Comparison of Simulated Standard Versus Modified Jaw Thrust I-Gel Insertion Technique in Novice Anesthesiologists. A Randomised Control Crossover Trial

Background: Novice anaesthesia trainees remain a challenge to train airway management skills in clinical practice. The advent of simulation labs provided a valuable platform to train airway skills in a controlled environment before engaging trainees with real patients. I-gel, a second-generation SAD, enhances safety and ease of use, but it can present insertion difficulties. The success rate depend on use of various insertion techniques. This study evaluates standard versus modified jaw thrust I-gel insertion technique among first-year anesthesia trainees using a manikin to analyse insertion ease and priority I-gel insertion technique in early phase of anesthesia training. Methods: This randomized controlled crossover trial was conducted at the simulation center of Aga Khan University. Fourteen novice trainees from various hospitals received comprehensive information prior to enrollment, including an educational tutorial, a video presentation, and hands-on practice with a manikin to familiarize themselves with standard and modified jaw thrust I-gel insertion technique. The study began with a questionnaire to assess the trainees' knowledge of supraglottic airway devices, insertion techniques, and their prior experiences. Second phase allowed trainees to insert I-gel ten times each with standard and modified jaw thrust technique in manikin for insertion ease in cross over manner by division of two groups using draw method. The third phase involved another questionnaire to determine the trainees’ preferred I-gel insertion technique for novice. Result: A total of 78.6% of trainees had prior knowledge of both LMA and I-gel, while 21.4% were only familiar with the LMA. The first standard I-gel insertion attempt revealed an average time of 7.43 ± 2.03 seconds, compared to 10.4 ± 2.59 seconds with modified jaw thrust technique. However, the Intragroup analysis revealed contrasting results; the standard technique’s insertion time remained consistent across all ten attempts, whereas the modified jaw thrust technique showed a significant reduction from 10.4 ± 2.59 seconds on the first attempt to 8.57 ± 2.41 seconds on the tenth attempt. There were no failed attempts with either technique. The post-study analysis highlighted significant results for the modified jaw thrust I-gel insertion technique: 71.4% of trainees found it easy to learn (p=0.023), and 78.6% preferred to practice it early in their anesthesia training (p=0.030). In comparison, only 28.6% found the standard technique easy, with 21.4% preferring it for early training period. Conclusion: The modified jaw thrust I-gel insertion technique demonstrated promising results in comparison to standard technique among novice anesthesia trainees practicing on a manikin. Most trainees supported integrating the modified technique into clinical practice alongside the standard I-gel insertion technique. Trial Registration: Trial was registered on 13 ^th September 2022, retrospectively at ClinicalTrial.gov, NCT05545163. https://trial.medpath.com/clinical-trial/f8c027f37bd7bccd/nct05545163-comparison-simulated-standard-modified-jaw-thrust-insertion-technique