Comparison Between Awake Versus Deep Removal of I-Gel Airway in Pediatrics Undergoing Cataract Surgery: A Randomized Controlled Trial

Ahmed Hesham Hasan Houssein Masoud, Resident of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, EgyptFollow
Enas Aly Abd EL Motalb, Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt
Ghada Fouad Mohamed Weefky, Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt
Maha Younis Youssef Abdallah, Assistant Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Egypt

Corresponding Author

Ahmed Hesham Hasan Houssein Masoud

Subject Area

Anaesthesia and Surgical Intensive Care

Article Type

Original Study

Abstract

Background: Establishing, securing, and maintaining a patent airway is essential throughout surgery under general anesthesia. The I-gel airway is a widely used supraglottic device for maintaining an open airway during anesthesia. This study aimed to compare deep versus awake removal of the I-gel airway in pediatric patients undergoing cataract surgery, with a primary focus on postoperative intraocular pressure changes.

Methods: This prospective randomized single-blind study included 48 pediatric patients (aged 4–8 years, ASA I–II) undergoing cataract surgery under general anesthesia with sevoflurane maintenance. Patients were randomly allocated into two equal groups: Group A (awake removal, n=24) and Group B (deep removal, n=24). The primary outcome was postoperative intraocular pressure change. Secondary outcomes included hemodynamic changes (heart rate, mean arterial pressure), airway hyperreactivity score, and airway-related adverse events (coughing, breath holding, laryngospasm, desaturation [SpO₂

Results: The deep removal group demonstrated a significant decrease in IOP after surgery compared to the awake removal group (14.81±1.46 vs. 15.88±1.55 mmHg, p=0.018). The absolute difference between groups was modest (1.07 mmHg). Additionally, the deep removal group showed a significant reduction in IOP from preoperative to postoperative values (pGroup A (awake removal) compared to Group B (deep removal) (HR: 108.7±11.6 vs. 98.3±9.2 beats/min, p=0.004; MAP: 77.6±8.2 vs. 69.6±7.3 mmHg, p=0.001). These differences persisted at 10 minutes post-removal (HR: 100.2±9.6 vs. 94.7±7.3 beats/min, p=0.012; MAP: 71.1±7.4 vs. 65.4±6.1 mmHg, p=0.009). Airway-related adverse events occurred more frequently in Group A (58.33%) than Group B (41.67%), though no individual complication reached statistical significance.

Conclusion: Deep removal of the I-gel airway in pediatric cataract surgery was associated with lower postoperative IOP compared with awake removal in this small randomized study, though the absolute difference was modest (1.07 mmHg) and its clinical significance remains uncertain. No statistically significant differences in individual airway complications were demonstrated, and the study may have been underpowered to detect differences in rare events. Larger adequately powered trials are required to confirm these findings and assess clinical relevance.

Recommended Citation

Masoud, Ahmed Hesham Hasan Houssein; EL Motalb, Enas Aly Abd; Weefky, Ghada Fouad Mohamed; and Abdallah, Maha Younis Youssef (2026) "Comparison Between Awake Versus Deep Removal of I-Gel Airway in Pediatrics Undergoing Cataract Surgery: A Randomized Controlled Trial," Mansoura Medical Journal: Vol. 56 : Iss. 3 , Article 6.
Available at: https://doi.org/10.58775/2735-3990.1622