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We are going to look at the I-gel now, inserting it when other airway adjuncts are not working correctly and we need to upgrade the airway because of potential vomiting threats or somebody with a high-risk airway; for example, in pregnancy or somebody who has been poisoned, I.e. An overdose. We would always try and maintain the airway with an OPR nasopharyngeal airway. But when that is not adequate, we need to look at a supraglottic airway. These are weight adjusted so that we can assess that this patient is probably somewhere in the seventy-kilogram range and this size four I-gel is for 50 to 90 kilograms. 

We know that this one will be adequate for this patient. Keeping a sterile field, this thermal plastic structure of this I-gel means that it is very soft at the end and it will adjust to the shape of the patient's oropharynx when it is inserted and when it warms up to body temperature. However, given the nature of the plastic, it is quite sticky as well. We do need to make sure that we lubricate the back of the I-gel prior to use. And a good method for doing that is to smear some gel onto there and then lubricating just the back of the I-gel, keeping the gel off of the front. And this is the part that sits over the opening to the larynx. A good method for inserting this is to hold it like a pen.

And to make sure that the patient's head is tilted back. Remove the existing airway that has become inadequate and insert the tip of the I-gel towards the hard plate of the mouth using your index finger to push it backwards and upwards. As the I-gel fits into place, it almost feels like it will just slots in there. We need to make sure that is inserted and it is working correctly. To do so, we would connect a catheter mount reach for a bag valve mask, connect the bag mask to there and then gently look for rising and fall of the chest. And we would confirm correct placement using a stethoscope. Once we have confirmed that the I-gel is in place and the patient's lungs are ventilating, we need to secure that in place. And there are a number of methods that work well. The good old care band is great for securing this device in place. Once it is secured in place confirm with a stethoscope.