Second-Gen Airway Device Safer for Surgical Anesthesia

TOPLINE:

In adults undergoing general anesthesia, the i-gel, a second generation supraglottic airway (SGA) device, is associated with fewer respiratory complications than the first generation LMA-Unique.

METHODOLOGY:

• Researchers conducted a retrospective cohort study which included 21,417 adults who underwent general anesthesia with an LMA-Unique or i-gel between January 2013 and June 2020 at the Beth Israel Deaconess Medical Center in Boston.
• The study was divided into an LMA-Unique period (2013-2015; n = 8313), a transition period (2016-2017; n = 5888), and a postimplementation phase when clinicians at the institution mainly used i-gel devices (2018-2020; n = 7216).
• The researchers assessed airway-related safety events, including desaturation, abnormal carbon dioxide levels, high pressure in the lungs, low breathing volumes, multiple attempts of insertion, and emergency breathing tubes during the time frames.

TAKEAWAY:

• In total, 26.5% of the patients experienced safety events during the LMA-Unique period, while 22.1% experienced such episodes during the i-gel period.
• The use of i-gel was associated with a greater reduction in airway-related safety events (0.3% per month; P< .001) than the use of LMA-Unique, which was linked to a 0.2% monthly reduction (P = .002).
• Patients in the i-gel group also had fewer episodes during which multiple attempts to insertion the airway device were required (0.9% vs 2.2%); lower frequency of desaturation (4.2% vs 4.8%), emergency tracheal intubation (1.8% vs 2.2%), or abnormal carbon dioxide levels in the blood (10.2% vs 12.1%).
• The effect was particularly evident in men, patients with higher body mass index or those at high risk for postoperative complications (absolute monthly reduction, 0.4%, 0.5%, and 0.7%, respectively).

IN PRACTICE:

“The implementation of i-gel in a large academic medical center was associated with a reduction in the occurrence and monthly trends of airway-related safety events. Leveraging purchase data, our study provides real-world clinical effectiveness and patient safety information for clinicians and decision-makers who are considering the use of i-gel as the primary SGA device for their institutions,” the authors of the study wrote.

SOURCE:

The study, led by Salameh S. Obeidat, MD, MSc, of the Department of Anesthesia and Perioperative Medicine at Oregon Health and Science University Hospital in Portland, Oregon, was published online on September 19, 2024, in Anesthesia & Analgesia.

LIMITATIONS:

The retrospective design of the study may have introduced biases. The use of purchase data as a proxy for device usage could limit the ability to establish a direct correlation between the supraglottic airway device and outcomes. The use of a composite endpoint could mask the importance of the less frequent yet more critical issues, overshadowing the more common but less severe concerns.

DISCLOSURES:

The study did not receive any specific funding. Two authors reported receiving grants and honoraria from pharmaceutical and healthcare companies. Other authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.