Comparing the i-gel to First- and Second-Generation LMAs

R. Eleanor Anderson, MD, Ron M. Walls, MD, FRCPC, FAAEM

Rates of successful insertion did not differ, but the i-gel and second-generation LMAs performed best.
Researchers compared performance of the i-gel and the laryngeal mask airway (LMA) in a meta-analysis of randomized, controlled trials involving patients undergoing elective surgery. The i-gel was compared to a first-generation LMA (Classic, La Premiere, AuraOnce, Solus, Unique) in 18 trials and to a second-generation LMA (ProSeal, Supreme) in 16.
Rates of successful insertion did not differ among groups. The i-gel was quicker to insert than first-generation but not second-generation LMAs (mean difference of –3.6 and +0.74 seconds, respectively). Sore throat was significantly less frequent in the i-gel than in the LMA groups. Leak pressure was statistically lower with first-generation LMAs than with the i-gel, and lower with the i-gel than with second-generation LMAs. The i-gel provided a better fiber-optic view than the LMAs (relative risk for a poor view, 0.29).
Comment: Heterogeneity of the meta-analysis dataset limits reliability of the results, even after subgroup analysis. The take-home message is that second-generation LMAs and the i-gel perform well. They are quick to insert with almost 100% success, and provide a functional conduit for positive pressure ventilation in primary and rescue use. It likely is time to move beyond first-generation LMAs.
Citation(s):
de Montblanc J et al. A systematic review and meta-analysis of the i-gel® vs laryngeal mask airway in adults. Anaesthesia 2014 Jul 5; [e-pub ahead of print]. (http://dx.doi.org/10.1111/anae.12772)
Copyright © 2014. Massachusetts Medical Society. All rights reserved.