A COMPARATIVE STUDY BETWEEN I-GEL VERSUS CUFFED ENDOTRACHEAL TUBE IN LAPAROSCOPIC SURGERIES IN ADULT PATIENTS

Abstract

Invention of the endotracheal tube made administration of anesthesia easy. However, laryngoscopic stimulation of oropharyngolaryngeal structures is associated with hemodynamic stress response. Recently, the I-gel has been invented. It is a new 2nd generation supraglottic airway device with a non-inflatable cuff which has several potential advantages including: easier insertion, minimal risk of tissue compression and stability after insertion. Objective: The aim of this study was to compare the I-gel to the cuffed endotracheal tube in laparoscopic surgeries in adult patients. Patients and Methods: A prospective randomized controlled clinical trial among 80 patients who underwent laparoscopic procedures. They were equally divided into two groups: I-gel and cuffed endotracheal tube (ETT) groups. Both the devices were compared as regards insertion characteristics, hemodynamic stability, gas exchange parameters, peak airway pressure changes and the incidence of postoperative complications. Results: No significant statistical difference between the two groups was found regarding heart rate, O2 saturation, end tidal CO2 and peak airway pressure changes. Regarding mean arterial blood pressure, it was more stable after insertion in the I-gel group (P=0.019). There was also significant difference in the insertion time (P=0.0029) and number of insertion attempts (P=0.04) between the two groups. Regarding ease of insertion of gastric tube, it was easier to be inserted in the ETT group (P=0.0001). The postoperative complications were higher in the ETT group; for dysphagia (P=0.0002), dysphonia (P=0.0007), nausea (P=0.0019), vomiting (P=0.00017). However, there was no difference in the presence of blood on the device (P=0.396). Conclusion: I-gel is a safe airway device during the laparoscopic procedures. It was better than the cuffed ETT regarding hemodynamic stability changes after insertion without affecting gas exchange parameters. Although the complications were higher in the ETT group but the gastric tube insertion was more difficult in the I-gel group.
Key words: Airway management, I-gel, Laparoscpic surgeries, Endotracheal tube