title: Evaluation of I-gel™ airway in different head and neck positions in anesthetized paralyzed children.
abstract: BACKGROUND
  Studies that have compared and quantified the oropharyngeal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of head-neck position changes on the functioning of I-gel(™) in pediatric population still remain unevaluated.
  
  
  OBJECTIVE
  This study aimed to quantify the influence of different head and neck positions namely neutral, maximum flexion, and maximum extension on OPLP, ventilation scoring, and fiberoptic grading using I-gel(™) in anesthetized, paralyzed children.
  
  
  METHODS
  I-gel(™) was inserted in 30 paralyzed, anesthetized children scheduled for elective urological and orthopedic procedures. Anesthesia was induced with sevoflurane in oxygen. Atracurium was administered intravenously to facilitate neuromuscular relaxation. Recordings of OPLP in neutral, maximum flexion, and maximum extension were taken as primary outcome. Fiberoptic grading, insertion of ryle's tube and ventilation scoring were also measured in different head and neck positions as secondary outcomes.
  
  
  RESULTS
  The OPLP was significantly higher in flexion (27.6 ± 3.3 cm H2 O, P = 0.000) and lower in extension (19.6 ± 3.2 cm H2 O, P = 0.006) in comparison to the neutral position (23.2 ± 3.2 cm H2 O). There was a worsening of the fiberoptic view in flexion compared to neutral position (0/5/19/6 vs 5/21/4/0). The ventilation score was poorer (1 [0-3], P < 0.05) and peak inspiratory pressures higher in flexion (15.2 ± 1.4 cm H2 O, P = 0.000) compared to the neutral position (10.4 ± 1.6 cm H2 O).
  
  
  CONCLUSIONS
  Caution is warranted in pediatric patients while ventilating with I-gel(™) in extreme flexion of head and neck owing to poor ventilation despite increase in OPLP.
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Jain
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Ghai
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Indu
authors.initials: I
authors.lastname: Bala
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Komal
authors.initials: K
authors.lastname: Gandhi
authors.affiliation: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Gargi
authors.initials: G
authors.lastname: Banerjee
mesh_terms: D000769:Anesthesia, Inhalation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology; D006257:Head; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D009333:Neck; D019637:Orthopedic Procedures; D010243:Paralysis; D056888:Patient Positioning / Q000379:methods*; D012121:Respiration, Artificial; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures
keywords: I-gel™; different head and neck positions; fiberoptic grading; gastric tube insertion; oropharangeal leak pressures; ventilation scoring