Comparison of endotracheal intubation laryngeal mask airway and I gel in children undergoing strabismus surgery

Insertion of the advanced airway during induction of general anesthesia can cause undesirable sympathetic stimulation such as increased intraocular pressure (IOP) and hemodynamic parameters. In this study, we compared insertion of three different advanced airway devices; endotracheal tube (ETT), laryngeal mask airway (LMA) and I‑gel in terms of IOP, hemodynamic changes and postoperative nausea and vomiting (PONV) following induction of general anesthesia with propofol and remifentanil in children undergoing strabismus surgery.

A total of 90 children (5.68 ± 1.49 years old) were randomly assigned to one of the three groups, ETT, LMA, or I‑gel insertion as advanced airway devices IOP and also hemodynamic variables were measured before (T0 and T1) and immediately after (T2) the insertion of these airway devices, although 2 min (T3) and 5 min (T4) after it. PONV was assessed about 2 h after the completion of surgery in the recovery room.

The mean arterial pressure (MAP), IOP, and systolic and diastolic blood pressures were significantly different between the three groups immediately (T2), 2 min (T3), and 5 min (T4) after the insertion of airway devices. The heart rate (HR) was significantly different between the three groups in all measurement times except of T0. Within‑group comparisons showed that the three groups had significant changes in MAP, IOP, HR, systolic and diastolic pressure before and after airway insertion (T1 and T2). The trend in the LMA and ETT groups was
descending‑ascending‑descending, whereas in the I‑gel group, it was quite descending. There was no significant difference among the three groups in terms of PONV.

As a result, our study showed that, compared with LMA and ETT, the I‑gel had less impact on undesirable stress responses and seems to be superior to LMA and ETT in children undergoing strabismus surgery.