# Comparison between head rotation and standard techniques for i-gel™ insertion: a randomized controlled trial

## TL;DR

Rotating a patient's head during i-gel insertion improves success rates and reduces insertion time compared to standard techniques.

## Contribution

This study introduces a novel head rotation technique that enhances i-gel insertion effectiveness in clinical settings.

## Key findings

- Head rotation increased first-attempt success rate to 75% compared to 57.7% with standard techniques.
- Head rotation reduced the time needed for successful i-gel insertion by approximately 3 seconds.
- The head rotation technique succeeded where the standard technique failed in 5 out of 7 cases.

## Abstract

This study evaluated the effect of head rotation on the first-attempt success rate of i-gel insertion, aiming to alleviate the effect of gravity on the tongue and reduce resistance between the device and the tongue.

Adult surgical patients were randomized to standard and head rotation technique groups. In the head rotation technique group, patients’ heads were maximally rotated to the left before i-gel insertion. The primary endpoint was the first-attempt success rate. Secondary endpoints included the success rate within two attempts (using the allocated technique), time required for successful i-gel placement within two attempts, and success rate at the third attempt (using the opposite technique).

Among 158 patients, the head rotation technique group showed a significantly higher first-attempt success rate (60/80, 75.0%) compared to the standard technique group (45/78, 57.7%; P = 0.021). The success rate within two attempts was similar between the groups (95.0% vs. 91.0%, P = 0.326). The time required for successful i-gel placement was significantly shorter in the head rotation technique (mean [SD], 13.4 [3.7] s vs. 16.3 [7.8] s; P = 0.030). When the head rotation technique failed, the standard technique also failed in all cases (n = 4), whereas the head rotation technique succeeded in five out of the seven patients where the standard technique failed.

The head rotation technique significantly improved the first-attempt success rate and reduced the time required for successful i-gel insertion. It was effective when the standard technique failed. The head rotation technique may be an effective primary or alternative method for i-gel insertion.

ClinicalTrials.gov (NCT05201339).