Supraglottic Airway Devices for Elective Pediatric Anesthesia: I-gel versus Air-Q, Which is the Best?

Abstract

Objectives: The objectives of the study were to compare the insertion facility, the effect on hemodynamic parameters, and effective ventilation using I-gel versus Air-Q supraglottic airway devices (SADs) for pediatric patients undergoing short-duration surgical procedures.

Patients and methods: One hundred and fifty children aged 3-10 years were randomly divided into two equal groups: Group I received I-gel and Group Q received Air-Q SAD. All patients were anesthetized by sevoflurane inhalation using a face mask without neuromuscular blockade. Study outcomes included SAD insertion success rate (SR), insertion time, anatomic alignment of the SAD to the larynx as judged using fiberoptic bronchoscope (FOB) inserted through the SAD, and tidal volume leak, and incidence of postoperative complications.

Results: Total and first attempt SRs were 97.3% and 85.3% for I-gel and 94.7% and 82.7% respectively, for Air-Q with nonsignificant differences. However, I-gel insertion time (12.3 ± 3.6 s.) was significantly (P = 0.034) shorter than Air-Q (13.7 ± 4.2 s). FOB grading of laryngeal view through SAD was better with I-gel but without significant difference for patients who had view Grades 1-2. Percentage of tidal volume loss was significantly decreased at 5 min after insertion than immediately after insertion, in all patients, with a nonsignificant difference in favor of I-gel. Intraoperative hemodynamic changes and postoperative complications showed a nonsignificant difference between both the groups.

Conclusion: Both Air-Q and I-gel SAD provided advantages for pediatric anesthesia during short-duration surgical procedure with nonsignificant differences. However, I-gel SAD required a shorter insertion time and provided a high SR which is satisfactory for trainees and during an emergency. I-gel SAD allowed minimization of tidal volume leak and gastric inflation and is associated with infrequent complications.

Keywords: Air-Q; I-gel; insertion success rate; insertion time; postinsertion complications; supraglottic airway devices.

Figure 1

Consort flow sheet

Figure 2

Patients’ distribution according to times of attempts for device insertion

Figure 3

Mean (±standard deviation) of device insertion time [significant differnces]

Figure 4

Distribution of patients had successful insertion according to fiberoptic bronchoscope grading of laryngeal view through the device

Figure 5

Mean tidal volume loss immediately and 5 min after insertion study outcomes included