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LETTER TO EDITOR
Year : 2022  |  Volume : 49  |  Issue : 1  |  Page : 86-87

Preloading of the suction catheter on I-gel: A stitch in time saves nine!!


1 Department of Anaesthesiology and Critical Care, Military Hospital, Ambala, Haryana, India
2 Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharashtra, India
3 Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission06-Sep-2021
Date of Acceptance10-Jan-2022
Date of Web Publication22-Apr-2022

Correspondence Address:
Vishal Mangal
Department of Internal Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_120_21

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How to cite this article:
Kaur KB, Singh DJ, Paul D, Mangal V. Preloading of the suction catheter on I-gel: A stitch in time saves nine!!. J Sci Soc 2022;49:86-7

How to cite this URL:
Kaur KB, Singh DJ, Paul D, Mangal V. Preloading of the suction catheter on I-gel: A stitch in time saves nine!!. J Sci Soc [serial online] 2022 [cited 2022 May 19];49:86-7. Available from: https://www.jscisociety.com/text.asp?2022/49/1/86/343697



Dear Sir,

Supraglottic airway devices (SGAs) are customarily used for airway maintenance in elective surgical procedures where aspiration is not a significant risk like patients with adequate fasting. SGAs are also used as rescue devices in difficult airway management and are a part of every difficult airway management algorithm. Second- and third-generation devices now have features that mitigate aspiration risk, such as drain tubes or compartments to manage regurgitated content.[1] They are less invasive than endotracheal tubes, which are accredited to their positioning outside of the larynx. Several classifications of these devices have been proposed: Based on the absence or presence of a drainage channel, site of seal, and mechanism of sealing.[2],[3] The most commonly used classification divides the SGAs into 1st-generation devices containing only a breathing lumen and 2nd-generation SGAs, which possess an additional channel for drainage of gastric contents. The 4th National Audit Project, conducted in the United Kingdom, estimated that 56% of the procedures done under general anesthesia were carried out using SGAs to manage the airway.[4]

The medical professionals need to modify the procedures and techniques as and when required. That is the path of progression in any field. Second-generation SGA has taken the safety margin few steps ahead, making its use more common. Although i-gel (Intersurgical Limited, Berkshire, United Kingdom), a second-generation SGA, is a single-use instrument, we at our institute are using it few times after proper sterilization because of resource constraints. The suction catheter is guided in the suction port in i-gel for placement in the esophagus, helping decongest the stomach. We were facing the problem of guiding the appropriately sized suction catheter into the gastric port of i-gel after its insertion even when the ventilation was appropriate, and there was no leak. We usually struggled to push the suction catheter into the gastric port even after adequate lubrication. Moreover, the suction catheter can get looped or coiled inside the lumen of the i-gel as insertion of suction catheter in the gastric port of i-gel is a blind procedure. This can increase the risk of aspiration of gastric contents because i-gel has lower sealing pressures.[5] This practical difficulty forced us to ponder over this problem. Finally, we found a solution; we preloaded the suction catheter in the gastric port of the i-gel till its tip beforehand [Figure 1]. After induction of the patient, this i-gel with the preloaded suction catheter is placed in the oral cavity, and correct placement is checked with no leak sound and bilateral chest lift. Following that, the suction catheter is smoothly pushed ahead, which directly goes into the esophagus. It saved us the struggle and time in correct placement of the catheter through the tip of the gastric port. The suction catheter preloaded on i-gel is more straightforward to place than the placement of suction catheter after insertion of i-gel. The preloading of suction catheter into the gastric port of i-gel under vision will prevent the looping or coiling of the suction catheter and thus attenuate the possibility of aspiration of gastric contents.
Figure 1: (a) Anteroposterior view, (b) Lateral view: I-gel pre-loaded with the suction catheter. The red arrow is showing the suction catheter at the tip of the gastric port of the i-gel

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Furthermore, preinsertion helps to overcome the resistance in a better way. Necessity is the mother of invention, and we keep on transforming our techniques according to our requirements.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hernandez MR, Klock PA Jr., Ovassapian A. Evolution of extragalactic airway: A review of its history, applications, and practical tips for success. Anesth Analg 2012;114:349-68.  Back to cited text no. 1
    
2.
Miller DM. A proposed classification and scoring system for supraglottic sealing airways: A brief review. Anesth Analg 2004;99:1553-9.  Back to cited text no. 2
    
3.
Michálek P, Miller DM. Airway management evolution – In a search for an ideal extragalactic airway device. Prague Med Rep 2014;115:87-103.  Back to cited text no. 3
    
4.
Woodall NM, Cook TM. National census of airway management techniques used for anesthesia in the UK: First phase of the Fourth National Audit Project at the Royal College of Anaesthetists. Br J Anaesth 2011;106:266-71.  Back to cited text no. 4
    
5.
Naik BN, Ganesh V, Saini V, Samra T. Looped suction catheter in an i-gel™; something to worry about or much ado about nothing? Indian J Anaesth 2019;63:420-1.  Back to cited text no. 5
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