Comparison of I-gel™ and Laryngeal Mask Airway Supreme™ in Different Head and Neck Positions in Spontaneously Breathing Pediatric Population

Overview

Journal Anesth Essays Res

Specialty Anesthesiology

Date 2017 Sep 21

PMID 28928564

Citations 7

Authors

Swati Gupta

Neelam Dogra

Kanchan Chauhan

Affiliations

Soon will be listed here.

Abstract

Background: Although the advantages of ventilation with i-gel™ and laryngeal mask airway Supreme (LMA-Supreme™) has been well documented, they are still under debate for surgeries requiring flexion and extension of neck such as thyroid surgery, tonsillectomy, and neck exploration. Hence, we conducted a study to demonstrate the effect of neck flexion and extension in spontaneously breathing anesthetized pediatric patients utilizing i-gel™ and LMA-Supreme™.

Methods: A prospective, randomized comparative study was conducted on sixty children, thirty each in i-gel™ and LMA-Supreme™ group. Oropharyngeal leak pressure (OPLP), fiberoptic view of vocal cords, and exhaled tidal volume were evaluated in neutral, flexion, and extension neck positions in spontaneously breathing children.

Results: OPLP for i-gel™ was found to be significantly higher in flexion (29.00 ± 1.95 cmHO, < 0.001) and lower in extension (21.07 ± 2.08 cmHO, < 0.001) as compared to neutral (24.67 ± 2.08 cmHO). Similar results were observed for LMA-Supreme™ which showed significantly higher OPLP in flexion (24.73 ± 2.26, < 0.001 respectively) and lower in extension (18.67 ± 1.42 cmHO, < 0.001) as compared to neutral (20.87 ± 1.80 cmHO). Worsening of fiberoptic view occurs for i-gel™ and LMA-Supreme™ in flexion (10/12/5/3/0 and 11/14/2/2/1, < 0.05) as compared to neutral position (17/10/2/1/0 and 15/12/1/1/1), respectively. Significant change did not occur in extension. Ventilation worsening occurred in flexion as compared to neutral position evidenced by significant decrease in exhaled tidal volume (92.90 ± 11.42 and 94.13 ± 7.75 ml, < 0.05) as compared to neutral (100.23 ± 12.31 and 101.50 ± 8.26 ml) for i-gel™ and LMA-Supreme™, respectively.

Conclusion: Neck flexion caused a significant increase in leak pressure in both i-gel™ and LMA-Supreme™. With deterioration of fiberoptic view and ventilation, both devices should be used cautiously in pediatric patients in extreme flexion.

Citing Articles

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