Evaluation of I‐gel^™ airway in different head and neck positions in anesthetized paralyzed children

Abstract

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.

Evaluation of I‐Gel™ size 2 airway in different degrees of neck flexion in anesthetized children – a prospective, self‐controlled trial

“…At flexion of 30° and more the majority of the delivered tidal volume could not reach the lungs owing to an extremely narrowed laryngeal inlet leading to a significant reduction in expired tidal volume to 7.6 ml·kg −1 at 30° flexion and 6 ml·kg −1 at 45° flexion from 9.1 ml·kg −1 in the neutral position. These results were in agreement with previous studies documenting loss of expired tidal volume at maximum neck flexion . In our previous report, we reported a decrease in expired tidal volume to 4.6 ml·kg −1 in maximum flexion of 45° from the neutral position.…”

“…These results were in agreement with previous studies documenting loss of expired tidal volume at maximum neck flexion . In our previous report, we reported a decrease in expired tidal volume to 4.6 ml·kg −1 in maximum flexion of 45° from the neutral position. Kim et al .…”

“…Mean A mean PIP of 16.5 cm H 2 O and ventilation score of 1[0-3] was observed at 45°flexion. These results are in accordance with our previous study which showed poor ventilation scores 1[0-3] and increase in the PIP mean to 15.2 cm H 2 O in maximum flexion (7) with the I-Gel TM . Kim et al (5) demonstrated an increase in the PIP from 19 cm H 2 O in the neutral position to 32 cm H 2 O in maximum flexion with the Laryngeal Tube.…”

“…A previous study by our group demonstrated an increase in OPLP, but a deterioration of ventilation with the I-Gel TM in maximum flexion (7). These results were in accordance with the majority of earlier trials documenting worsening of ventilation with flexion (8)(9)(10).…”

“…Sample size was calculated using G*Power 3.1.9.2 software with anova : Repeated measures, within factor F ‐test assuming effect size of 15% change in PIP with every 15° change in every position, that is, neutral, flexion 15°, flexion 30°, and flexion 45° (1 group with 4 different measurements). This assumption was based on the results obtained from our previous study, in which PIP mean (95% CI) cm H 2 O in neutral position was 10.4 (9.2–11.3) and 15.2 (13.6–16.7) cm H 2 O with 45° flexion . Correlation was set to be 0.60 for all within factor measures with 80% power of the study and 5% level of significance we had to recruit 50 subjects.…”