Original Article

Conventional versus reverse insertion of i‑gel®

in overweight and obese patients – Interventional
randomised controlled trial

Address for correspondence: Sonali Ahuja, Gurpreeti Kaur, Kamakshi Garg, Anju Grewal
Dr. Kamakshi Garg, Department of Anaesthesiology, DMCH Ludhiana, Punjab, India
H No. 4, Professor Colony,
Barewal Road, Ludhiana,
Punjab - 141 012, India. ABSTRACT
E-mail: drkamakshigarg@
gmail.com
Background and Aims: The supraglottic airway device, i-gel, is used in obese patients for short- to
Submitted: 01-Sep-2022 medium-duration surgical procedures. Insertion techniques have contributed to the successful
Revised: 11-May-2023
and proper placement of i-gel in the first attempt. This study aims to compare two techniques for
Accepted: 18-May-2023
Published: 15-Aug-2023 successfully inserting i-gel in the first attempt in overweight and obese patients as measured by
oropharyngeal leak pressure (OLP). Methods: This interventional, randomised, controlled study
was conducted after ethical approval, and trial registration in overweight and obese patients.
Patients were randomised into two groups: In Group C, the conventional technique was used,
while in Group R, the reverse technique was used to insert i-gel. OLP, successful placement,
required manipulations, time taken for insertion, number of attempts, and intraoperative and
postoperative complications were studied. The collected data were analysed statistically.
Access this article online Results: The mean OLP (30.46 ± 3.76 vs. 32.12 ± 3.10 mmHg, P = 0.018) and the mean time of
insertion (16.42 ± 1.86 vs. 13.98 ± 1.97 s, P = 0.001) for conventional and reverse techniques,
Website: https://journals.lww.
com/ijaweb respectively, were statistically significant and favourable for Group R compared to Group C.
Successful placement of i-gel at the first attempt, ease of insertion, number of attempts and all
DOI: 10.4103/ija.ija_749_22
the manipulations except withdrawal and advancement were comparable in both the groups.
Quick response code
No postoperative complications were noted. Conclusion: The reverse technique significantly
favoured the actual OLP values and the mean insertion time. Successful placement of i-gel at the
first attempt was observed with both conventional and reverse techniques.

Key words: Airway management, i-gel, obese, oropharyngeal leak pressure, overweight,
supraglottic airway device

INTRODUCTION avoiding multiple insertion attempts. Minimal airway

Obesity causes a physiologically and sometimes
anatomically difficult airway; therefore, managing
the airway and oxygenation in obese patients can
be challenging. Supraglottic airway devices (SADs)
are an excellent alternative to the endotracheal
tube (ETT) in securing the airway in obese
patients.[1] i-gel® (a second-generation SAD) has been
used in obese patients for short- to medium-duration
surgical procedures. Due to its high leak pressure in
handling prevents trauma to the oral cavity and requires
less time to secure the airway. This will avert episodes
of desaturation and other associated respiratory or
haemodynamic complications. Preventing these
complications is necessary for obese patients owing to
shorter safe apnoea time.[4-6]
This is an open access journal, and articles are distributed under the terms of
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conjunction with easier positioning and faster insertion, For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

it has been proven beneficial in obese patients.[2,3]

How to cite this article: Ahuja S, Kaur G, Garg K, Grewal A.
Conventional versus reverse insertion of i-gel® in overweight and
Insertion techniques contribute to the successful and obese patients – Interventional randomised controlled trial. Indian J
proper placement of i-gel in the first attempt, thereby Anaesth 2023;67:708-13.

708 © 2023 Indian Journal of Anaesthesia | Published by Wolters Kluwer - Medknow

Page no. 44
 Ahuja, et al.: Reverse i-gel insertion in obese patients
The present study hypothesised that the reverse
technique of insertion would confer benefits in terms
of better airway seal in obese patients in comparison
to the conventional insertion technique. The current
study aimed to evaluate two different insertion
techniques for the successful placement of i-gel in
the first attempt in overweight and obese patients as
measured by an oropharyngeal leak pressure (OLP).
METHODS
This interventional, randomised, controlled study
was conducted in a tertiary health care institute after
obtaining institutional ethics committee approval (vide
approval number BFUHS/2K21p-TH/5005 dated
20 April 2020). The trial was registered at the Clinical
Trials Registry of India (vide registration number
CTRI/2020/09/027780, http://ctri.nic.in). The duration
of the study was from October 2020 to September
2021. Written and informed consent was obtained
from all the patients for participation in the study and
use of the patient data for research and educational
purposes. The study was carried out in accordance
with the principles of the Declaration of Helsinki,
2013.
Patients of the American Society of
Anesthesiologists (ASA) physical status I–III posted
for elective surgical procedures lasting up to 120 min
in a supine position with body mass index (BMI) ≥23
and ≤40 kg/m², classified as overweight, obese class I
and II as per the Asian criteria of BMI for nutritional
status, were included in the study.[7] Patients with
known or predicted difficult airway, those posted for
surgeries in the prone or lateral position, those with
any pathology of the upper respiratory tract, abnormal
head, neck or airway anatomy, presence of any
significant acute or chronic lung disease, emergency
surgeries, thoracic surgeries, neuro surgeries, cardiac
surgeries, airway surgeries, cervical spine injury,
pregnant women and those who refused to participate
were excluded from the study.
One hundred patients were randomised into
Group C (n = 50) and Group R (n = 50) by
computer-generated random numbers and allocation
concealment using opaque, sequentially numbered,
sealed envelopes opened by an anaesthesiologist not
involved in the study.
Patients underwent routine preoperative assessment
and standard fasting protocols. In the operating
Indian Journal of Anaesthesia | Volume 67 | Issue 8 | August 2023
Page no. 45
room (OR), all patients were positioned in ramped
position, standard ASA monitoring was done, and
baseline values were recorded. Intravenous (IV)
0.05 mg/kg midazolam and 10 mg metoclopramide were
administered. After preoxygenation with 100% oxygen
for 3–5 min; anaesthesia was induced with IV 2 µg/kg
fentanyl and 2–2.5 mg/kg 1% propofol titrated to loss
of verbal response. Thereafter, IV 0.5 mg/kg atracurium
was administered for neuromuscular blockade.
After achieving adequate jaw relaxation, the airway
was secured by an appropriately sized i-gel using
the technique randomly allocated to that patient. In
Group C, the conventional technique was to insert
i-gel, with the concave end of the device facing the
mandible in a pen-holding manner and advancing it
further until it fitted over the larynx (Brain’s technique).
While in Group R, the reverse technique was used to
insert i-gel, with the device’s concave end positioning
towards the hard palate, rotated by 180° after reaching
the oropharynx and further inserting it until it fitted
over the larynx (Guedel’s airway). Weight-based
selection criteria were used to select the size of i-gel as
per the manufacturer’s instructions (size 3: 30–60 kg,
size 4: 50–90 kg, size 5: >90 kg). The i-gel cuff was
lubricated with a water-based jelly before insertion.
An anaesthesiologist with an experience in ≥100
SADs insertions and ≥50 i‑gel insertions performed
the procedure.
The primary outcome was OLP; to measure it, the
fresh gas flow was calibrated to 3 l/min, and the circle
system’s adjustable pressure-limiting (APL) valve
was closed. With no peak end-expiratory pressure,
the minimum airway pressure was recorded for the
audible gas leak using a stethoscope at the lateral
side of the thyroid cartilage. Airway pressures
were maintained at ≤40 cmH2O. Among secondary
outcomes, the successful placement of i-gel at the
first attempt was confirmed by gently squeezing the
reservoir bag and observing visible chest rise, bilateral
chest auscultation and appearance of a square wave
end-tidal carbon dioxide (EtCO2) waveform. The time
of insertion was recorded from picking up the i-gel
till the commencement of mechanical ventilation and
the appearance of a square wave capnograph.[8] The
maximum time allowed for each attempt was 60 s.
A maximum of three attempts were allowed for the
insertion of each device. Any change in the device’s
size was also considered an attempt. It was regarded
as failed placement if, after three attempts at i-gel
placement, the criteria for successful placement were
not met. The need to change the type of airway device
709
 Ahuja, et al.: Reverse i-gel insertion in obese patients

was also considered a failed placement. The number
of desaturation episodes, that is, peripheral oxygen
saturation (SpO2) <90%, was noted, and the patients
were ventilated with 100% oxygen using a face mask
till optimal SpO2 level (95%) was attained. This time
of ventilation was included in the effective airway
time.[9]
sample size of 50 patients per group was proposed to
identify a clinically related difference of 3 cmH2O with
a standard deviation (SD) of 5 cmH2O in OLP based on
a previous study and a pilot study performed in our
institute using conventional and reverse techniques.
This proposed sample size was computed with 0.05%
alpha error, 80% power and a 10% dropout rate.

Any manipulations done during the insertion of the The data were expressed as mean ± SD and frequencies
i-gel, like gentle withdrawal, jaw thrust, chin lift, neck (regarding the number of cases). The Kolmogorov–
flexion, head extension or change in size, were noted. Smirnov test was employed to assess the normal
The anaesthesiologist graded the difficulty in insertion distribution of the data. Student’s t-test (parametric)
as easy: 1, moderate: 2, difficult: 3 and impossible: 4.[8] and Mann–Whitney U test (non-parametric) were
used to compare the quantitative variables between
A suction catheter was inserted through the gastric the different study groups. The Chi-square test was
tube channel in all cases. The patients were put on employed to compare the categorical data, and when
mechanical ventilation using volume-controlled the expected frequency was <5, the Fisher exact test
ventilation set to deliver a tidal volume of 8 ml/kg, was applied. P value < 0.05 was considered to be
respiratory rate to maintain EtCO2 value between 30 statistically significant. All statistical analyses were
and 40 mmHg, inspiratory and expiratory ratio (1:2) performed using Statistical Package for the Social
and a peak end-expiratory pressure of 5 cm H2O. Total Science (SPSS) version 21 (International Business
fresh gas flow was maintained at 1.5 l/min. Anaesthesia Machines SPSS Inc., Chicago, IL, USA) statistical
was maintained by 4%–6% desflurane in 50:50 oxygen program for Microsoft Windows.
and nitrous oxide. Additional IV 1 µ g/kg fentanyl was
given when clinically needed during anaesthesia. RESULTS
Finally, neuromuscular blockade was reversed with an
IV injection of 0.04 mg/kg neostigmine and 0.001 mg/kg In the present study, 100 patients were recruited;
glycopyrrolate. I-gel was removed after confirming the each completed the study [Figure 1]. Both groups in
recurrence of the spontaneous and regular ventilation the study were compared regarding demographic data
pattern and sustained head lift for at least 5 s. Patients [Table 1].
were shifted to the post-anaesthesia care unit (PACU)
for observation. Both groups had a statistically significant difference
in OLP (P = 0.018). The mean OLP of Group C
Haemodynamic parameters were recorded at 1-min was 30.46 ± 3.76 mmHg and Group R was
intervals from the beginning of the process till the 32.12 ± 3.10 mmHg. Both techniques had a high success
successful placement, once after placement, after the rate on the first attempt (98%). One patient in each group
removal of the device and after shifting the patient to required a second attempt for successful placement. The
the PACU. Blood staining during the removal of i-gel
and dental injury, if any, was noted at the end of the Table 1: Demographic data of the patients
surgery. Postoperatively, patients were followed up for Parameter Group C Group R P
(n=50) (n=50)
up to 12 h for any complaints of sore throat, dysphagia
Male/female 35/15 42/8 0.153
and dysphonia. Numerical Rating Scale (NRS) (0–10) Age (years) 40.56±14.16 38.16±11.77 0.359
was used to rate sore throat by asking the patient Height (cm) 160.94±7.81 159.30±6.33 0.252
verbally about the intensity of throat pain, that is, 0: Weight (kg) 73.64±14.42 71.36±11.64 0.396
no pain, 1–3: mild, 4–6: moderate and 7–10: severe. BMI (kg/m²) 28.39±4.44 28.14±4.05 0.769
NRS of ≥4 was interpreted as a sore throat.[10] Overweight/Obese I/Obese II 16/17/17 13/22/15 0.584
ASA class 1/II/III (number) 22/24/4 26/23/1 0.341
Duration of surgery (min) 51.90±18.62 53.40±24.69 0.732
The sample size was determined based on a
Size of the i-gel inserted
previous study[2], which compared the OLP values 3/4/5 (number) 8/33/9 13/32/5 0.309
in obese versus non-obese patients with i-gel using Data are expressed as mean±SD or number. ASA=American Society of
Anesthesiologists, BMI: body mass index, SD=standard deviation. BMI values:
a conventional technique. The mean OLP reported overweight: 23–24.9 kg/m², obese I: 25–29.9 kg/m², obese II: ≥30 kg/m²
was 27.38 ± 4.38 cmH2O in the obese group. Hence, a (Asian criteria of BMI for nutritional status).[7]

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 Ahuja, et al.: Reverse i-gel insertion in obese patients

mean time of insertion in Group C was 16.42 ± 1.86 s,
and in Group R was 13.98 ± 1.97 s. The difference in
the mean time of successful i-gel insertion between the
groups was statistically significant (P < 0.001).
Withdrawal and advancement were required in five
patients in Group C, while they were not needed in
Group R (P = 0.02). Other manipulations required
during the study, like chin lift, jaw thrust, head
extension and neck flexion, were minimal and
statistically insignificant. None of the patients in
each group had intraoperative or postoperative
complications like desaturation episodes, dental
injury, blood staining, dysphagia, dysphonia or sore
throat [Table 2]. The sore throat was graded on NRS;
even though the result was statistically significant,
none of the patients experienced sore throat (NRS >4).
The haemodynamic parameters, like heart rate, blood
pressure, oxygen saturation and EtCO2, remained
stable throughout the procedure [Table 3].
DISCUSSION
Our study found that using the reverse technique
produced a significantly higher OLP and better
placement than the conventional technique. We

Enrolment Assessed for eligibility (n = 100)

Excluded (n = 0)
(n = 0)
(n = 0)
(n = 0)

Randomised (n = 100)

Allocation

Allocated to Group C (n = 50) Allocated to Group R (n = 50)

(n = 50) (n = 50)
(n = 0) (n = 0)

Follow-up

Lost to follow-up (n = 0) Lost to follow-up (n = 0)

(n = 0) (n = 0)

Analysis

Analysed (n = 50) Analysed (n = 50)

(n = 0) (n = 0)

Figure 1: Consolidated standards of reporting trials (CONSORT) flow diagram

Table 2: Data comparing study parameters between the groups

Parameter Group C (n=50) Group R (n=50) P
Successful placement at the first attempt (number) 49 49 1.000
OLP (mmHg) 30.46±3.76 (29.39–31.53) 32.12±3.10 (31.24–33.00) 0.018
Time of insertion (s) 16.42±1.86 (15.89–16.95) 13.98±1.97 (13.42–14.54) 0.001
Withdrawal and advancement (number) 5 0 0.022
Chin lift (n) 3 1 0.307
Jaw thrust (n) 0 0 -
Head extension and neck flexion (n) 2 2 1.000
Ease of insertion (n)
Difficult/moderate/easy 1/17/32 1/13/36 0.681
Data are expressed as Mean±SD (95% CI) or number. CI=confidence interval, OLP=oropharyngeal leak pressure, SD=standard deviation

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 Ahuja, et al.: Reverse i-gel insertion in obese patients

Table 3: Study data showing haemodynamic parameters Table 3: Contd...

recorded during the study Parameter Group C Group R P
Parameter Group C Group R P 95% CI 98.69–99.19 98.81–99.31
HR Baseline 80.08±13.04 81.54±11.64 0.556 EtCO2 Baseline 31.36±1.55 31.80±1.77 0.189
95% CI 76.37–83.79 78.23–84.85 95% CI 30.92–31.80 31.30–32.30
1 min 80.92±14.09 81.88±12.08 0.715 1 min 31.16±1.72 31.08±1.81 0.821
95% CI 76.92–84.92 78.45–85.31 95% CI 30.67–31.65 30.57–31.59
2 min 80.40±13.93 81.52±12.68 0.675 2 min 31.40±1.46 31.58±1.65 0.565
95% CI 76.44–84.36 77.91–85.13 95% CI 30.99–31.81 31.11–32.05
3 min 80.48±14.83 80.72±12.54 0.931 3 min 31.68±1.57 32.10±1.61 0.189
95% CI 76.26–84.70 77.16–84.28 95% CI 31.23–32.13 31.64–32.56
Placement 80.00±14.88 80.92±14.32 0.753 Placement 32.16±1.56 32.42±1.73 0.431
95% CI 75.77–84.23 76.85–84.99 95% CI 31.72–32.60 31.93–32.91
Removal 84.80±13.73 86.24±12.78 0.588 Removal 31.92±1.68 32.46±1.67 0.110
95% CI 80.90–88.70 82.61–89.87 95% CI 31.44–32.40 31.99–32.93
PACU 82.36±12.54 83.52±10.87 0.622 PACU 31.74±1.52 32.06±1.49 0.291
95% CI 78.80–85.92 80.43–86.61 95% CI 31.31–32.17 31.64–32.48
NIBP SYS Baseline 133.28±14.38 130.08±15.16 0.282 Data are expressed as Mean±SD (95% CI). CI=confidence interval,
95% CI 129.19–137.37 125.77–134.39 EtCO2=end-tidal carbon di-oxide (mmHg), HR=heart rate (per min), NIBP
DIA=diastolic non-invasive blood pressure (mmHg), NIBP SYS=systolic
1 min 129.32±15.48 126.88±17.43 0.461 non-invasive blood pressure (mmHg), SpO2=peripheral oxygen saturation (%),
95% CI 124.92–133.72 121.93–131.83 PACU=post-anaesthesia care unit, SD=standard deviation
2 min 122.84±13.97 120.12±16.10 0.369
95% CI 118.87–126.81 115.54–124.70 observed a high success rate of i-gel insertion in the
3 min 120.84±14.52 116.04±15.83 0.147
first attempt for both techniques.
95% CI 116.35–124.61 111.54–120.54
Placement 118.80±14.38 113.96±14.46 0.097
95% CI 114.71–122.89 109.85–118.07 Kim et al.,[5] who studied the insertion of i-gel by standard
Removal 131.04±16.81 127.32±14.19 0.235 and rotational techniques in non-obese patients,
95% CI 126.26–135.82 123.29–131.35 reported the insertion of i-gel by a non-conventional
PACU 130.16±14.78 126.68±13.42 0.221 technique in a first randomised controlled trial. They
95% CI 125.96–134.36 122.87–130.49
encountered difficulty because tongue folding resulted
NIBP DIA Baseline 81.12±9.31 78.04±8.51 0.087
95% CI 78.47–83.77 75.62–80.46
in the i-gel embedding at the posterior pharynx during
1 min 78.88±8.36 75.64±9.04 0.066 insertion by the conventional technique. Still, they
95% CI 76.50–81.26 73.07–78.21 found higher OLP in the rotational technique than
2 min 74.44±8.95 72.68±10.46 0.368 in the conventional technique. Our study found
95% CI 71.90–76.98 69.71–75.65
higher OLP in the reverse technique than in the
3 min 73.00±9.41 69.56±9.66 0.074
95% CI 70.33–75.67 66.82–72.30
conventional technique. Bhardwaj et al.[6] compared
Placement 72.16±10.58 68.48±10.47 0.084 three techniques, standard, rotational and reverse,
95% CI 69.15–75.17 65.50–71.46 for i-gel. They studied the insertion characteristics,
Removal 77.40±10.03 75.36±8.37 0.272 first-attempt insertion and overall success rate in
95% CI 74.55–80.25 72.98–77.74 non-obese patients. They found that i-gel insertion
PACU 77.28±8.34 75.64±7.38 0.300
with reverse technique resulted in better positioning
95% CI 74.91–79.65 73.54–77.74
SpO2 Baseline 98.38±1.16 98.64±1.08 0.249 in the first attempt and overall success rate along with
95% CI 98.05–98.71 98.33–98.95 higher leak pressures, but the results were statistically
1 min 98.90±0.97 99.20±0.90 0.114 insignificant.
95% CI 98.62–99.18 98.94–99.46
2 min 99.10±0.89 99.32±0.84 0.207 Our study was conducted in overweight and obese
95% CI 98.85–99.35 99.08–99.56
patients, and current literature evidence on using
3 min 99.22±0.82 99.36±0.83 0.396
95% CI 98.99–99.45 99.12–99.60
the reverse technique in obese patients is limited.
Placement 99.28±0.81 99.48±0.68 0.183 Nevertheless, reversing the device prevents tongue
95% CI 99.05–99.51 99.29–99.67 folding and reduces the resistance between i-gel and
Removal 99.04±0.81 99.24±0.87 0.236 the posterior pharyngeal wall. The flexible nature
95% CI 98.81–99.27 98.99–99.49 of its cuff and the laryngeal soft tissue in the airway
PACU 98.94±0.87 99.06±0.89 0.496
helps push the i-gel cuff more effectively. It leads to
Contd... a better seal and higher leak pressures between the

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 Ahuja, et al.: Reverse i-gel insertion in obese patients
laryngeal inlet and the i-gel cuff. This could be why
the OLP in this study was significantly higher with the
reverse technique.
The study by Prabha et al.[2] compares i-gel insertion for
general anaesthesia in non-obese and obese patients
using conventional techniques. The study showed
higher mean OLP in obese patients than non-obese
patients (28.7 vs. 25.8 cmH2O). OLP depends upon
the seal between the cuff and perilaryngeal tissues.
The anatomically shaped i-gel is flexible and fits
comfortably to the perilaryngeal anatomy. The
thermoelastic material of the cuff expands due to the
body temperature and provides a reliable seal. The
OLP is higher due to excess soft tissue in the oral and
pharyngeal cavity. I-gel can be safely used in obese
patients as obesity is no more identified as a risk
factor for the failure of i-gel insertion, as stated by
Theiler et al.[11] I-gel is a rescue device for oxygenation
in the difficult airway, although proper seal of i-gel
is critical to prevent its displacement.[12] To use i-gel
safely in obese patients, the safest and fastest insertion
technique is required.
There was a comparable difference in the ease of
i-gel insertion between the two techniques in the
current study. The mean time of i-gel insertion in
Group R was significantly lesser than that of Group C
(P < 0.001).
In the present study, minimal manipulations
were required in both groups for the successful
placement of i-gel. Furthermore, no postoperative
complications were observed during the insertion of
the i-gel. Nevertheless, the insertion was performed
by an experienced anaesthesiologist. Using a muscle
relaxant facilitated the smooth insertion of i-gel with
fewer attempts and reduced oral, pharyngeal and
perilaryngeal trauma.
The limitations of the present study were that blinding
was not possible for insertion technique, there was no
use of a fibreoptic bronchoscope to grade the view
of glottis for proper placement, and we relied on
other clinical factors for successful and appropriate
placement of i-gel.
CONCLUSION
This study demonstrated a relatively higher value of
OLP, significantly shorter insertion times and fewer
manipulations while using the reverse technique.
Indian Journal of Anaesthesia | Volume 67 | Issue 8 | August 2023
Page no. 49
However, there was a comparable successful placement
of i-gel at the first attempt with both conventional and
reverse techniques.
Study data availability
De-identified data may be requested with reasonable
justification from the authors (email to the
corresponding author) and shall be shared after
approval as per the authors’ Institution policy.
Financial support and sponsorship
Nil.
There are no conflicts of interest.
REFERENCES
1. Nicholson A, Cook TM, Smith AF, Lewis SR, Reed SS.
Supraglottic airway devices versus tracheal intubation for
airway management during general anaesthesia in obese
patients. Cochrane Database Syst Rev 2013;9:CD010105.
2. Prabha R, Raman R, Khan MP, Kaushal D, Siddiqui AK,
Abbas H. Comparison of I-gel for general anaesthesia in obese
and nonobese patients. Saudi J Anaesth 2018;12:535-9.
3. Choudhary N, Kumar A, Kohli A, Wadhawan S, Bhadoria P.
I-Gel as an intubation conduit: Comparison of three different
types of endotracheal tubes. Indian J Anaesth 2019;63:218-24.
4. Sharda M, Kapoor MC, Atray R, Garg S. Insertion of
i-gel™ by the reversed technique improves the success
rate and reduces the time taken for its placement:
A prospective, randomized, controlled, interventional trial.
J Anaesthesiol Clin Pharmacol 2017;33:226-30.
5. Kim HC, Yoo DH, Kim HJ, Jeon YT, Hwang JW, Park HP.
A prospective randomised comparison of two insertion methods
for i-gel™ placement in anaesthetised paralysed patients:
Standard vs rotational technique. Anaesthesia 2014;69:729-34.
6. Bhardwaj M, Singhal SK, Rashmi AD. A prospective randomised
trial to compare three insertion techniques for i-gel™ placement:
Standard, reverse, and rotation. Indian J Anaesth 2020;64:618.
7. Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Khalid AK,
et al. Epidemiology of obesity in the Asia-Pacific region. In: The
Asia-Pacific perspective: Redefining obesity and its treatment.
Health Communications Australia 2000;18:1-55.
8. Weber U, Oguz R, Potura LA, Kimberger O, Kober A, Tschernko E.
Comparison of the i-gel and the LMA-Unique laryngeal mask
airway in patients with mild to moderate obesity during
elective short-term surgery. Anaesthesia 2011;66:481-7.
9. Singh A, Bhalotra AR, Anand R. A comparative evaluation of
ProSeal laryngeal mask airway, I-gel and Supreme laryngeal
mask airway in adult patients undergoing elective surgery:
A randomised trial. Indian J Anaesth 2018;62:858-64.
10. Koo BW, Oh AY, Hwang JW, Na HS, Min SW. Comparison of standard
versus 90° rotation technique for LMA Flexible™ insertion:
A randomized controlled trial. BMC Anaesthesiology 2019;19:1-6.
11. Theiler L, Gutzmann M, Kleine-Brueggeney M, Urwyler N,
Kaempfen B, Greif R. i-gel™ supraglottic airway in clinical
practice: A prospective observational multicentre study. Br J
Anaesth 2012;109:990-5.
12. Solanki SL, Johnson JE, Samantaray A. Supraglottic airway
devices: Placement and pharyngeal seal matters! Indian J
Anaesth 2020;64:649-52.
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