Efficiency of I-gel Supraglottic Airway Device in Supine and Lateral Decubitus Position in Obese Patient
Condition: Obesity, Airway
MeSH terms: Pressure Ulcer; Obesity
Study type: Interventional

Summary: 
      Obesity is linked to many complications of respiratory care which are directly related to the
      obstructive apnea syndrome: difficult airway management including difficult mask ventilation,
      difficult intubation and obstruction of the upper airway.

      I gel which is a non inflatablesupraglottic airway device with a gastric channel is gaining
      popularity in anesthesia practice because of its ease of insertion and stable positioning.

      There are many studies evaluating I-gel for airway managment during different head and necks
      position ,in prone and lateral position showing both successeful results. Morover, it was
      evaluated during spontanous and mechanically ventilated patients.

      There are limited number of studies evaluating the efficacy of I- gel in mild to moderate
      obese patients.

      The primary aim of this study is to Measure the oropharyngeal airway leak pressure in both
      supine and lateral position and to determine laryngeal glottic view grade by the fibreoptic
      bronchoscope.
    

Detailed description: 
      prospective observational cohort study. Induction of anethesisa will be started after
      pre-oxygenating the patient for 3min , with administerating Propofol (2mg/kg)(lean body
      weight)), Fentanyl (2μg/kg) and Atracurium (0.5mg/kg)(based on ideal body weight.The patient
      will to be ventilated by a 100% oxygen and 1.2% isoflurane with fresh gas flow 6L/min for 5
      min.immediately after induction heart rate , blood pressure and oxygen saturation will be
      recorded.

      A proper sized I-gel according to the patient's weight and manifacturer instructions
      (Intersurgical Ltd, UK) ( 4 or 5 adult sizeI-gel) will be lubricated with a water based
      lubricant from the front and back sides of the device, will be inserted after compelete
      muscle relaxation (Train of four = zero) In case of insertion problem various adjuvant
      manoeuvres will be used such as such as head flexion or extension, or slightly pulling or
      pushing the device. Any additional manoeuvres will be recorded. If insertion or ventilation
      fails three times in succession, Endotracheal tube will be immediately inserted and the
      patient will be excluded from the study. The number of excluded cases will be recorded The
      circut will be connected to the device,Capnograph will be attached and end tidal carbon
      dioxide will be recorded.

      The ventilator parameters will be set with tidal volume (4-6 ml/kg) at a respiratory
      rate(12-15 breath/min) to maintain ETCO2 from 30-35 mmHg.

      Anaethesia will be maintanied by a mixture of 50% oxygen and 50% medical air,Isoflurane 1.2%
      and Atracurium (0.01 mg/kg) will be given according to train of four . Analgesia of pethidine
      100mg IV will be given as intraoperative analgesia.

      In order to confirm proper positioning of the I-gel,a fiberoptic bronchoscope will be pass
      through the device and pushed forward up to1 cm proximal to it to obtain a glottic view.

      Afterwards the same patient will be placed in the lateral decubitus position.Blood
      pressure,Heart rate ,Oxygen saturation and End tidal CO2 will be recorded immedialy. After
      confirming proper ventilation as before ,confirmation of I-gel position using fiberoptic
      bronchoscope will be done and recorded.The leak air way pressure test will be done as
      previously done in supine position and recorded.

      The patient will be returned to supine position where a proper size Orogastric tube will be
      inserted.The surgery can be started and Heamodynamics and ventilation will be monitored.

      By the end of the surgery the patient will be reversed from general anaesthesia by
      administrating Neostigmine (0.04mg/kg) and Atropine (0.01mg/kg). intravenously at (TOF=3) and
      the I-gel will be removed at the end.The presence of blood on the I-gel device, or the
      occurrence of any complications, will be recorded.

      The patient will be transfered to the post operative care unit
    

Intervention name(s): I-gel supraglottic airway device
Intervention type(s): Device
Intervention description(s): After induction of general anesthesia, we will measure the Oropharyngeal leak airway pressure during controlled ventilation in supine and in positions after insertion of I-gel.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: obesity; Igel; suraglotic device