Evaluation of I-Gel™ size 2 airway in different degrees of neck flexion in anesthetized children - a prospective, self-controlled trial
© 2016 John Wiley & Sons Ltd..
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.
| Errataetall: |
CommentIn: Paediatr Anaesth. 2017 Apr;27(4):444. - PMID 28300351 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Paediatric anaesthesia - 26(2016), 12 vom: 12. Dez., Seite 1136-1141 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jain, Divya [VerfasserIn] |
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| Links: |
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| Themen: |
Airway-laryngeal mask airway |
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| Anmerkungen: |
Date Completed 01.09.2017 Date Revised 01.09.2017 published: Print-Electronic CommentIn: Paediatr Anaesth. 2017 Apr;27(4):444. - PMID 28300351 Citation Status MEDLINE |
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| doi: |
10.1111/pan.13001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM265633869 |
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| 500 | |a CommentIn: Paediatr Anaesth. 2017 Apr;27(4):444. - PMID 28300351 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2016 John Wiley & Sons Ltd. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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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