Influence of head and neck position on cuff position and oropharyngeal sealing pressure with the laryngeal mask airway in children

Abstract

We studied how head and neck position affect the cuff position and oropharyngeal sealing pressures of the laryngeal mask airways (LMAs) in children. We studied 39 non-paralyzed healthy children aged 1.5-8.0 yr, weighing 10.3-27.0 kg, managed with size 2 or 2.5 LMAs during elective surgery. Head and neck movements did not adversely affect airway patency in 97% of patients. One child developed apparent airway obstruction with head and neck flexion, which was relieved in the neutral position. Oropharyngeal sealing pressure was significantly greater during neck flexion compared with the neutral position (P<0.02). Fibreoptic examination revealed that the epiglottis covered a larger area of the LMA aperture during neck flexion, compared with the neutral position (P<0.02).

The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal™ laryngeal mask airway*

“…To minimise these problems, it is usually recommended that at least 2-3 cm (two fingerbreadths) space between the chin and the anterior chest wall should be maintained when the anaesthetised patients head is placed in flexion [8]. For this reason, we used moderate head flexion in this study, rather than maximum head flexion used in previous studies [2,[16][17][18][19].…”

“…This finding is in agreement with the previously reported results in the studies of the ProSeal [2] .............................................................................................................................................................................................................................................................................................. and the classic laryngeal mask airway [16][17][18][19]. Based on our results and those from previous studies, there seems to be no significant difference between the ProSeal LMA (0.6-0.7 kPa) and the classic laryngeal mask airway (0.5-0.7 kPa) in the mean increase in airway seal pressure caused by the head flexion, though the design of their cuff shape and tube configuration differs significantly [1].…”

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

“…Fiberoptic scoring was done based on scores used by Okuda et al . (4—<1/3 view covered with epiglottis, 3—1/3 to 2/3 view covered with epiglottis, 2—>2/3 view covered with epiglottis, 1—completely covered with epiglottis but having adequate function). In children, in spite of the optimal placement of SAD a supraglottic airway device, the epiglottis covers a large part of the laryngeal inlet.…”

Laryngeal Mask Airway Anaesthesia in Hypotonic Cases with Expected Difficult Intubation

“…ProSeal LMA ve I-gel'in baş ve boynun farklı pozisyonlarında karşılaştırıldığı bir çalışmada; orofarengeal kaçak basıncının fleksiyonda arttığı, ekstansiyonda ise azaldığı görülürken, fleksiyonda havayolu basınçlarının ProSeal LMA ile daha fazla olmak üzere iki grupta da arttığı saptanmıştır (4). Çocuklarda yapılan bir çalışmada baş ve boyun fleksiyonuyla erişkinlerde olduğu gibi orofarengeal kaçak basıncının arttığı, ancak fiberoptik incelemelerde bu pozisyonda nötral pozisyona göre epiglotun LMA girişini daha fazla kapattığı saptanmıştır (5 …”

“…Zor entübasyon veya zor ventilasyon beklenen bir olguda halihazırda olması gereken LMA anestezisi planı göz önünde bulundurulmalıdır. VP şant takılması için de LMA anestezisi yeterli ve güvenli bir uygulamadır (4,5).…”