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  • Title: Evaluation of I-Gel™ size 2 airway in different degrees of neck flexion in anesthetized children - a prospective, self-controlled trial.
    Author: Jain D, Ghai B, Gandhi K, Banerjee G, Bala I, Samujh R.
    Journal: Paediatr Anaesth; 2016 Dec; 26(12):1136-1141. PubMed ID: 27779349.
    Abstract:
    BACKGROUND: A previous study by our group demonstrated an increase in oropharyngeal leak pressures and a deterioration of ventilation in maximum neck flexion with the I-Gel™ . To ascertain the optimal degree of neck flexion which increases OPLP without compromising ventilation we conducted a prospective self-controlled trial with the I-Gel™ in different degrees of neck flexion in anesthetized paralyzed children. METHODOLOGY: The I-gel™ was inserted in 60 children undergoing inhalation induction with muscle paralysis for routine general anesthesia. Recordings of peak inspiratory pressures (PIP) at flexion of 15°, 30°, and 45° were taken as the primary outcome. Expired tidal volume, ventilation scoring, fiberoptic gradings, and OPLP in different degrees of flexion were recorded as secondary outcomes. RESULTS: There was a significant increase in mean PIP in cm H2 O at flexion 30° [13.3 (95% CI 12.8-13.8) cm H2 O, P < 0.001] and 45° flexion (16.5 [15.9-17.1] cm H2 O, P < 0.001) compared to neutral. A decrease in the expired tidal volume was seen at flexion of 30° (7.6 [7.3-7.8] cm H2 O, P = 0.00) and 45° (7.6 [7.3-7.8] cm H2 O, P = 0.00). There was deterioration of ventilation score, mean [range] at 30° flexion 2[0-3], and 45° flexion 1[0-3] compared to the neutral 3[2-3]. There was a significant increase in OPLP with an increase in degree of flexion. CONCLUSION: We conclude that 15° neck flexion can safely be applied without compromising ventilation with the I-Gel™ in anesthetized paralyzed children. However, Flexion of 30° or more warrants caution or the use of alternative devices like an endotracheal tube due to increase in PIP and worsening of ventilation score.
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