Influence of Head and Neck Position on Ventilation Using Three Different Supraglottic Airway Devices (I-Gel, Ambu Auragain, BaskaMask) in Anaesthetized and Paralyzed Patients: A Prospective Randomized Clinical Study

Abstract

Background: Supraglottic airway devices play a crucial role in managing the airway during various surgical procedures conducted under general anesthesia. In this study, we evaluated the impact of different head and neck positions (extension, flexion, neutral, and right rotation) on ventilation while using I-gel, Ambu AuraGain, and Baska masks in anesthetized paralyzed patients. Methodology: A total of 114 patients were randomly allocated into Group I (n=38) using I-Gel, Group II (n=38) using Ambu AuraGain, and Group III (n=38) using Baska Mask. Clinical performance in terms of OLP (Oropharyngeal Leak Pressure) and anatomical position of the device was evaluated after insertion under general anaesthesia. Ventilation parameters including peak airway pressure, EtCO2 (End-tidal Carbon Dioxide), expiratory tidal volume and ventilation score were assessed at different head and neck positions using three supraglottic airway devices. Results : Maximum OLP was observed in Group II and minimum OLP was observed in Group I. In all three devices, OLP was maximum in the flexion position and minimum in the extension position. The Median Brimacombe score was 3 in all three groups at all head and neck positions except at maximum extension in Group I. Although peak airway pressure in Group II is significantly higher than the other two groups, ventilation is not impacted as evidenced by comparable ventilation score, EtCO2 and expiratory tidal volume in all patients of three groups at different head and neck positions. Conclusion : To conclude, Ambu Auragain has better anatomical seal at all head and neck positions as compared to I-gel and Baska Mask. However, despite differences in OLP, the ventilatory performances of the three devices were not significantly affected. Keywords: Ambu Auragain, Baska Mask, I-Gel, Supraglottic Airway Device, Head And Neck Position, Oropharyngeal Leak Pressure