Second generation supraglottic airway devices have made airway management safer in children during surgery under general anaesthesia. The i gel is one of the most commonly used devices because it is easy to insert, usually requires fewer attempts, and provides a good seal that allows normal and assisted breathing. Traditionally, doctors insert the i gel without directly seeing the airway, known as blind insertion. However, studies using fibreoptic scopes have shown that even when the breathing looks fine, the device may not always be positioned correctly.

Previous research has compared the blind method with using a video laryngoscope, which is a camera that lets the doctor see the airway while inserting the device. Kumar and colleagues found that using the camera resulted in much fewer malpositions compared to the blind method and also gave better airway seal and visibility, though both methods were similarly successful in overall placement. Another study by Behera and colleagues, which used a different airway device called the Ambu AuraGain, did not find the same benefit, suggesting that results may vary depending on the device type.

Other studies have confirmed that the i gel performs well compared with other airway devices in children, offering faster placement and good ventilation. Imaging studies have also shown that blind insertion can lead to malposition in many children, even when breathing seems adequate. Overall, using video guidance to insert the i gel appears to improve how well the device fits, although more studies are needed in different age groups and situations.