Skip to main content


Log in

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript



This study investigated the hypothesis that the efficacy of insertion of the supraglottic device i-gel® (i-gel) can be improved by laryngoscopy and can provide better sealing pressure in anesthetized patients by novice doctors.


Eighty-four adult patients were assigned to the laryngoscopy group (L group, 42 patients) or control group (i.e., conventional blind insertion; C group, 42 patients). Anesthesia was induced with propofol and remifentanil, and rocuronium 0.6–0.9 mg/kg was administered. The number of attempts until successful insertion, sealing pressure, vital sign changes upon insertion, and subjective difficulty of insertion by novice doctors were compared between the groups.


The total number of insertion attempts was one (L group 36 cases, C group 23 cases), two (L group 6 cases, C group 18 cases), and three (L group 0 case, C group 1 case), with significant differences between groups (P = 0.007). The sealing pressure was significantly higher in the L group than in the C group (L group 22.3 ± 2.6 cmH2O, C group 19.5 ± 2.7 cmH2O, P < 0.001). Vital sign changes (heart rate and blood pressure) did not differ between the two groups. The subjective difficulty of insertion was significantly lower in the L group than in the C group (L group 26.8 ± 11.8 mm, C group 47.0 ± 15.1 mm, P < 0.001). The incidence of postoperative pharyngeal pain was significantly lower in the L group than in the C group (P < 0.001), while the incidence of hoarseness did not differ between the two groups (P = 1.00).


Our results suggest that laryngoscopy facilitates i-gel insertion by novice doctors, as reflected in the rate of successful insertions, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:S729–67.

    Article  PubMed  Google Scholar 

  2. Reinhart DJ, Simmons G. Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. Ann Emerg Med. 1994;24:260–3.

    Article  CAS  PubMed  Google Scholar 

  3. Kohama H, Komasawa N, Ueki R, Samma A, Nakagawa M, Nishi S, Kaminoh Y. Comparison of Supreme® and Soft Seal® laryngeal masks for airway management during cardiopulmonary resuscitation in novice doctors: a manikin study. J Anesth. 2011;25:98–103.

    Article  PubMed  Google Scholar 

  4. Asai T, Hidaka I, Kawachi S. Efficacy of the laryngeal tube by inexperienced personnel. Resuscitation. 2002;55:171–5.

    Article  PubMed  Google Scholar 

  5. de Montblanc J, Ruscio L, Mazoit JX, Benhamou D. A systematic review and meta-analysis of the i-gel® vs laryngeal mask airway in adults. Anaesthesia. 2014;69:1151–62.

    Article  PubMed  Google Scholar 

  6. Häske D, Schempf B, Gaier G, Niederberger C. Performance of the i-gel™ during pre-hospital cardiopulmonary resuscitation. Resuscitation. 2013;84:1229–32.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. Russo SG, Cremer S, Eich C, Jipp M, Cohnen J, Strack M, Quintel M, Mohr A. Magnetic resonance imaging study of the in vivo position of the extraglottic airway devices i-gel™ and LMA-Supreme™ in anaesthetized human volunteers. Br J Anaesth. 2012;109:996–1004.

    Article  CAS  PubMed  Google Scholar 

  9. Gabbott DA, Beringer R. The iGEL supraglottic airway: a potential role for resuscitation? Resuscitation. 2007;73:161–2.

    Article  PubMed  Google Scholar 

  10. Fujiwara A, Komasawa N, Nishihara I, Miyazaki S, Tatsumi S, Nishimura W, Minami T. Muscle relaxant effects on insertion efficacy of the laryngeal mask ProSeal® in anesthetized patients: a prospective randomized controlled trial. J Anesth. 2015. doi:10.1007/s00540-015-1982-3.

  11. Komasawa N, Nishihara I, Tatsumi S, Minami T. Pre-warming i-gel® to 42 C facilitates successful insertion and ventilation efficacy with muscle relaxation: a randomized study. J Clin Anesth. 2014;26:663–7.

    Article  PubMed  Google Scholar 

  12. Komasawa N, Ueki R, Fujii A, Samma A, Nakagawa M, Nishi S, Kaminoh Y. Comparison of Laryngeal Mask Supreme® and Softseal® for airway management in several positions. J Anesth. 2011;25:535–9.

    Article  PubMed  Google Scholar 

  13. Asai T, Murao K, Shingu K. Efficacy of the ProSeal laryngeal mask airway during manual in-line stabilisation of the neck. Anaesthesia. 2002;57:918–20.

    Article  CAS  PubMed  Google Scholar 

  14. Janakiraman C, Chethan DB, Wilkes AR, Stacey MR, Goodwin N. A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway. Anaesthesia. 2009;64:674–8.

    Article  CAS  PubMed  Google Scholar 

  15. Sanuki T, Uda R, Sugioka S, Daigo E, Son H, Akatsuka M, Kotani J. The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients. Eur J Anaesthesiol. 2011;28:597–9.

    Article  PubMed  Google Scholar 

  16. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A. American Society of Anesthesiologists task force on management of the difficult airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013;118:251–70.

    Article  PubMed  Google Scholar 

  17. Japanese Society of Anesthesiologists. JSA airway management guideline 2014: to improve the safety of induction of anesthesia. J Anesth. 2014;28:482–93.

    Article  Google Scholar 

  18. Komasawa N, Ueki R, Kaminoh Y, Nishi S. Evaluation of chest compression effect on airway management with air-Q®, aura-i®, i-gel®, and Fastrack® intubating supraglottic devices by novice physicians: a randomized cross over simulation study. J Anesth. 2014;28:676–80.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. Hashimoto Y, Asai T, Arai T, Okuda Y. Effect of cricoid pressure on placement of the I-gel™ : a randomised study. Anaesthesia. 2014;69:878–82.

    Article  CAS  PubMed  Google Scholar 

  21. Yih PS. Laryngoscopy for pediatric laryngeal mask airway insertion. Can J Anaesth. 1999;46:617.

    Article  CAS  PubMed  Google Scholar 

  22. Elwood T, Cox RG. Laryngeal mask insertion with a laryngoscope in paediatric patients. Can J Anaesth. 1996;43:435–7.

    Article  CAS  PubMed  Google Scholar 

  23. Ismail SA, Bisher NA, Kandil HW, Mowafi HA, Atawia HA. Intraocular pressure and haemodynamic responses to insertion of the i-gel, laryngeal mask airway or endotracheal tube. Eur J Anaesthesiol. 2011;28:443–8.

    Article  PubMed  Google Scholar 

  24. Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. I-gel insertion by novices in manikins and patients. I-gel insertion by novices and patients. Anaesthesia. 2008;63:991–5.

    Article  CAS  PubMed  Google Scholar 

  25. Abukawa Y, Hiroki K, Ozaki M. Initial experience of the i-gel supraglottic airway by residents in pediatric patients. J Anesth. 2012;26:357–61.

    Article  PubMed  Google Scholar 

  26. Asai T, Liu EH, Matsumoto S, Hirabayashi Y, Seo N, Suzuki A, Toi T, Yasumoto K, Okuda Y. Use of the Pentax-AWS in 293 patients with difficult airways. Anesthesiology. 2009;110:898–904.

    Article  PubMed  Google Scholar 

Download references


Financial support for the study was provided by our institution.

Conflict of interest

The authors have no affiliation with any manufacturer of any device described in the manuscript and declare no financial interest in relation to the material described herein.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nobuyasu Komasawa.

Additional information

Trial registry number: UMIN000015013.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyazaki, Y., Komasawa, N., Matsunami, S. et al. Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial. J Anesth 29, 654–659 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: