Clinical performance of i-gel and i-gel Plus for airway management of obese patients: A prospective randomised controlled trial

Background and Aims: The i-gel Plus (i-gelP) is a refined version of i-gel supraglottic airway device (SAD), featuring an extended cuff tip, an intubation ramp, and a broader gastric channel, which may contribute to better performance. However, despite the anatomical and physiological airway challenges in obese individuals, scientific data on its use in this population are unavailable. The aim of this trial was to compare i-gel and i-gelP for perioperative airway management in obese patients. Methods: It is a prospective, single-centre, single-blind, randomised controlled trial. Seventy-six adult obese patients (body mass index ≥30 kg/m²) of American Society of Anesthesiologists physical status II–III, undergoing elective surgery, were randomised for airway management using either i-gel or i-gelP. The primary outcome variable was oropharyngeal leak pressure (OLP). The secondary outcomes were first-attempt and overall insertion success rates, leak fraction, insertion time, ease of device placement, fibreoptic glottic view, and complications. Statistical comparison was done using unpaired t -test for continuous data, Mann–Whitney U-test for non-parametric continuous data, and Fisher’s exact test for categorical variables. Results: Three patients were excluded after failed SAD insertion, leaving 36 in the i-gel group and 37 in the i-gelP group for analysis. Demographic characteristics were comparable between groups. i-gelP achieved significantly higher OLP than i-gel {34.57 (2.85) [33.62–35.52] vs 27.67 (2.88) [26.69–28.64] cm H 2 O, P < 0.001}. No difference was observed in the secondary outcomes. Conclusion: I-gelP is superior to i-gel for managing the airway of obese patients, mainly class 1 obesity during elective surgery.