A randomized controlled study to compare oropharyngeal leak pressure between I-gel™ and laryngeal mask airway supreme™ in children in lateral position under general anesthesia

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Abstract

Background
Supraglottic airway devices (SADs) are the mainstay for airway management in pediatric ambulatory surgeries and may often be a suitable alternative to endotracheal intubation due to their favorable profile. Optimal oropharyngeal leak pressure of SAD is essential for adequate ventilation and prevention of aspiration. Occasionally, lateral position is required for administration of regional block or for the surgery itself.
Results
Oropharyngeal leak pressure of i-gel™ was higher than that of LMA Supreme™ in both supine (25.4 ± 1.4 cm HO Vs 22.9 ± 1.5 cm HO) and lateral position (23.9 ± 1.6 vs 21.5 ± 1.5 cm HO) and was statistically significant ( < 0.001). The success rate of insertion of i-gel™ and LMA Supreme™ was similar (95% and 97.5% respectively). The ease of insertion for both devices was statistically similar ( = 0.593). The mean time for insertion was longer for i-gel™ (15.4 ± 1.72 s vs 12.4 ± 1.73 s) as compared to LMA Supreme™ ( < 0.001). Ventilatory parameters for both devices decreased in the lateral position, which was statistically significant. The fractional volume loss after change of position was 0.123 vs 0.478 for i-gel™ and LMA Supreme™ respectively. In both groups, fiberoptic views worsened with a change of position.
Conclusions
Oropharyngeal leak pressure of both devices reduced in lateral position as compared to supine position. I-gel™ yielded higher leak pressures in supine as well as in lateral position as compared to LMA Supreme™.
Implications
The above findings offer valuable insight for decision-making in pediatric daycare surgeries requiring lateral position where GA is warranted.
Trial registration
CTRI NUMBER (CTRI/2021/01/030442)—the trial was registered with the Clinical Trial Registry of India on 13 January 2021.

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