Comparison of four different techniques of i-gel insertion by anaesthesia trainees in children undergoing daycare surgery: A single-blind, randomised, comparative study

Background and Aims: 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 degrees rotation, 180 degrees rotation, jaw thrust-assisted and standard insertion techniques.Methods: 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 degrees rotation, 180 degrees 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.Results: The incidence of malposition was the least in the 180 degrees rotation technique group (27%) versus 39% in the standard and 90 degrees rotation technique groups and 70% in the jaw thrust technique group (P = 0.004). Oropharyngeal leak pressure (OLP) was highest in the 180 degrees rotation technique group, that is, 27.1 (5.3) cm H2O in the 180 degrees rotation technique group versus 23 (4.3), 25.8 (4.1) and 24.7 (5.6) cm H2O in the standard, 90 degrees rotation and assisted jaw thrust groups, respectively (P = 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 degrees rotation group, 19.5 (3.2) s in the180 degrees rotation group and 20.1 (3.4) s in the assisted jaw thrust technique group (P < 0.001).Conclusion: The 180 degrees 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.