Anesthesiology Department, Metaxa Hospital of Piraeus, Piraeus, Greece.
Eur J Emerg Med. 2012 Feb;19(1):24-7. doi: 10.1097/MEJ.0b013e3283474ab3.
Airway management is of utmost importance in critical patients, for whom endotracheal intubation remains the gold standard. However, it is a difficult skill to acquire and success rates in novices are unacceptably low. Supraglottic devices constitute promising alternatives. The aim of this study was to assess the use of laryngeal mask airway (LMA) classic LMA (cLMA) and a relatively new supraglottic device, the i-gel, in experienced and novice doctors in a manikin setting.
The study population comprised 116 doctors. After a brief educational session and presentation of cLMA and i-gel, participants were randomly allocated to insert both devices in an adult manikin. Insertions were performed using a size-4 cLMA and a size-4 i-gel. The primary endpoints were the success rate for each device and the duration of the insertion attempt. Secondary endpoint was the perception of ease of use with each device.
First attempt success rate was 90.5% for i-gel and 63.8% for cLMA (P<0.001). I-gel use reduced insertion times (13.32±4.99 s vs. 17.99±6.87 s, P<0.001) and was related with significantly higher first attempt success rates than cLMA in novices (90 vs. 48.3%, P<0.001). In addition, i-gel use provided almost equal success rates for experienced and novice doctors (91 vs. 90%, P=not significant), whereas cLMA use resulted in significantly lower success rates for novices (48.3 vs. 80.4%, P<0.001).
In this manikin setting i-gel significantly improved success rates and insertion time compared with cLMA. Most importantly, i-gel use resulted in high first pass success rates for novice doctors, equal to those achieved by experienced doctors.
气道管理对危重症患者至关重要，对于这些患者，气管内插管仍然是金标准。然而，这是一项难以掌握的技能，新手的成功率低得令人无法接受。声门上设备是很有前途的替代方法。本研究旨在评估有经验和新手医生在模型上使用喉罩气道（LMA）经典型 LMA（cLMA）和一种相对较新的声门上设备 i-gel 的情况。
研究人群包括 116 名医生。在简短的教育课程和介绍 cLMA 和 i-gel 后，参与者被随机分配在成人模型上插入这两种设备。插入使用尺寸为 4 的 cLMA 和尺寸为 4 的 i-gel。主要终点是两种设备的成功率和插入尝试的持续时间。次要终点是使用每种设备的易用性感知。
i-gel 的首次尝试成功率为 90.5%，而 cLMA 的首次尝试成功率为 63.8%（P<0.001）。i-gel 的使用减少了插入时间（13.32±4.99 s 比 17.99±6.87 s，P<0.001），并且与新手 cLMA 相比，首次尝试成功率显著更高（90%比 48.3%，P<0.001）。此外，i-gel 的使用为有经验和新手医生提供了几乎相等的成功率（91%比 90%，P=无显著差异），而 cLMA 的使用则导致新手的成功率显著降低（48.3%比 80.4%，P<0.001）。
在本模型设置中，i-gel 与 cLMA 相比，显著提高了成功率和插入时间。最重要的是，i-gel 的使用使新手医生的首次通过成功率很高，与有经验的医生相当。
