank our professors and colleagues in the Anaesthesia Department of Cairo University for their help and support.

Availability of data and material

The data that support the findings of this study are the possession of the Cairo University Hospital. However, data are available from the corresponding author upon reasonable request after permission from Cairo University.

Authors’ contributions

BA and IF were responsible for idea conception of the study. BA, HM and IF contributed to the study design, data analysis, and manuscript writing. MW, BA and IF contributed to the data collection. BA, IF, MH, HM and MW contributed to the manuscript writing and revision. All the authors have read, revised and approved the final manuscript.

Disclosure statement

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Ethics approval from the Cairo University Hospital Research Committee - Department of Anaesthesia was obtained (S-12-2019). Written informed consent was obtained from the participants before inclusion.

Additional information

Funding

No funding was obtained for this study. This research was conducted at the Cairo University Hospital using the equipment and resources available.