i-gel

Carlos Danger

Carlos Danger

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So we finally got these at work. Holy crap they are nice. Much easier to use than any of the LMA's that I've used over the years (with the possible exception of the air-Q - that may still be my favorite). They just slide right in, and they just work. I used one on a pretty juicy guy yesterday who also required fairly high ventilation pressures (~20 cmh20), and had no problems.

I would recommend these for every EMS unit.
 
We carried iGels in ABQ w/ AMR. I'm not a big fan of LMAs over Kings, but I will take an iGel hands down as my favorite BIAD. We had great luck with them, especially when we figured out a little ELM after insertion helped achieve a very good seal.
 
I was talking to someone, an anesthesia tech I think, and they were saying that there were some reports of the igels causing burns where the gel sits around the airway. I'll see if I can find out more.
 
We carry them. Only used one once but it worked like a champion in a patient who I thought was going to buy a scalpel.


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Haven't put one in for a while, but I haven't had any problems with them. Sometimes it takes a little wiggle to get it seated in just right, but they are not hard to use at all. It is actually our primary airway for cardiac arrests.
 
These do look pretty efficient. I am hard pressed to believe that most EMS services aimed at turning a profit may fail to see the benefit of holding higher airway pressures over the cost of a more "practical" device such as a King airway, though I could be wrong. I am amazed at how far SGA's truly have come, and this further indicates the likelihood of endotracheal intubation all but becoming obsolete, particularly in the urban EMS setting.

Along the same lines, has or does anyone have any experience with the S.A.L.T. airway device? I'd be curious to know how easily an ET tube can actually be passed through this device as advertised.

https://www.mooremedical.com/index....G=CTL&CS=HOM&FN=ProductDetail&PID=21754&spx=1
 
TXmed said:
we trialed them at my current service, their success rate was like 40% or something awful.
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Yeah, I had heard they don't work quite like they're advertised, except for maybe "Fred the Head"?
 
I heard WilCo tried these a few years back but, as mentioned, had pretty poor success rates. I've only ever Fred the Headed them.
 
We have not had great success with them (air leaking from the mouth, lots of it), but I think it is likely a sizing issue. Once I identified that the weight based sizing on the package was ideal body weight, a function of height, I retrained everyone. We've not had any i-gel insertions since that time, but I am optimistic that we will see some improvement in our success rates.
 
Grimes said:
I heard WilCo tried these a few years back but, as mentioned, had pretty poor success rates. I've only ever Fred the Headed them.
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Still use them with good success as a rescue airway.


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FireWA1 said:
I was talking to someone, an anesthesia tech I think, and they were saying that there were some reports of the igels causing burns where the gel sits around the airway. I'll see if I can find out more.
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Never heard of that.
 
FiremanMike said:
We have not had great success with them (air leaking from the mouth, lots of it), but I think it is likely a sizing issue. Once I identified that the weight based sizing on the package was ideal body weight, a function of height, I retrained everyone. We've not had any i-gel insertions since that time, but I am optimistic that we will see some improvement in our success rates.
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They are a little more dependent on size since you can't compensate for poor sizing with changes in cuff volume.
 
So our ER is starting to use them as an Intubation adjunct. the drop an iGel, thread a bougie down into it, pull the igel and drop an ET tube over it. Kind interesting in replacing larygnoscopy with this method. On of the anesthetists says you can just shove and 7.0 tube through it and get a good tube. Id be interested to see if this becomes a thing
 
Bullets said:
So our ER is starting to use them as an Intubation adjunct. the drop an iGel, thread a bougie down into it, pull the igel and drop an ET tube over it. Kind interesting in replacing larygnoscopy with this method. On of the anesthetists says you can just shove and 7.0 tube through it and get a good tube. Id be interested to see if this becomes a thing
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That is interesting, because the only thing that I don't like about the igel is that it is harder to do this with it than with other LMA's. The lumen is more angulated towards the bottom than is an LMA, and it can be hard to get around that angle.

The Air-Q LMA is specifically designed for that and is really easy to pass a tube through.
 
I really like the I-Gels. Like you said, insertion is incredibly easy. They are more rigid than other brands. The cheaper LMAs they had in the OR would constantly fold up on itself and I had to guide it in with my finger.
 
Remi said:
Never heard of that.
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Yeah I cant seem to find what he was quoting so my guess is that it was anecdotal for his sisters brothers girlfriend who worked as an anesthesiologist once back in the day.
 
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