A prospective randomised comparison of two insertion methods for i-gel placement in anaesthetised paralysed patients: standard vs rotational technique

In this prospective randomised study, we compared two techniques for i-gel insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n=91), the i-gel was inserted using the standard technique. In the rotation group (n=90), the i-gel was rotated 90 degrees anticlockwise in the mouth and re-rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs 87 (97%; p=0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs 22.4 (10.2)s; p=0.016) and air leak pressure was lower (22.5 (10.4) cmH2O vs 27.1 (9.4)cmH2O; p=0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs 1 (1%); p=0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.