Head and neck movements affect the curvature of the pharynx, which impacts ventilation with supragothic airway devices and oropharyngeal leakage pressures. Anaesthetized paralyzed children were fitted with laryngeal mask airways (PLMA) made of gel and silicone. The PLMAs were used to study the effect of different head/neck positions on oropharyngeal leak pressures and ventilation. PLMA (n = 35) and I-GelTM (n = 35) were randomly assigned to 70 children for airway management. At maximum extension, maximum flexion, and neutral position, either for oropharyngeal leak pressure was the primary outcome. Among the data collected were PIPs, expiratory tidal volumes, ventilation scores, and fiber optic grading. When neutral, flexion, or extensions were performed, there was no significant difference in leak pressure between PLMA and I-GelTM. Compared to PLMA, I-GelTM had a bigger mean (standard deviation, P = 0.002) and a significantly lower mean (SD). In addition, expired tidal volume was significantly lower, with 5.5 [1.6] compared to 6.9 ml/kg, P = 0.0017. There was no significant difference in fibreoptic grading or ventilation score between the two groups in any of the three head-and-neck positions. The oropharyngeal leakage pressures of PLMA and I-GelTM were the same in all three headand-neck positions. When using I-Gel, higher peak pressures and lower expiratory volumes may necessitate caution and further investigation when the patient is in maximal neck flexion.

I-GEL TM, PLMA, Supraglottic airway disease