Not Always Smooth Sailing: A Case of Unanticipated Difficulty in i-gel Insertion Due to Large Epiglottis in a Young Patient Undergoing Laparoscopic Cholecystectomy

Abstract Supraglottic airway devices (SGAs) such as the i-gel are increasingly favored in elective laparoscopic surgeries for their ease of insertion, minimal haemodynamic impact and lower risk of airway trauma compared to endotracheal intubation. However, anatomic variations may compromise blind placement. We describe the case of a young male posted for elective laparoscopic cholecystectomy for gall bladder polyp. After induction of anaesthesia, multiple blind attempts at i-gel insertion failed. Oxygenation was maintained with bag–mask ventilation, and direct laryngoscopy was performed. A large floppy epiglottis was visualised obstructing the path of the device. By lifting the epiglottis with the laryngoscope, the i-gel was advanced successfully, providing an effective seal and allowing uneventful positive pressure ventilation throughout the surgery. This case highlights that even in young patients with unremarkable airway assessment, anatomic variations such as a large epiglottis may cause supraglottic device failure. Laryngoscopy can facilitate successful placement without conversion to intubation, preserving the advantages of i-gel use.