Anesth Pain Med.  2019 Apr;14(2):172-179. 10.17085/apm.2019.14.2.172.

A comparison of clinical performance between i-gel and endotracheal tube in pediatric laparoscopic surgeries

• Hong JI
• Lee TY
• Park SY
• Choi SR
• Lee SC
• Chung CJ
• Kim JH

• KMID: 2447965
• DOI: http://doi.org/10.17085/apm.2019.14.2.172

Abstract

BACKGROUND
The current evidence on the safe use of supraglottic airway for pediatric laparoscopic surgeries is limited. Although i-gel has been successfully used in adult laparoscopic surgeries, to our knowledge, no studies have compared it to the endotracheal tube (ETT) in pediatric laparoscopic surgeries. This study evaluated the effectiveness of i-gel over ETT with regards to the respiratory and hemodynamic parameters during pediatric laparoscopic surgeries.
METHODS
A total of 60 pediatric patients undergoing elective laparoscopic surgeries were randomly allocated to either the i-gel or ETT groups. Anesthetics used included ketamine, sevoflurane, and rocuronium. The primary outcome measured was the peak airway pressure (PAP) and the secondary outcomes measured were leak fraction, end-tidal COâ‚‚, respiratory rate, insertion time, heart rate, blood pressure and perioperative complications.
RESULTS
The PAP during surgeries was higher in the ETT group than in the i-gel group. There were no statistically significant differences in the leak fraction, end-tidal COâ‚‚, and respiratory rate. The i-gel group had a shorter insertion time compared with the ETT group. The changes in heart rate were comparable in both groups. However, systolic and diastolic pressures were higher in the ETT group following intubation, before and after the creation of pneumoperitoneum. The incidence of perioperative complications was similar in both groups.
CONCLUSIONS
The i-gel provided adequate ventilation with lower PAP compared with ETT. In addition, it provided minimal hemodynamic changes compared with ETT. Therefore, the i-gel may provide a suitable alternative to ETT in pediatric laparoscopic surgeries.

Keyword

Intubation, intratracheal; I-gel; Laparoscopy; Pediatrics

MeSH Terms

Adult
Anesthetics
Blood Pressure
Heart Rate
Hemodynamics
Humans
Incidence
Intubation
Intubation, Intratracheal
Ketamine
Laparoscopy*
Pediatrics
Pneumoperitoneum
Respiratory Rate
Ventilation
Anesthetics
Ketamine

Figure

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  Fig. 1 Consort flow diagram. ETT: endotracheal tube.

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  Fig. 2 Box plot graphic of the peak airway pressure (A) and the leak fraction (B). Values are presented as median (1Q, 3Q). ETT: endotracheal tube, T1: after intubation, T2 and T3: 5 min before and after the beginning of pneumoperitoneum, respectively, T4 and T5: 5 min before and after the end of pneumoperitoneum, respectively. *P < 0.05 compared to the ETT group.

• 

  Fig. 3 Box plot graphic of the end-tidal CO2 (A) and respiratory rate (B). Values are presented as median (1Q, 3Q). ETT: endotracheal tube, T1: after intubation, T2 and T3: 5 min before and after the beginning of pneumoperitoneum, respectively, T4 and T5: 5 min before and after the end of pneumoperitoneum, respectively.

• 

  Fig. 4 Box plot graphic of the heart rate (A), systolic blood pressure (B), and diastolic blood pressure (C). Values are presented as median (1Q, 3Q). ETT: endotracheal tube, T0: before intubation, T1: after intubation, T2 and T3: 5 min before and after the beginning of pneumoperitoneum, respectively, T4 and T5: 5 min before and after the end of pneumoperitoneum, respectively. *P < 0.05 compared to the ETT group.

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