The influence of head rotation on ProSeal laryngeal mask airway sealing during paediatric myringotomy.

Myringotomy with ventilation tube insertion in children involves turning the head from neutral to allow surgical access to the ear. In adults, rotation of the head from the mid-line generally increases the oropharyngeal leak pressure when a ProSeal laryngeal mask airway (PLMA) is used to manage the airway. There are concerns that these manoeuvres may distort or obstruct the paediatric airway. Paediatric sizes (1.5, 2.0 and 2.5) of the PLMA differ from the adult versions in that they do not have a dorsal cuff. This study examines the effect of these head position changes on the seal of the PLMA in children. Twenty-nine children (ASA 1-2, aged 0.9 to 7.5 years) scheduled for myringotomy were recruited. After PLMA insertion, oropharyngeal leak pressure and fibreoptic determined PLMA position scores were measured in the neutral position and with head rotation of 45 degrees to the left or right. Fibreoptic positioning scores were similar in all positions. Head rotation was associated with a statistically significant but modest increase in oropharyngeal leak pressure versus the neutral position (P < 0.05). After rotating the head from neutral, 38% (11 of 29) of subjects had an increase of oropharyngeal leak pressure of at least 2 cmH2O. Only 7% (2 of 29) of subjects had a decrease in oropharyngeal leak pressure with head rotation, the maximum decrease being 2 cmH2O. Airway obstruction did not occur in any of the positions. We conclude that the efficacy of the seal for the pediatric sizes PLMA is improved by head rotation for myringotomy.