What are the factors associated with successful I-gel™ insertion and uneventful anaesthesia in children under age two?
BACKGROUND
Our purpose was to evaluate I-gel™ sizes 1 and 1.5.


METHODS
I-gel™ insertion was attempted in 60 children<2 years of age undergoing short elective surgery. The main endpoints were the determination of independent factors associated with successful first attempt insertion and those associated with uneventful anaesthesia (i.e. no adverse events during insertion or during the intraoperative period of removal).


RESULTS
Size 1 and size 1.5 I-gel™ devices were used (intraoperatively) in 33 and 27 cases, respectively. Median age and weight were 3 (1-12) months and 4.97 (4.00-9.00) kg. Ventilation modes were spontaneous breathing (8.3%), pressure support (45%), controlled pressure (15%) or volume (31.7%) ventilation. I-gel™ insertion was successful on the first attempt in 45 cases (75%). A time between induction and insertion>11min (OR: 4.85 [1.08-21.77]) and age<6 months (OR: 5.501 [1.20-16.8]) were identified as the independent factors of successful first attempt insertion (AUC: 0.715). Adverse events were reported in 35 (58.3%) cases, during insertion in 18 (30%) cases, during the intraoperative period in 25 (41.7%) cases and/or during recovery in 3 (5.08%) cases. Age<6 months (OR: 4.497 [1.197-16.89]) and I-gel™ removal in the operating room (OR: 6.034 [1.153-31.577]) were identified as independent factors associated with uneventful anaesthesia (AUC: 0.761).


CONCLUSIONS
I-gel™ sizes 1 and 1.5 were interesting alternatives to intubation with all ventilation modes. However, the high incidence of adverse events calls for careful monitoring. The superiority of removal under anaesthesia must be confirmed.
Service d'anesthésie et de réanimation chirurgicale, hôtel-Dieu, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
Cécile
C
Magne
Service d'anesthésie et de réanimation chirurgicale, hôtel-Dieu, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
Vincent
V
Pichenot
Service d'anesthésie et de réanimation chirurgicale, hôtel-Dieu, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
Péan
P
Didier
Service d'anesthésie et de réanimation chirurgicale, hôtel-Dieu, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
Luc
L
Bérard
Service d'anesthésie et de réanimation chirurgicale, hôtel-Dieu, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France. Electronic address: corinne.lejus@chu-nantes.fr.
Corinne
C
Lejus-Bourdeau
D060666:Airway Extubation; D058109:Airway Management; D000758:Anesthesia; D000768:Anesthesia, General; D000072080:Anesthesiologists; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012121:Respiration, Artificial
Airway; Anaesthesia; Children; I-gel™; Infant; Paediatric; Supraglottic