Reply: Only with an optimal position of the supraglottic airway in situ, valid conclusions can be drawn about oropharyngeal airway pressure.

Sir,

We would like to thank Van Zundert et al. for their interest in our article.[1]

They have highlighted a very important point regarding confirmation of the optimal position of the supraglottic airway before measuring the oropharyngeal airway pressures.[2]

We agree that confirmation of the optimal position is mandatory, but we believe the definition of optimal placement of supraglottic airway device (SAD) in adults cannot be applied in children.

This can be attributed to the difference in the airway anatomy of children and adults. Our study was conducted on children between 10 and 30 kg. In contrast to the fibreoptic view seen in adults, where the perfect view denotes no view of the epiglottis, very often the epiglottis is seen hanging over through the aperture of the SAD in children.

Considering this important difference, Okuda et al.[3] came up with a new classification to define the fibreoptic view of the glottic aperture through the SAD in children.

According to this classification, Grade 4: less than one-third glottic aperture covered with anterior epiglottis, Grade 3: one-third to two-third glottic aperture covered with anterior epiglottis, Grade 2: greater than two-third glottic aperture covered with anterior epiglottis and Grade 1: glottis aperture completely covered with anterior epiglottis but having an adequate function).

The best position of the fibreoptic view through the SAD, that is Grade 4 also has the epiglottis visible through the SAD aperture. Moreover in Grade 1 (worst view), despite the epiglottis completely covering the glottis, the SAD has adequate function.

In our study, we also assessed the ventilation score with SAD and majority of children in our study had the ventilation score 3.

Therefore, we feel that although the suggestion by Van Zundert seems very valid, we can apply it in children only after defining the optimal position of the SAD and the optimal view of the glottis aperture through the SAD in the paediatric population.

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Nil.

Conflicts of interest

There are no conflicts of interest.