Comparison between I-Gel and Classic Laryngeal Mask Airway for Airway Management of Patients with Anticipated Difficult Airway: A Randomised Clinical Trial

Introduction: I-gel and classic Laryngeal Mask Airway ( cLMA) are two Supraglottic Airway Devices ( SAD) used for management of airway in various situations, including for management of difficult airway. Despite widespread use of these devices, there are very few trials studying I-gel and classic LMA for management of patients with difficult airway. The outcome of present study determines which SAD is better for managing difficult airway. Aim: To compare I-gel and cLMA in managing anticipated difficult airway. Materials and Methods: This randomised and single blinded clinical trial study was conducted in King George's Medical University, Lucknow, Uttar Pradesh, India, between February 2019 to January 2020. Adult patients with Mallampati class 3 or 4, thyromental distance <6 cm, sternomental distance <12 cm, restricted neck movement, micrognathia/ retrognathia or short/thick neck undergoing elective short duration surgery under general anaesthesia were included in this study. Total 50 patients divided into group C received cLMA while group I patients received I-gel for airway management. Fifty patients were recruited in each group. Nominal variables were analysed using chi-squared test. A two-sided p<0.05 were considered significant for all the tests. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 25.0 for windows. Results: Mean age in group C was 40.38 +/- 12.96 (years) and in group I was 37.94 +/- 11.77 (years) with p-value 0.327. Overall (n=44 in group C, 50 in group I, p-value=0.012) and first attempt (n=10 in group C, 40 in group I, p-value<0.001) success rate of device placement was higher for I-gel. Number of attempts, manipulations, time needed to insert and Leak Fraction was significantly lower for I-gel (p-value<0.001). Compared to cLMA, Oropharyngeal Leak Pressure (OLP) was higher with I-gel. Fibreoptic view on a four-point scale was better with I-gel. Desaturation, tachycardia, bradycardia, and postoperative sore throat was more frequent with cLMA. Conclusion: Compared to cLMA, I-gel has higher success rate of insertion in patients with difficult airway and has added advantage of more rapid insertion, higher OLP and need for fewer insertion attempts and manipulations with lower rates of complications.