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Randomized Controlled Trial
. 2017 Jan 6;17(1):3.
doi: 10.1186/s12871-016-0291-1.

I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position

Chih-Jun Lai  1 , Chih-Min Liu  2 , Chun-Yu Wu  2 , Feng-Fang Tsai  2 , Ping-Huei Tseng  3 , Shou-Zen Fan  4
Affiliations
Randomized Controlled Trial

I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position

Chih-Jun Lai et al. BMC Anesthesiol. .

Abstract

Background: The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients.

Methods: In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period.

Results: In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge.

Conclusions: The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients.

Trial registration: Registered at Clinicaltrials.gov NCT02462915 , registered on 1 June 2015.

Keywords: Endotracheal tube; Laparoscopic surgery; Leak fraction; Pneumoperitoneum; Respiratory parameters; Trendelenburg position; i-gel.

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Figures

Fig. 1
Fig. 1
Illustration of experimental settings. a GE S/5 compact anesthesia monitor (GE Healthcare, Helsinki, Finland). b spirometry tube (GE Healthcare, Helsinki, Finland). c D-lite sensor (GE Healthcare, Helsinki, Finland)
Fig. 2
Fig. 2
Study flow diagram. ETT: endotracheal tube
Fig. 3
Fig. 3
Boxplot of leak fraction for i-gel and ETT groups. Data are median [IQR]. ETT: endotracheal tube
Fig. 4
Fig. 4
The force causes less leak fraction in the LPT position than in the supine position. a Body weight force. b Component of body weight and cephalic shifting pressure due to LPT position. c LPT position induced force on the diaphragm. d Force caused by pneumoperitoneum. e LPT position induced pressure on the stomach. LPT: Laparoscopic pneumoperitoneum and Trendelenburg
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