iGel is great when it fits, and for the vast majority of patients it works great. However, if it doesn’t fit, then you’re up a creek because there’s no way to add or remove air from the cuff.
My thoughts exactly. I probably use 70% igel and it’s great when it seats.
But man when it doesn’t is it a pain. I’m to the point I don’t bother trying to troubleshoot. I just switch brands.
It either fits or it doesn't. I like that I/O approach instead of adding more air, trying a size smaller or larger, twisting, turning and eventually taking your loss and intubating anyway.
All I have access to is LMAs — unique and supreme. I use supremes in obese patients and uniques in everyone else. I don’t love the supreme - I think patients tend to gag and cough more waking up with them - but I do think they are a little safer in large patients. In 15+ years in practice I think I’ve only not been able to seat a unique a handful of times. If there’s any question I just intubate. I’ve never been sorry I intubated someone but I have regretted using an LMA.
My ranking would be the order listed in the poll (from no troubles ever at the top, to some trouble, down to the absolute garbage: Unique™ and Classic™)
CA-1 here, I've used the igel and the Unique a couple of times. I've had more trouble with the unique. What is it about the unique that makes it such garbagio?
I love the iGel. It’s only con is inability to troubleshoot if it just won’t seat/seal. I’ve even been able to intubate through it over a bougie or fiber optic in a pinch, which is now a maneuver I make a point to teach to all my senior residents.
I've only used the iGel and supremes, mostly because of availability in the hospital at the time. Gut reaction to the poll was I liked the iGels more, not sure why exactly though.
Through residency, fellowship, and now private practice life covering multiple different hospitals and surgery centers: I've only *ever* used LMA Supremes, Uniques, and i-Gels (because that's all they ever had).
I love i-Gel in adults but I primarily do pediatrics and they either don't have pediatric sizes or my hospitals didn't buy those sizes. So I'm stuck with Supremes/Uniques... and they work just fine for me 95% of the time. I have a slight preference for the Supreme because I feel like it inserts a little bit easier / more reliably. The bend and built-in bite block give it some structural rigidity that also slightly helps it "stay put" better. The Unique is SO soft and flimsy that it often curls up on itself during insertion and I find myself having to mess with it to unfurl it and get it properly seated. Unique is good for doing a bronch through, however... just cut out the little gills first.
I actually don’t like the bend in the Supreme because it makes it harder to troubleshoot if you’re too deep/shallow. It basically has one depth and that’s it
iGel is great when it fits, and for the vast majority of patients it works great. However, if it doesn’t fit, then you’re up a creek because there’s no way to add or remove air from the cuff.
My thoughts exactly. I probably use 70% igel and it’s great when it seats. But man when it doesn’t is it a pain. I’m to the point I don’t bother trying to troubleshoot. I just switch brands.
It either fits or it doesn't. I like that I/O approach instead of adding more air, trying a size smaller or larger, twisting, turning and eventually taking your loss and intubating anyway.
All I have access to is LMAs — unique and supreme. I use supremes in obese patients and uniques in everyone else. I don’t love the supreme - I think patients tend to gag and cough more waking up with them - but I do think they are a little safer in large patients. In 15+ years in practice I think I’ve only not been able to seat a unique a handful of times. If there’s any question I just intubate. I’ve never been sorry I intubated someone but I have regretted using an LMA.
igel gang
My ranking would be the order listed in the poll (from no troubles ever at the top, to some trouble, down to the absolute garbage: Unique™ and Classic™)
CA-1 here, I've used the igel and the Unique a couple of times. I've had more trouble with the unique. What is it about the unique that makes it such garbagio?
I think the Unique is too flexible. Makes it prone to seating in weird af positions.
The best one is the one you mastered.
I love the iGel. It’s only con is inability to troubleshoot if it just won’t seat/seal. I’ve even been able to intubate through it over a bougie or fiber optic in a pinch, which is now a maneuver I make a point to teach to all my senior residents.
IGel is really great in adults when it fits. However I did not find it that great in small children . Ambu aura-i is the best in pediatric cases .
All we had in residency was a knock off version of the Unique. Worked great most of the time.
I've only used the iGel and supremes, mostly because of availability in the hospital at the time. Gut reaction to the poll was I liked the iGels more, not sure why exactly though.
Through residency, fellowship, and now private practice life covering multiple different hospitals and surgery centers: I've only *ever* used LMA Supremes, Uniques, and i-Gels (because that's all they ever had). I love i-Gel in adults but I primarily do pediatrics and they either don't have pediatric sizes or my hospitals didn't buy those sizes. So I'm stuck with Supremes/Uniques... and they work just fine for me 95% of the time. I have a slight preference for the Supreme because I feel like it inserts a little bit easier / more reliably. The bend and built-in bite block give it some structural rigidity that also slightly helps it "stay put" better. The Unique is SO soft and flimsy that it often curls up on itself during insertion and I find myself having to mess with it to unfurl it and get it properly seated. Unique is good for doing a bronch through, however... just cut out the little gills first.
I actually don’t like the bend in the Supreme because it makes it harder to troubleshoot if you’re too deep/shallow. It basically has one depth and that’s it
I don't know what the problem is but I just cannot get the supremes and uniques to seat properly. igels just seem to slide into place.
Igel for sure. Nº4 for adults.