Positive end-expiratory pressure with I-gel in children - Is it safe and effective

Background & Aim: I-gel is designed to suit the anatomy of hypo-pharyngeal and peri-laryngeal areas in adults without an inflatable cuff. There is inadequate evidence regarding quality of seal of I-gel during PEEP application in pediatric patients. The objective of this study was to evaluate the performance of I-gel utilization in children during general anesthesia with PEEP application at a caliber of 5 cm H2O and assess whether it ameliorates oxygenation. Patients & Methods: A total of 42 ASA physical status I, and II children undergoing surgery under general anesthesia were included. Patients were arbitrarily allocated to one of two equal groups to be on Pressure-Control Ventilation (PCV) with PEEP 5 cm H2O (group I) and PCV without PEEP (group II). I-gel size 2 1⁄2 was utilized in children weighing from 25-35 kg. Leak Volume (LV) and Leak Fraction (LF) were recorded. Peak Inspiratory Pressure (PIP), expiratory and inspiratory tidal volume as well as minute volume and End tidal CO2 (ETCO2) were withal recorded at 5 min, 30 min and 1 h after I-gel insertion. Results: Leak volume and leak fraction had no statistical consequential distinctions between both groups. Patients with PEEP had significantly lower (ETCO2), higher PIP, higher inspiratory tidal volume, and higher expiratory tidal volume (p=0.001) during the post I-gel insertion follow up period. Patients with PEEP additionally had significantly higher PaO2 and lower PaCO2 levels (p= 0.001). Conclusions: I-gel may be used safely during PCV while applying PEEP of 5cm H2O in children with an efficacious seal pressure, amelioration in oxygenation and without leak or gastric insufflation.

Author(s): Ghada Kamhawy

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