To the Editor:
In the July 2009 issue of Anesthesiology, Theiler et al. 1published an article in which they compared the Laryngeal Mask Supreme ™ (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) with the i-gel™ (Intersurgical Ltd., Wokingham, Berkshire, United Kingdom) airway. The authors commented that the bulky design of the i-gel™ made insertion time longer, and that tongue size may have an influence on insertion. We noticed a similar problem during the insertion of i-gel™ a few times. During insertion, the cuff carried the tongue along with it posteriorly, making further motion of the i-gel™ impossible. All the patients were in “sniffing the morning air” position as advised by the manufacturer.2The device was adequately lubricated. Jaw thrust and insertion with deep rotation were tried2when difficulty occurred, but these maneuvers did not solve the problem. Hence, we had to remove and then reinsert the i-gel™ after pulling out and stabilizing the tongue.
The i-gel™ has a noninflatable cuff made of styrene ethylene butadiene styrene. This cuff fits snugly onto the perilaryngeal framework.2Unfortunately, the texture and design of the cuff entraps the tongue during insertion. The manufacturers recommend insertion of the device without introducing the fingers,2but we feel, in difficult circumstances similar to ours, insertion after stabilizing the tongue may be necessary.
*Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. firstname.lastname@example.org