title: Evaluation of I-Gel™size 2 airway in different degrees of neck flexion in anesthetized children - a prospective, self-controlled trial.
abstract: BACKGROUND
  A previous study by our group demonstrated an increase in oropharyngeal leak pressures and a deterioration of ventilation in maximum neck flexion with the I-Gel™. To ascertain the optimal degree of neck flexion which increases OPLP without compromising ventilation we conducted a prospective self-controlled trial with the I-Gel™in different degrees of neck flexion in anesthetized paralyzed children.
  
  
  METHODS
  The I-gel™was inserted in 60 children undergoing inhalation induction with muscle paralysis for routine general anesthesia. Recordings of peak inspiratory pressures (PIP) at flexion of 15°, 30°, and 45° were taken as the primary outcome. Expired tidal volume, ventilation scoring, fiberoptic gradings, and OPLP in different degrees of flexion were recorded as secondary outcomes.
  
  
  RESULTS
  There was a significant increase in mean PIP in cm H2O at flexion 30° [13.3 (95% CI 12.8-13.8) cm H2O, P < 0.001] and 45° flexion (16.5 [15.9-17.1] cm H2O, P < 0.001) compared to neutral. A decrease in the expired tidal volume was seen at flexion of 30° (7.6 [7.3-7.8] cm H2O, P = 0.00) and 45° (7.6 [7.3-7.8] cm H2O, P = 0.00). There was deterioration of ventilation score, mean [range] at 30° flexion 2[0-3], and 45° flexion 1[0-3] compared to the neutral 3[2-3]. There was a significant increase in OPLP with an increase in degree of flexion.
  
  
  CONCLUSIONS
  We conclude that 15° neck flexion can safely be applied without compromising ventilation with the I-Gel™in anesthetized paralyzed children. However, Flexion of 30° or more warrants caution or the use of alternative devices like an endotracheal tube due to increase in PIP and worsening of ventilation score.
authors: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Divya
authors: D
authors: Jain
authors: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Babita
authors: B
authors: Ghai
authors: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Komal
authors: K
authors: Gandhi
authors: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Gargi
authors: G
authors: Banerjee
authors: Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Indu
authors: I
authors: Bala
authors: Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Ram
authors: R
authors: Samujh
mesh_terms: D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D017214:Laryngeal Masks; D008297:Male; D009333:Neck; D009960:Oropharynx; D056888:Patient Positioning / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies
keywords: airway-laryngeal mask airway; anesthesia-pediatrics; position-head and neck