Background Supraglottic airway devices (SADs) are the mainstay for airway management in pediatric ambulatory surgeries and may often be a suitable alternative to endotracheal intubation due to their favorable profile. Optimal oropharyngeal leak pressure of SAD is essential for adequate ventilation and prevention of aspiration. Occasionally, lateral position is required for administration of regional block or for the surgery itself. We aim to compare the oropharyngeal leak pressure of igel™ and LMA Supreme™ in children in lateral position. A prospective, randomized study was performed on eighty children of either sex, weighing 5–10 kg, belonging to ASA grade I and II undergoing elective surgery requiring lateral position. The primary objective was comparison of Oropharyngeal leak pressure of both devices in lateral position. Secondary objectives included assessment of insertion success rate, number of insertion attempts and manipulations, time and ease of insertion; and comparison of fiberoptic view of the larynx, fractional volume loss, and displacement with respect to both devices in supine and lateral position. Results Oropharyngeal leak pressure of i-gel™ was higher than that of LMA Supreme™ in both supine (25.4 ± 1.4 cm H2O Vs 22.9 ± 1.5 cm H2O) and lateral position (23.9 ± 1.6 vs 21.5 ± 1.5 cm H2O) and was statistically significant (p < 0.001). The success rate of insertion of i-gel™ and LMA Supreme™ was similar (95% and 97.5% respectively). The ease of insertion for both devices was statistically similar (p = 0.593). The mean time for insertion was longer for i-gel™ (15.4 ± 1.72 s vs 12.4 ± 1.73 s) as compared to LMA Supreme™ (p < 0.001). Ventilatory parameters for both devices decreased in the lateral position, which was statistically significant. The fractional volume loss after change of position was 0.123 vs 0.478 for i-gel™ and LMA Supreme™ respectively. In both groups, fiberoptic views worsened with a change of position. Conclusions Oropharyngeal leak pressure of both devices reduced in lateral position as compared to supine position. I-gel™ yielded higher leak pressures in supine as well as in lateral position as compared to LMA Supreme™. Implications The above findings offer valuable insight for decision-making in pediatric daycare surgeries requiring lateral position where GA is warranted. Trial registration CTRI NUMBER (CTRI/2021/01/030442)—the trial was registered with the Clinical Trial Registry of India on 13 January 2021.

Congenital hemangiomas are benign tumors of endothelium most often occurring as a solitary lesion with a predilection for the head- and-neck. This report presents a case of a giant friable hemangioma of the lower lip in a 1-month-old male child posted for excision of the lesion. Airway management was challenging as the size, site, and history of repeated local site bleeding made mask ventilation impossible. Bypassing mask ventilation, a supraglottic device (SGD) was directly inserted and adequate lung ventilation was ensured followed by C-MAC® video laryngoscope-guided intubation. Challenging extubation was also overcome by the use of a SGD. This case demonstrates how an airway with impossible bag and mask ventilation can be managed by securing the airway with SGD before intubation.