Priyadarshi Priya, Behera Bikram Kishore, Misra Satyajeet
Department of Anesthesiology and Critical Care, AIIMS Bhubaneswar, Odisha, India.
Indian J Anaesth. 2023 Nov;67(Suppl 4):S232-S237. doi: 10.4103/ija.ija_111_23. Epub 2023 Nov 21.
Different techniques of i-gel insertion have been described with variable success rates. This study aimed to assess the incidence of malposition of i-gel in children with 90° rotation, 180° rotation, jaw thrust-assisted and standard insertion techniques.
The study included 132 children undergoing elective surgery under general anaesthesia without neuromuscular blockade after approval from the Institutional Ethics Committee. The i-gel was inserted using one of the four randomised techniques (90° rotation, 180° rotation, jaw thrust-assisted insertion or standard insertion technique) by anaesthesia trainees. The primary objective of this study was to assess device malposition using three alternative techniques compared to the standard insertion technique by flexible video bronchoscopy.
The incidence of malposition was the least in the 180° rotation technique group (27%) versus 39% in the standard and 90° rotation technique groups and 70% in the jaw thrust technique group ( = 0.004). Oropharyngeal leak pressure (OLP) was highest in the 180° rotation technique group, that is, 27.1 (5.3) cm HO in the 180° rotation technique group versus 23 (4.3), 25.8 (4.1) and 24.7 (5.6) cm HO in the standard, 90° rotation and assisted jaw thrust groups, respectively ( = 0.006). The time to i-gel insertion was the least with the standard insertion technique, that is, 16.9 (3.3) s, compared to 18.4 (3.1) s in the 90° rotation group, 19.5 (3.2) s in the180° rotation group and 20.1 (3.4) s in the assisted jaw thrust technique group ( < 0.001).
The 180° rotation technique for i-gel placement in children by anaesthesia trainees has the lowest incidence of malposition and the best OLP versus other techniques but lacks any clear advantage in clinical performance and ventilation.
已描述了不同的喉罩插入技术，成功率各不相同。本研究旨在评估在儿童中采用90°旋转、180°旋转、下颌前推辅助和标准插入技术时喉罩位置不当的发生率。
本研究纳入了132例在机构伦理委员会批准后接受全身麻醉且无神经肌肉阻滞的择期手术儿童。麻醉实习生使用四种随机技术之一（90°旋转、180°旋转、下颌前推辅助插入或标准插入技术）插入喉罩。本研究的主要目的是通过可弯曲视频支气管镜检查，与标准插入技术相比，使用三种替代技术评估装置位置不当情况。
180°旋转技术组位置不当的发生率最低（27%），而标准技术组和90°旋转技术组为39%，下颌前推技术组为70%（P = 0.004）。180°旋转技术组的口咽漏气压（OLP）最高，即180°旋转技术组为27.1（5.3）cm H₂O，而标准技术组、90°旋转技术组和下颌前推辅助技术组分别为23（4.3）、25.8（4.1）和24.7（5.6）cm H₂O（P = 0.006）。标准插入技术插入喉罩的时间最短，即16.9（3.3）秒，而90°旋转组为18.4（3.1）秒，180°旋转组为19.5（3.2）秒，下颌前推辅助技术组为20.1（3.4）秒（P < 0.001）。
麻醉实习生在儿童中采用180°旋转技术放置喉罩时，与其他技术相比，位置不当的发生率最低，口咽漏气压最佳，但在临床性能和通气方面没有明显优势。
