The Laryngeal Mask Airway SupremeTM– a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the Laryngeal Mask Airway ProSealTM in paralysed, anaesthetised patients

The LMA Supreme^TM is a new extraglottic airway device which brings together features of the LMA ProSeal^TM, Fastrach^TM and Unique^TM. We test the hypothesis that ease of insertion, oropharyngeal leak pressure, fibreoptic position and ease of gastric tube placement differ between the LMA ProSeal^TM and the LMA Supreme^TM in paralysed anesthetised patients. Ninety‐three females aged 19–71 years were studied. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. Oropharyngeal leak pressure and fibreoptic position were determined during cuff inflation from 0 to 40 ml in 10 ml increments. Gastric tube insertion was attempted if there was no gas leak from the drain tube. First attempt and overall insertion success were similar (LMA ProSeal^TM, 92% and 100%; LMA Supreme^TM 95% and 100%). Guided insertion was always successful following failed digital insertion. Oropharyngeal leak pressure was 4–8 ml higher for the LMA ProSeal^TM over the inflation range (p < 0.001). Intracuff pressure was 16–35 cm higher for the LMA ProSeal^TM when the cuff volume was 20–40 ml (p < 0.001). There was an increase in oropharyngeal leak pressure with increasing cuff volume from 10 to 30 ml for both devices, but no change from 0 to 10 ml and 30–40 ml. There were no differences in the fibreoptic position of the airway or drain tube. The first attempt and overall insertion success for the gastric tube was similar (LMA ProSeal^TM 91% and 100%; LMA Supreme^TM 92% and 100%). We conclude that ease of insertion, gastric tube placement and fibreoptic position are similar for the LMA ProSeal^TM and LMA Supreme^TM in paralysed, anaesthetised females, but oropharyngeal leak pressure and intracuff pressure are higher for the LMA ProSeal^TM.     

A performance comparison of the paediatric i‐gel™ with other supraglottic airway devices

We performed a review of published literature comparing the i‐gel^? with other supraglottic airway devices in children. Sixty‐two articles were identified following a literature search; we included data from 14 randomised controlled trials and eight observational studies that compared i‐gel sizes 1–2.5 with other commonly used, equivalently‐sized, devices. The primary outcome in most studies was oropharyngeal leak pressure. In the 14 randomised trials the i‐gel performed the same as the comparator device in five trials, significantly better in eight studies (p < 0.05) and significantly worse in one (p < 0.01). Seven studies assessed fibreoptic views of the larynx through the device; two found significantly better views through the i‐gel. Three studies reported a shorter insertion time for the i‐gel, whereas two reported a longer time. Insertion success rate, gastric tube placement and complications were similar for all the devices. Seven of the eight observational studies measured average oropharyngeal leak pressures of 20–27 cmH₂O and all had first‐time insertion success rates exceeding 90%. We conclude that the i‐gel is at least equivalent to other supraglottic airway devices currently available for use in children, and may enable a higher oropharyngeal leak pressure and an improved fibreoptic view of the glottis.     

A randomised comparison of the LMA SupremeTM and LMAProSealTM in children

We conducted a randomised trial comparing the size‐2 LMA Supreme? with the LMA ProSeal? in 60 children undergoing surgery. The outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement, quality of the airway during anaesthetic maintenance and complications. There were no statistically significant differences between the LMA Supreme and LMA ProSeal in median (IQR [range]) insertion time (12 (10–15 [7–18]) s vs 12 (10–13 [8–25]) s; p = 0.90), airway leak pressures (19 (16–21 [12–30]) cmH₂O vs 18 (16–24 [10–34]) cmH₂O; p = 0.55), fibreoptic position of the airway or drain tube, ease of gastric access and complications. Both devices provided effective ventilation requiring minimal airway manipulation. The LMA Supreme can be a useful alternative to the LMA ProSeal when single‐use supraglottic devices with gastric access capabilities are required.     

Evaluation of the LMA Supreme™ in 100 non‐paralysed patients*

We studied the LMA Supreme^? in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10–25 (5–120)] s. During ventilation, an expired tidal volume of 7 ml.kg^?1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20–28 (13–40)] cmH₂O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side‐effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices.     

Comparative efficacy and safety of the Ambu® AuraOnce™ laryngeal mask airway during general anaesthesia in adults: a systematic review and meta‐analysis

Previous comparisons between the Ambu^® AuraOnce^? and other laryngeal mask airways have revealed different results across various clinical studies. We aimed to perform a systematic review with meta‐analysis on the efficacy and safety of the AuraOnce compared with other laryngeal mask airways for airway maintenance in adults undergoing general anaesthesia. Our search of PubMed, PubMed Central, Scopus and the Central Register of Clinical Trials of the Cochrane Collaboration yielded nine randomised controlled trials eligible for inclusion. Comparator laryngeal mask airways were the LMA Unique^? (four trials), the LMA Classic^® (five trials) and the Portex^® Soft Seal^® (three trials). The AuraOnce provided an oropharyngeal leak pressure higher than the LMA Unique (304 participants, mean (95% CI) difference 3.1 (1.6–4.7) cmH₂O, p < 0.0001) and equivalent to the LMA Classic. The Soft Seal provided a higher leak pressure than the AuraOnce (229 participants, mean (95% CI) difference 3.5 (0.4–6.7) cmH₂O, p = 0.03). Insertion was significantly faster with the AuraOnce than the LMA Unique (304 participants, mean (95% CI) difference 5.4 (2.1–8.71) s, p = 0.001) and Soft Seal (229 participants, mean (95% CI) difference 9.5 (3.0–15.9) s, p = 0.004), but similar to the LMA Classic. The first‐insertion success rate of the AuraOnce was equivalent to the LMA Unique, LMA Classic and Soft Seal. We found a higher likelihood of bloodstaining on the cuff with the Soft Seal and a higher incidence of sore throat with the LMA Classic. We conclude that the AuraOnce is an effective alternative to the LMA Classic and LMA Unique, and easier to insert than all three other devices studied.     

Comparison of the Intersurgical SolusTM laryngeal mask airway and the i‐gel supralaryngeal device

We compared the performance of the Intersurgical Solus^TM laryngeal mask airway (LMA) with that of the i‐gel in 120 patients of ASA physical status during general anaesthesia with respect to oropharyngeal leak pressure, peak airway pressure, airway manipulation, insertion time, fibreoptic view, ventilatory parameters, and peri‐operative complications . After receiving a standardised induction of anaesthesia, either a Solus LMA (60 patients) or an i‐gel (60 patients) was inserted. One hundred and fifteen patients completed the study. The leak pressure was significantly higher in the LMA group than the i‐gel group (mean (SD) 22.7 (7.7) cmH₂O vs 19.3 (7.1) cmH₂O; p = 0.02). A better fibreoptic view of the larynx was obtained in patients in the LMA group (p = 0.02) compared to those in the i‐gel group and less airway manipulation was required in the LMA group (p < 0.01). Both devices have good performance with very low peri‐operative complications . However, the Solus LMA provides a better oropharyngeal seal, provides a better fibreoptic view, and requires less manipulation to secure the airway than the i‐gel.     

Saline as an alternative to air for filling the laryngeal mask airway cuff

We have assessed a new method to evacuate saline completely from the laryngeal mask airway (LMA) cuff and tested the hypothesis that intracuff pressures, fibreoptic position and oropharyngeal leak pressures are similar for saline compared with air during nitrous oxide- oxygen anaesthesia. Eight size 4 LMA were inflated with saline 30 ml. After syringe evacuation, median residual weight was 0.56 (range 0.24- 0.98) g; after additional manual cuff squeezing it was 0.26 (0.21-0.35) g; and after drying for 12 h at 60 degrees C with the valve open it was -0.02 (-0.05-0.04) g. Pressure-volume curves of four size 3-5 LMA showed that compliance was lower for the saline-filled cuff. A clinical study of 20 patients allocated randomly to have saline or air in the cuff showed a significant increase in intracuff pressure with air, but not saline, during nitrous oxide-oxygen anaesthesia. The fibreoptic position of the LMA changed more frequently in the air, compared with the saline-filled group (four of 10 vs none of 10; P = 0.04). Oropharyngeal leak pressures were similar between groups. We conclude that the saline-inflated LMA cuff was reliably emptied and more stable in terms of intracuff pressures and possibly fibreoptic position. Filling the LMA cuff with saline is a viable option during laser surgery to the airway.      

A randomised comparison of the Ambu® AuraGain™ and the LMA® supreme in infants and children

We conducted a randomised trial in 100 children in order to compare the clinical performance of the Ambu^® AuraGain^? and the LMA^® Supreme^* for airway maintenance during mechanical ventilation. The primary outcomes were initial and 10‐min airway leak pressures. Ease, time and success rates for device and gastric tube insertion, fibreoptic grades of view, airway quality during anaesthetic maintenance, and complications were also assessed. There were no differences in the initial and ten min airway leak pressures between the Ambu AuraGain and LMA Supreme, median (IQR [range]) initial: 19 (16–22 [10–34]) vs 18 (14–24 [8–40]) cmH₂O, p = 0.4; and ten min: 22 (18–26 [11–40]) vs 20 (16–26 [12–40]) cmH₂O, p = 0.08, respectively. Ease, time and success rates for device placement, gastric tube insertion and complications were also not significantly different. Children receiving the LMA Supreme required more airway manouevers (7 vs 1 patient, p = 0.06) to maintain a patent airway. Our results suggest that the Ambu AuraGain may be a useful alternative to the LMA Supreme, as demonstrated by comparable overall clinical performance in children.     

Appropriate size of laryngeal mask airway for children

The aim of this crossover study was to determine the optimal size of laryngeal mask airway in children weighing 10 to 20 kg. In each of 67 apnoeic anaesthetized children, the size 2 and size 2 1/2 laryngeal mask airways were inserted consecutively by a skilled user and the cuff inflated to 60 cmH2O. Each LMA was assessed for the ease of insertion (by the number of attempts), oropharyngeal leak pressure, anatomical position (assessed fibreoptically) and the volume of air required to achieve intracuff pressure of 60 cmH2O. During the measurement of oropharyngeal leak pressure, the airway pressure was not allowed to exceed 30 cmH2O. There was no failed attempt at insertion with any size. The oropharyngeal leak pressure was significantly less for the size 2 LMA compared to the size 2 1/2 LMA (P < 0.001). The oesophagus was visible on three occasions, all with the size 2 LMA. Gastric insufflation occurred in three patients, all with the size 2 LMA. The incidence of low oropharyngeal leak pressure (< 10 cmH2O) was low (9.0%) and all occurred with the size 2 LMA. The fibreoptic bronchoscope scores were not significantly different between the two sizes of LMAs. The volume of air to achieve intracuff pressure of 60 cmH2O was much lower than the maximum recommended volume (5.1 ml for size 2 and 6.2 ml for size 2 1/2). We conclude that the size 2 1/2 LMA provides a better fit than size 2 in children 10 to 20 kg.     

The LMA® ProtectorTM in anaesthetised,non-paralysed patients: a multicentre prospective observational study

We evaluated the LMA ^® Protector^TM in 280 ASA physical status 1–3 patients aged 18–75 years by assessing the ease of insertion, insertion time, oropharyngeal leak pressure, ease of gastric tube passage and complications. First-attempt and overall insertion success was 234/280 (84; 95%CI 79–88%) and 274/280 (98; 95–99%). Median (IQR [range]) insertion time was 17 (12–25 [5–44]) s, and manoeuvres to facilitate insertion were required in 56 (50–63)% of patients. Median oropharyngeal leak pressure was 31 (26–36 [14–40]) cmH₂O. Multivariate analysis identified two risk factors for oropharyngeal leak pressure < 25 cmH₂O: male sex (OR 2.44; 1.01–5.91, p = 0.048) and the insertion of a LMA size different to that recommended by weight (OR 1.98; 0.97–4.03, p = 0.06). Gastric tube insertion was possible in 256 out of 274 patients (93%). On fibreoptic view, vocal cords were visible in 86% of patients. During maintenance, 14 patients (5%) required airway manipulation. There were no episodes of regurgitation or aspiration. Blood staining on LMA removal was present in 70 out of 280 patients (25%). Use of the LMA Protector appears safe and is associated with a high success rate, provision of a highly effective seal and low rates of clinical complications. These attributes would suggest considerable potential for use during anaesthesia.     

The effect of a cervical collar on the seal pressure of the LMA Supreme™: a prospective,crossover trial

For personnel inexperienced in airway management, supraglottic airway devices may be the first choice in an emergency. Changing head position is known to reduce the seal pressure of a laryngeal mask airway. The aim of this study was to investigate whether the use of a cervical collar improves the stability of airways secured with the LMA Supreme? (The Laryngeal Mask Company Limited, Mahé, Seychelles). In this crossover trial, the primary endpoint was the difference in the seal pressure of the LMA Supreme in anaesthetised patients in maximum passive extension of the neck, with and without a cervical collar. The median (IQR [range]) seal pressure was 18 (13.8–22.1 [0–30]) cmH₂O in maximum passive extension without a cervical collar. With a cervical collar in place, the seal pressure increased to 28 (22.8–30 [17–30]) cmH₂O (p < 0.001). In the neutral head position, the seal pressure was 22 (17.6–24.5 [12–30]) cmH₂O without and 27 (22–30 [12–30]) cmH₂O with a cervical collar in place (p < 0.001). We found that a cervical collar stabilises the airway with an LMA Supreme in place and we recommend this combination for (pre‐hospital) emergency cases.     

A systematic review and meta‐analysis of the i‐gel® vs laryngeal mask airway in children

We systematically reviewed randomised controlled trials of the i‐gel^® vs different types of laryngeal mask airway in children. We included nine studies. There was no evidence for differences in: rate of insertion at first attempt; insertion time; ease of insertion; or gastric tube insertion. The mean (95% CI) oropharyngeal leak pressure was 3.29 (2.25–4.34) cmH₂O higher with the i‐gel, p < 0.00001. The relative rate (95% CI) of a good fibreoptic view through the i‐gel was 1.10 (1.01–1.19), p = 0.02. There were no significant differences in the rates of complications, except for blood on the airway, relative rate with the i‐gel 0.46 (0.23–0.91), p = 0.02. We concluded that the clinical performance of the i‐gel and LMA was similar, except for three outcomes that favoured the i‐gel.     

ORIGINAL ARTICLE: Comparison of guided insertion of the LMA ProSeal™ vs the i‐gel™

In a randomised, non‐crossover study, we tested the hypothesis that the ease of insertion using a duodenal tube guided insertion technique and the oropharyngeal leak pressure differ between the LMA ProSeal? and the i‐gel? in non‐paralysed, anesthetised female subjects. One hundred and fifty‐two females aged 19–70 years were studied. Insertion success rate, insertion time and oropharyngeal leak pressure were measured. First attempt and overall insertion success were similar (LMA ProSeal, 75/76 (99%) and 76/76 (100%); i‐gel 73/75 (97%) and 75 (100%), respectively). Mean (SD) insertion times were similar (LMA ProSeal, 40 (16) s; i‐gel 43 (21) s). Mean oropharyngeal leak pressure was 7 cmH₂O higher with the LMA ProSeal (p < 0.0001). Insertion of the LMA ProSeal and i‐gel is similarly easy using a duodenal tube guided technique, but the LMA ProSeal forms a more effective seal for ventilation.     

A comparison of the i‐gel™ and the PRO‐Breathe® laryngeal mask during pressure support ventilation in children

Many studies comparing the i‐gel^? with laryngeal masks include patients in whom laryngeal mask cuff inflation pressures are higher than recommended, or involve the use of neuromuscular blocking drugs and positive pressure ventilation. We compared the i‐gel with the PRO‐Breathe^® laryngeal mask in anaesthetised, spontaneously breathing children. Two hundred patients aged up to 16 years were randomly allocated to either the i‐gel or the PRO‐Breathe laryngeal mask. The PRO‐Breathe was inflated to an intracuff pressure of 40 cmH₂O. All patients received pressure support of 10 cmH₂O and positive end‐expiratory pressure of 5 cmH₂O. Successful insertion at the first attempt was 82% for the i‐gel compared with 93% for the PRO‐Breathe (p = 0.019). Leakage volume was significantly higher with i‐gel sizes 1.5 (p = 0.015), 2 (p = 0.375), 2.5 (p = 0.021) and 3 (p = 0.003) compared with the equivalent‐sized PRO‐Breathe device. Device dislodgement following successful initial placement was more frequent with the i‐gel (5%) compared with the PRO‐Breathe laryngeal mask (0%). We conclude that the PRO‐Breathe laryngeal mask is superior to the i‐gel in terms of leakage volume and device dislodgement.     

Influence of cuff volume on oropharyngeal leak pressure and fibreoptic position with the laryngeal mask airway

We studied the size 4 laryngeal mask airway (LMA) to test the hypothesis that oropharyngeal leak pressure and fibreoptic position improves with increasing cuff volume. After LMA insertion, 50 anaesthetized adult patients had the cuff inflated in 5-ml increments to 40 ml. Oropharyngeal leak pressure was optimal at 15 ml and decreased at higher volumes. The fibreoptic position was optimal at 0- 20 ml and deteriorated at higher volumes. Gastric insufflation was detected more frequently when the cuff volume exceeded 20 ml. We conclude that inflation of the size 4 LMA to the maximum recommended volume provides suboptimal conditions and that this value should be reduced from 30 to 20 ml.      

LMA Supreme™ vs i-gel™--a comparison of insertion success in novices

Two new supraglottic airway devices, the LMA Supreme? (LMA) and the i‐gel?, offer potential benefits when inserted by inexperienced operators. This study compared the insertion success rate and ventilation profile between the LMA Supreme and the i‐gel when inserted by operators without previous airway management expertise. Following a short lecture and manikin training, airway novices were randomly allocated to insert either the LMA Supreme or the i‐gel into 80 patients undergoing breast surgery. The primary outcome was first‐time success rate, and secondary outcomes were overall success rate, insertion time, airway leak pressure, tidal volume during pressure controlled ventilation at 17 cmH₂O, and adverse events. First‐time insertion success rate was significantly higher for the LMA Supreme than the i‐gel (30/39 (77%) vs 22/41 (54%); p = 0.029). Significantly more placement failures occurred with the i‐gel (6 vs 0, p = 0.025). Mean (SD) leak pressure (29 (8) vs 23 (11) cmH₂O, p = 0.007) and expired tidal volume (PCV 17 cmH₂O) (785 (198) vs 654 (91), p = 0.001) were significantly greater with the LMA Supreme than with the i‐gel, respectively. More patients complained of pharyngolaryngeal pain with the LMA Supreme than with the i‐gel (17/39 (44%) vs 8/41 (20%); p = 0.053). We found better first time success rate, fewer failures, and a better seal with the LMA Supreme compared with the i‐gel, indicating that the LMA Supreme may be preferable for emergency airway use by novices.     

LMA SupremeTM insertion by novices in manikins and patients

The LMA Supreme? has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non‐anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. Fifty airway novices inserted the LMA Supreme in anaesthetised patients undergoing elective surgery. First time insertion success rate was 86% and overall insertion success rate was 100%. Mechanical ventilation was successful in all cases. Median (IQR [range]) time to establish an airway was 34 s (26‐40 [18–145] s). Median (IQR [range]) pharyngeal seal pressure was 23 cmH₂O (19‐28 [13–40] cmH₂O). There were no important complications. Results are consistent with previous studies of use of the LMA Supreme by airway experts. We conclude that the LMA supreme is suitable for use by airway novices. Further research is needed before it may be recommended for cardiopulmonary resuscitation and emergency airway use.     

Reduced air leakage by adjusting the cuff pressure in pediatric laryngeal mask airways during spontaneous ventilation

Background: Optimal inflation of the laryngeal mask airway (LMA) cuff should allow ventilation with low leakage volumes and minimal airway morbidity. Manufacturer’s recommendations vary, and clinical end‐points have been shown to be associated with cuff hyperinflation and increased leak around the LMA. However, measurement of the intra‐cuff pressure of the LMA is not routine in most pediatric institutions, and the optimal intra‐cuff pressure in the LMA has not been determined in clinical studies. Methods: This was a prospective audit in100 pediatric patients undergoing elective general anesthesia breathing spontaneously via LMA (size 1.5–3). Cuff pressure within the LMA was adjusted using a calibrated pressure gauge to three different values (60, 40, and 20 cmH₂O) within the manufacturers’ recommended LMA cuff pressure range (≤60 cmH₂O). Three corresponding inspiratory and expiratory tidal volumes were recorded, and the differences were calculated as the ‘leak volume’. Results: Compared with 20 and 60 cmH₂O intra‐cuff pressure, measured leakage volumes were the lowest at cuff inflation pressures of 40 cmH₂O [median (range) 0.42 (0.09–1.00) ml·kg^?1] in most patients (83%), while 17% of children demonstrated minimally smaller leakages at 20 cmH₂O [0.51 (0.11–1.79) ml·kg^?1]. Maximum leakage values occurred with cuff pressures of 60 cmH₂O in all groups [0.65 (0.18–1.27) ml·kg^?1] and were not associated with the smallest value of air leakage in any patient. Conclusion: Using cuff manometry, an intra‐cuff pressure of 40 cmH₂O was associated with reduced leak around the LMA while higher (60 cmH₂O) and lower (20 cmH₂O) cuff pressures resulted in higher leak volumes during spontaneous ventilation. In spontaneously breathing children, reducing the intra‐cuff pressure of pediatric‐sized LMAs even below the manufacturers’ recommendations allows ventilation with minimized leakage around the LMA cuff.     

A randomised comparison of the self-pressurised air-Q(TM) intubating laryngeal airway with the LMA Unique(TM) in children*

We conducted a randomised trial comparing the self‐pressurised air‐Q^TM intubating laryngeal airway (air‐Q SP) with the LMA‐Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air‐Q SP (12 (10–15 [5–18])) s than with the LMA‐Unique (14 (12–17 [6–22]) s; p = 0.05). There were no statistically significant differences between the air‐Q SP and LMA‐Unique in initial airway leak pressures (16 (14–18 [10–29]) compared with 18 (15–20 [10–30]) cmH₂O, p = 0.12), an airway leak pressures at 10 min (19 (16–22 [12–30]) compared with 20 (16–22 [10–30]) cmH₂O, p = 0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air‐Q SP is an alternative to the LMA‐Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.     

A prospective randomised comparison of two insertion methods for i‐gel™ placement in anaesthetised paralysed patients: standard vs rotational technique

In this prospective randomised study, we compared two techniques for i‐gel^? insertion. One hundred and eighty‐one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i‐gel was inserted using the standard technique. In the rotation group (n = 90), the i‐gel was rotated 90° anticlockwise in the mouth and re‐rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs 87 (97%; p = 0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cmH₂O vs 27.1 (9.4) cmH₂O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i‐gel insertion.