i-gel® in Paediatric Surgery Discussion on the results of the first independent global study.
Initial series 50 patients aged 6 months to 14 years. C Bopp, G C Carrenard, C Chauvin, C Schwaab, P Diemunsch, University Hospital of Strasbourg, France.
Presented as an abstract at SFAR Congress Paris 23rd-26th September 2009. ASA Congress New Orleans 17th-21st October 2009.
Interview with Professor Pierre Diemunsch. Chairman of the European Airway Management Society. Consultant, Surgical Anaesthesia Dept, Hautepierre University Hospital, Strasbourg.
Can we really state that i-gel® is a significant step forward for paediatric anaesthesia?
In our opinion it is certainly true that the i-gel® introduction has represented a
major step forwards. In fact we all know or we all recognize a major
I mean improvement brought by the introduction of the supraglottic airway
devices but those devices so far had some limitation mainly related to their
average degree of stability in the mouth of the patient
in fact with the i-gel® we could overcome these limitations. In fact in our department we
tried to switch between the usual intubation of the patient towards a
less invasive control of the airway during surgical procedures and in this
regard in fact we tried to use something that may allow us to in fact rotate the
patient in the lateral position in order to be able to perform a caudal anaesthesia
on the top of the general anaesthesia for the sake of post-operative pain control
in this situation it has been very useful to have a very stable i mean
airway control device in the mouth of the patient allowing us to avoid any
displacement of the tube during this rotation of the patient and the i-gel®
device proved very useful in this situation. As far as learning curve is
concerned youreally didn't encounter any problems in
fact at the first attempt all the anesthesiologist who tried the i-gel®
were successful in fact there is a rate of success
was 80% at the first attempt and the rate of success was 100% with two attempts
so in fact no real difficulty in the learning curve could be could be could
be seen with the i-gel® device. As far as the quality of ventilation is concerned
we checked of course the saturation and we didn't observe any desaturation
I mean episodes during the short series which has been published in 2009 we also
didn't see any major problem associated with leaks. I mean the maximal pressures
the leak pressure in in those patients was 25 centimeters of water which is far
above the requested level of pressure needed to ventilate those patients so the
ventilation was very adequate. The main advantage we saw is related to
specific issues in paediatric anaesthesia and again we could in paediatric patients
in fact avoid intubation in 2/3 of the cases according to the usual protocol in
our institution, so during those cases we just could perform ventilation avoiding
all the problems related to intubation in the paediatric patient and as you know
a paediatric patient is very prone to experience laryngeal spasm
laryngeal I mean reflects reactions upon intubation but also upon
extubation at the end of the procedure so certainly avoiding intubation
represents a major step forward in the management of the pediatric patients the
i-gel® device was very well received among the anaesthesiologist population
here in our paediatric anaesthesia department and the satisfaction I mean
rate among the practitioner was more than four point five of our scale of
five so I mean it was very well received and people are very anxious to
get it I mean for the usual clinical practice.
We would like to thank the following people: P Diemunsch, C Bopp, C Chauvin, C Schwaab, J F Mayer, G Carrenard, L Marcoux, J Bonnomet and all of the staff at The University Hospital of Strasbourg.