Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

Abstract

Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis) and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left). The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation), lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

Comparison of Baska Mask® and Classical Laryngeal Mask® for Seal Pressures in Ambulatory Urological Surgery

“…Laringeal maske yerleştirme sırasındaki deneme sayısı, ek manevra ihtiyacı, yerleştirme ve ventilasyon süreleri kaydedildi. Yeterli ventilasyon sağlandıktan sonra, ventilatör tekrar manuel moda alınarak ve ayarlanabilir basınç sınırlayıcı valf valvi kademeli olarak 40 cmH 2 O'ya kadar kapatıldı, hastalar 3 L/dk taze gaz akımı ile manuel ventile edildi. Ventilasyon sırasında oluşan kaçak sesinin oskültasyonu, tiroid kartilaj hizasından yapıldı.…”

Evaluation of Head and Neck Position on Oropharyngeal Leak Pressure with Baska Mask and Streamlined Liner of Pharyngeal Airway (SLIPA<sup>TM</sup>): Arandomized Clinical Trial

“…Mishra and Nawaz et al [8] in their study compared the effect of head and neck position on the oropharyngeal leak pressures and fibreoptic view of the glottis and ventilation scores between ProSeal LMA and the I-gel. Compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck.…”

“…The patient head is put in the sniffing position. An experienced anesthesiologist inserted the lubricated supraglottic airway device chosen for that patient [7,8]. Size selection of the SLIPA TM and Baska mask was based on manufacturer guidelines.…”

“…Head and neck movement can lead to changes in the shape of the pharynx. This shape changes can alter the forces transmitted along the airway device during ventilation which may lead to displacement of the SGA and increasing the airway leak [8]. Pressure with Baska Mask and Streamlined Liner of Pharyngeal Airway (SLIPA TM…”

Comparison of Laryngeal Mask Airway SupremeTM Versus UniqueTM in Edentulous Geriatric Patients

“…The number of elderly patients is increasing with advances in medicine and public healthcare (23). However, an adequate depth of anaesthesia is required for successful insertion of LMA to prevent untoward events such as coughing and laryngospasm (24). We provided the depth of anaesthesia with BIS values.…”