The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients

Abstract

Effective ventilation with an i-gel can be performed in patients in whom the head and neck is extended or rotated, whereas flexion of the head and neck adversely affects ventilation. Clinically, flexion of the head and neck should be avoided during ventilation with the i-gel.

A prospective randomised comparison of two insertion methods for i-gel™placement in anaesthetised paralysed patients: standard vs rotational technique

“…However, two previous studies showed that the success rate of i-gel insertion is high, even for novices [8,17]. We also think that our results can be generalised because the success rate, insertion time, and seal pressure in the standard technique group were similar to data from other experienced operators [8,10,21].…”

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial

“…Several clinical studies have shown that the i-gel effectively conforms to the perilaryngeal anatomy and consistently achieves proper positioning for supraglottic ventilation [14,15]. SGDs are also suited for difficult airway management, especially in "cannot intubate, cannot ventilate" situations [16,17].…”

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

“…Sanuki et al [10] started the evaluation of effectiveness of head and neck positions on ventilation on I-gel airway devices, as they investigated the effect of different positions on oropharyngeal leak pressure and ventilation scores during ventilation with I-gel. Compared with the neutral position (25.8±5.2cm H 2 O), oropharyngeal leak pressure was significantly higher with flexion (28.5±3.4cm H 2 O, P=0.015) and lower with extension (23.0±4.2cm H 2 O, P=0.015), but similar with rotation (26.7±5.1 cm H 2 O, P=0.667).…”

“…Sample size was calculated, with a confidence interval of 95% and a power of 90%, based upon previous studies [10,15]. The maximum sample size was 30 in each group for flexion with a difference between means of 4 cm of H 2 O for oro-pharyngeal leak pressures.…”

“…Thus, the ventilation score equals 3 if all three criteria exist which is the maximum score [9,10]. To evaluate the effect of changing the position of the head and neck on the SGA the patient's head was put first in the neutral position in which a line joining the superior orbital margin and the external ear canal with the top of the shoulder is vertical.…”