Influence of different head and neck positions on oropharyngeal leak pressure with laryngeal mask airway protector in elective surgeries

Airway management has evolved considerably over the past decade, primarily due to advancements in Supraglottic Airway Devices These devices provide a significant alternative in general anesthesia for situations where tracheal intubation poses challenges, facilitating ventilation and oxygenation. It is particularly beneficial in emergency situations and for patients with anatomically complex airways.SADs are generally categorized into first and second generation devices. First generation equipments include the use of a basic airway pipes such as the laryngeal mask airway  without features aimed at minimizing aspiration. Second generation, like the ProSeal LMA, I-gel and LMA Protector contains more newer features like gastric drainage port and epiglottis blockers which both improve safety and efficiency. The effectiveness of supraglottic airway devices particularly their ability to maintain a proper seal can depend on head movements. Flexing neck decreases anteroposterior diameter of pharynx by relieving anterior pharyngeal muscle tension, while extending the neck increases this diameter.Most supraglottic airway devices are designed to be inserted gently into oropharynx to create a reliable seal, ensuring consistent ventilation. Ongoing clinical research evaluating the LMA Protector have indicated that it allows for straightforward insertion and achieves superior oropharyngeal leak pressures relative to other routinely utilised devices. We hypothesize that laryngeal mask airway protector achieves superior OLP in flexion head position.

AIM

To observe the Influence of different head and neck positions on oropharyngeal leak pressure with Laryngeal Mask Airway Protector airway in elective surgeries

PRIMARY OBJECTIVE:

Comparing the difference in oropharyngeal leak pressure with changes in head and neck positions using the LMA Protector airway device

SECONDARY OBJECTIVE:

To study the insertion time of LMA Protector

To study the number of attempt required for insertion

To study the ease of insertion of the deviceTo study hemodynamic variations in different head and neck positions

To study fiberoptic assessment of glottic view through the device. To study post-operative complications such as sore throat, stridor or hoarseness, dental

trauma, any other relevant complications.

METHODOLOGY

The study protocol outlines thorough pre anaesthesia workup including physical examinations and various test and assessment of dufficult airway.patients will be advised fasting and will be premedicated accordingly.During anaesthesia standard procedures will be followed,including preoxygenation,induction with propofol,and neuromuscular blockade.After insertion of LMA,monitoring parameters are measured. mode. Hemodynamic parameters [HR (heart rate), ECG, NIBP,SpO2 and End Tidal Carbon dioxide will be monitored and recorded with every head positions.After the end of surgery and reversal from anaesthetic agents, the study device will be removed and the incidence of blood stain on the device will be recorded.

Following observations will be recorded in all the patients:

1. OLP in cm of water, in neutral, flexion, extension, right lateral and left lateral position of head and neck

2. Time taken for SAD insertion

3. Ease of insertion of SAD. The ease of insertion of device will be graded.

4. Number of attempts for successful SAD insertion.

5. Fibreoptic grading of the laryngeal view through the study device.

6. Any adverse events during the procedure like oxygen desaturation, soft tissue or dentaltrauma, blood stain on device.

7. Degree of postoperative sore throat

8. Intraoperative hemodynamic parameters HR, NIBP,oxygen saturation end-tidal carbondioxide level preoperatively, before and after insertion, in all head positions.