Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover study

Kim, H.J.; Lee, Ki-Young; Bai, Sun Joon; Kim, M.H.; Oh, Ein; Yoo, Young Chul

doi:10.1093/bja/aew448

Cited by 25 publications

(55 citation statements)

References 21 publications

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“…Similar results have been reported in studies using different SGADs in both children and adults. [ 16 17 ] Flexion results in a decrease in the longitudinal tension on anterior pharyngeal muscles, which settle over the mask of SGADs providing better seal and reverse is seen during extension. In the current study, group B resulted in a 10.2% increase in mean OSP compared to 7% with I-gel™ from neutral to the flexed neck position.…”

Section: Discussionmentioning

confidence: 99%

“…But the area of cross-section of ventilation holes is larger in Baska mask ® (30 × 6 mm 2 for size 4) as compared to I-gel™ (16 × 7 mm 2 for size 4) hence providing an eminent buffer area leading to better preservation of ventilation and added advantage over I-gel™ during neck flexion to tide over limited laryngeal space [ Figure 3 ]. [ 17 19 ]…”

Section: Discussionmentioning

confidence: 99%

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Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study

et al. 2020

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Background and Aims: Oropharyngeal seal pressure (OSP) achieved by a supraglottic airway device holds due importance as it indicates the feasibility of positive pressure ventilation, the degree of airway protection from supra-cuff soiling and also relates to postoperative morbidity. The primary outcome measure was to assess and compare OSP in different head and neck positions with Baska mask ® and I-gel™. Secondary outcome measures were to compare peak inspiratory pressure (PIP), exhaled tidal volume (ETV), ease of insertion, time taken for insertion, number of attempts, intraoperative manipulations, and postoperative airway morbidity with both the devices. Materials and Methods: Seventy consenting adults scheduled for a variety of surgical procedures under general anesthesia were allocated to Group B and Group G using Baska mask ® and I-gel™ respectively. All statistical calculations were done using SPSS (Statistical Package for the Social Science). The comparison of quantitative variables between the study groups was done using Student t -test and within the variables was done by paired t -test. For comparing categorical data, Chi-square (χ 2 ) test was performed. Results: OSP was significantly higher in group B than in group G in all head and neck positions (neutral 33 ± 2.8 vs. 23.2 ± 1.8, flexion 35.5 ± 2.5 vs. 25.2 ± 1.6, extension 30.6 ± 2.7 vs. 21.4 ± 1.7, right lateral 32.6 ± 2.8 vs. 23.0 ± 1.5. left lateral 32.6 ± 2.7 vs. 23.1 ± 1.7 cm H 2 O, respectively) ( P = 0.000). PIP increased significantly in group G as compared to group B in flexion. ( P = 0.009). Baska mask ® had significantly higher ETV in flexion compared to I-gel™. ( P = 0.009). Conclusion: Baska mask ® may provide a useful alternative to I-gel™ where the glottic seal has precedence over ease of insertion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study

et al. 2020

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“…Although the most convenient method to assess the accuracy of anatomic placement of the LMA for clinical studies is fiberoptic examination, the value of the fiberoptic scoring system as a means of assessing proper positioning and airway seal function of the LMA has been debatable [4, 11, 19, 20]. Some studies demonstrated that there was no correlation between position and tightness of the LMA, and no prediction of tightness was possible [7, 20].…”

Section: Discussionmentioning

confidence: 99%

“…To ensure safety, the maximal allowable OPLP was fixed at 40 cmH 2 O. Because position of head can impact the OPLP [11], the head and neck were kept in the sniffing position during the study. A fiberoptic scope was passed through the LMA tube to a position 1 cm proximal to the end of the tube, and the fiberoptic position was evaluated using the fiberoptic scoring system [5, 14]: 4, only the vocal cords seen; 3, vocal cords plus posterior epiglottis seen; 2, vocal cords plus anterior epiglottis seen; 1, vocal cords not seen, but function adequate; and 0, functional failure with the vocal cords invisible.…”

Section: Methodsmentioning

confidence: 99%

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Kim

et al. 2019

BMC Anesthesiol

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BackgroundInsertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator.MethodsAfter approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded.ResultsData were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001).ConclusionLaryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion.Trial registrationcris.nih.go.kr, identifier: KCT0001945 (2016-06-17).

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“…[1–5] Compared with tracheal intubation, the use of SADs has been shown to reduce the incidence of postoperative pharyngolaryngeal complications and shorten recovery time from anesthesia. [4] Despite these advantages, the performance of SADs can be affected by head and neck position. [5,6]…”

Section: Introductionmentioning

confidence: 99%

Influence of head and neck position on the performance of supraglottic airway devices: A systematic review and meta-analysis

et al. 2019

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Background Changes in head and neck position may significantly affect the performance of supraglottic airway devices (SADs) by altering the pharyngeal structure. Purpose This systematic review and meta-analysis aimed to elucidate the effect of changes in head and neck position on performance of SADs. Data source Bibliographic databases, including PubMed, EMBASE, the Cochrane library, and the Web of Science. Study eligibility criteria Prospective studies investigating the effects of head and neck positions on the performance of SADs. Methods A random effect model was applied in the all analyses. Subgroup analysis was performed according to the type of device and the age of patient. The oropharyngeal leak pressure was the primary outcome measure. Secondary outcome measures included peak inspiratory pressure, fibreoptic view, and ventilation score (PROSPERO, CRD42017076971). Results Seventeen studies met the eligibility criteria. Overall, the oropharyngeal leak pressure significantly increased (mean difference 4.07 cmH 2 O; 95% confidence interval 3.30 to 4.84) during neck flexion with adverse effects on ventilation and fibreoptic view. Conversely, the oropharyngeal leak pressure decreased (mean difference − 4.05; 95% confidence interval − 4.90 to − 3.20) during neck extension with no significant effect on ventilation or fibreoptic view. Rotation of the head and neck did not significantly affect SAD performance. Conclusions The reduced oropharyngeal leak pressure in the extended neck position was not associated with impaired ventilation except with the air-Q self-pressurizing airway. The flexed neck position significantly worsens ventilation and the alignment between the SAD and glottis despite improving the seal except with the air-Q self-pressurizing airway and LMA Proseal.

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Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover study

Abstract: NCT02402387.

Cited by 25 publications

References 21 publications

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Influence of head and neck position on the performance of supraglottic airway devices: A systematic review and meta-analysis

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Influence of head and neck position on ventilation using the air-Q® SP airway in anaesthetized paralysed patients: a prospective randomized crossover study

Abstract: NCT02402387.

Cited by 25 publications

References 21 publications

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask® versus I-gel™; A randomised clinical study

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask® versus I-gel™; A randomised clinical study

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Influence of head and neck position on the performance of supraglottic airway devices: A systematic review and meta-analysis

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Product

Resources

About

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study

Influence of head and neck positions on oropharyngeal seal pressure with Baska mask^® versus I-gel™; A randomised clinical study