Comparison of Triple Airway Manoeuvre and Reverse Insertion Technique for I-gel® Placement in Paediatric Patients under General Anaesthesia: A Randomised Controlled Trial

Introduction: I-gel®, a second-generation supraglottic airway device with a soft, anatomically shaped cuff, which produces an airway seal without the need for air inflation. Distinctive features of the paediatric airway may interfere with ideal insertion of Supraglottic Airway Devices (SADs). Therefore, it is important to recognise the most effective technique for I-gel® placement in paediatric patients to minimise airway-related complications. Aim: To compare the triple airway manoeuvre and reverse insertion technique for I-gel® placement in paediatric patients under general anaesthesia. Materials and Methods: This single blinded, Randomised Controlled Trial (RCT) was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, over a period of 14 months from July 2023 to September 2024 in 100 paediatric patients (7-12 years), American Society of Anaesthesiologists-Physical Status (ASA-PS) grade I and II of either gender planned for elective surgery. Randomisation was performed into two groups using a computer-generated random number table, with 50 patients in each group. In Group R, I-gel® placement was done using the reverse insertion technique (n=50) and in Group TAM, I-gel® was placed using the triple airway manouvre, i.e. head tilt, jaw thrust, mouth open (n=50). Mean insertion time was measured as the primary outcome. Other parameters studied were the number of attempts, overall success rate, ease of I-gel® insertion, ease of nasogastric tube insertion and postoperative complications. Wilcoxon-Mann-Whitney U test, Chi-squared test, Fisher’sexact test were used to analyse data. A p-value