I-Gel Supraglottic Airway

The I-Gel supraglottic airway has become a preferred choice for paramedics, emergency responders, and critical care teams due to its ease of use, rapid insertion, and high success rates in securing an airway.

Indications for I-Gel

The I-Gel supraglottic airway device is indicated in situations where airway management is required, but endotracheal intubation is not feasible or necessary. Common scenarios include:

Cardiac Arrest: Used as a primary or rescue airway device when ventilation via bag-valve-mask (BVM) is ineffective or endotracheal intubation is delayed or unsuccessful.

Decreased Level of Consciousness: Patients with a reduced Glasgow Coma Scale (GCS) who are unable to maintain their airway, such as those experiencing overdose, post-seizure states, or stroke.

Difficult or Failed Intubation: Serves as a rescue airway when endotracheal intubation is challenging or unsuccessful due to anatomical or situational difficulties.

Anaesthesia and Procedural Sedation: Used in controlled settings to maintain airway patency during short surgical procedures or sedation where a less invasive approach is preferred.

In all cases, the I-Gel is intended to provide a clear, unobstructed airway while reducing aspiration risk compared to other supraglottic devices.

I-Gel Contraindications

The I-Gel supraglottic airway device has several contraindications, including: 

Gag reflex: The patient is conscious and has a gag reflex.

Limited mouth opening: The patient has trismus (lockjaw) or limited ability to open their mouth. 

Airway obstruction: The patient has a known or suspected airway obstruction, such as epiglottitis. 

Trauma: The patient has trauma to the neck, trachea, or oropharynx.

Laryngectomy: The patient has a laryngectomy with a stoma 

Bleeding, swelling, or unstable jaw fracture: The patient has oral trauma with bleeding, swelling, or an unstable jaw fracture 

Distorted anatomy: The patient has distorted anatomy that prevents proper placement of the device.

I-Gel Cautions

When using an I-Gel supraglottic airway, you should be cautious about the patient’s anatomy, the device’s size, and the risk of airway obstruction

Consider other causes of difficult ventilation, such as airway obstruction, before using an I-Gel.

Be aware of patients with oesophageal disease, caustic ingestions, or limited mouth opening.

Consider the patient’s age, gender, and dentition, as these can affect the likelihood of I-Gel failure. 

I-Gel Complications

Complications of using an I-Gel supraglottic airway device include laryngospasm, nerve damage, and blood staining. Other complications of airway devices include dental injuries, vocal cord injuries, and blood staining on the device; while other broader airway device complications can include dental injuries, vocal cord injuries, and cervical spine injuries. 

Laryngospasm: This can occur during insertion of the i-gel, causing the vocal cords to spasm and obstruct the airway. 

Dental injuries: Damage to teeth can happen during insertion or removal of an airway device, especially if forceful manipulation is required. 

Benefits Of I-Gels

The I-Gel is a supraglottic airway device that has several benefits, including ease of use, high seal pressure, and reduced trauma. It’s used in a variety of situations, including anesthesia, emergency medicine, and difficult airway management.

Easy to use: The I-Gel is quick and easy to insert, even for first-time users. 

High seal pressure: The I-Gel provides high seal pressures.

Reduced trauma: The I-Gel’s shape and contours mirror the patient’s anatomy, which reduces compression and displacement trauma.

Gastric channel: The I-Gel’s gastric channel protects against aspiration. 

Stable: The I-Gel remains stable despite changes in head and neck position.

Versatile: The I-Gel can be used as a rescue device, for intubation, and for ventilation. 

I-Gel Sizing

The size of an I-Gel supraglottic airway is chosen based on the patient’s ideal weight. The colour-coded sizing system ensures quick and accurate selection for effective airway management.

How To Insert An I-Gel

It’s quick, simple, and does not require laryngoscopy. Below is a step-by-step guide on how to insert an I-Gel supraglottic airway.

I-Gel supraglottic airway (appropriate size)

I-Gel Strap or String

Lubricant (water-based gel)

Filter

Bag-Valve-Mask (BVM)

Suction device (to clear any secretions)

Oxygen source

Capnography (if available)

Position the Patient:

Place the patient in the supine position.

Ensure the head is in a neutral or slightly extended position (sniffing position) if not contraindicated (e.g., suspected C-spine injury).

Pre-Oxygenate:

Deliver high-flow oxygen via a mask for a few minutes if possible.

Check Equipment:

Select the appropriate I-Gel size.

Inspect for any damage.

Apply a generous amount of lubricant to the back, sides, and tip of the I-Gel and store in cradle.

Open the Airway:

Perform a jaw thrust or head-tilt chin lift (unless spinal injury is suspected).

Insert the I-Gel:

Hold the I-Gel by the integral bite block. Gently press the tongue downwards using the I-Gel, gliding it along the hard palate. Advance the device until resistance is felt, indicating proper placement over the laryngeal inlet.

Secure the Airway:

The I-Gel should naturally sit in the correct position. Secure it using a fixation strap or tape.

Confirm Placement:

Connect the Filter, BVM and ventilate.

Observe chest rise and fall.

Listen for breath sounds over the lungs and absence of air in the stomach.

Use capnography to confirm the presence of end-tidal CO₂ (if available).

Monitor the patient’s oxygen saturation, respiratory rate, and capnography.

If resistance is felt during insertion or if ventilation is inadequate, remove the device and attempt reinsertion.

Be prepared to suction if necessary.

Leakage or poor seal: Adjust the position or consider a larger/smaller size.

Obstruction: Check for secretions or obstruction and clear using suction.

Difficult ventilation: Reassess placement and confirm no kinking of the device.

I-Gel Supraglottic Airway Video

I-Gel Key Points

Bibliography

Gregory, P. and Mursell, I. (2010). Manual of clinical paramedic procedures. Chichester: Wiley-Blackwell.

Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2022). JRCALC Clinical Guidelines 2022. Class Professional Publishing.

Resuscitation Council UK (2021). 2021 Resuscitation Guidelines. Resuscitation Council UK. Available at: https://www.resus.org.uk/library/2021-resuscitation-guidelines