title: I-Gel is a suitable alternative to endotracheal tubes in the laparoscopic pneumoperitoneum and trendelenburg position.
abstract: The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients.
  
  
  
  In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period.
  
  
  
  In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge.
  
  
  
  The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients.
  
  
  
  Registered at Clinicaltrials.gov NCT02462915 , registered on 1 June 2015.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, NO. 25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, 30059, Taiwan (R.O.C.).
authors.forename: Chih-Jun
authors.initials: CJ
authors.lastname: Lai
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan (R.O.C.).
authors.forename: Chih-Min
authors.initials: CM
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan (R.O.C.).
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan (R.O.C.).
authors.forename: Feng-Fang
authors.initials: FF
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan (R.O.C.).
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan (R.O.C.). shouzen@gmail.com.
authors.forename: Shou-Zen
authors.identifier: 0000-0002-6849-8453
authors.initials: SZ
authors.lastname: Fan
mesh_terms: D000328:Adult; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology*; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010612:Pharyngitis / Q000517:prevention & control; D011027:Pneumoperitoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D053120:Respiratory Aspiration / Q000517:prevention & control; D012143:Respiratory Physiological Phenomena; D055815:Young Adult
keywords: Endotracheal tube; Laparoscopic surgery; Leak fraction; Pneumoperitoneum; Respiratory parameters; Trendelenburg position; i-gel