Abstract
Purpose: To compare the effectiveness of various laryngeal mask airway (LMA) sizes and their performance during positive pressure ventilation (PPV) in paralyzed pediatric patients.
Methods: Pediatric patients (n=158),<30 kg, ASA 1 or 2 were studied. After paralysis, an LMA of the recommended size was inserted and connected to a volume ventilator. Fibreoptic bronchoscopy (FOB) was performed and graded: 1, larynx only seen; 2, larynx and epiglottis posterior surface seen; 3, larynx, and epiglottis tip or anterior surface seen—visual obstruction of epiglottis to larynx: <50%; 4, epiglottis down-folded, and its anterior surface seen—visual obstruction of epiglottis to larynx: >50%; 5, epiglottis down-folded and larynx not seen directly. Inspiratory and expiratory tidal volumes (VT), and airway pressure were measured by a pneumo-tachometer, and the fraction of leakage (FL) was calculated. In 79 cases, LMA was used for airway maintenance throughout surgery.
Results: Successful LMA placement was achieved in 98% of cases: three failures were due to gastric insufflation. For LMA # 1, 1.5, 2, and 2.5, FOB grades [median (range)] were 3(1–5), 3(1–5), 1(1–5) and 1(1–3) respectively. In smaller LMAs, the cuff more frequently enclosed the epiglottis (P<.001). FL of LMA #1 was higher than those of LMA # 1.5 and LMA # 2.5 (P<.05), and FL of LMA # 2 was higher than that of LMA # 2.5 (P<.05). In the 79 patients, the number of patients experiencing complications decreased as LMA size increased (P<.05).
Conclusion: Use of the LMA in smaller children results in more airway obstruction, higher ventilatory pressures, larger inspiratory leak, and more complications than in older children.
Résumé
Objectif: Comparer l’efficacité de masques laryngés (ML) de tailles différentes et leur performance pendant la ventilation à pression positive (VPP) chez des enfants curarisés.
Méthode: On a étudié 158 patients pédiatriques, de moins de 30 kg et d’état physique ASA I ou II. Après la curarisation, un ML de taille appropriée a été inséré et raccordé à un ventilateur volumique. La fibroscopie bronchique (FB) réalisée a été graduée: 1, vision du larynx seulement; 2. vision du larynx et de de la surface postérieure de l’épiglotte; 3, vision du larynx, de la pointe et de la surface antérieure de l’épiglotte—vision du larynx obstruée par l’épiglotte: <50%; 4, épiglotte repliée vers le bas et vision de sa surface antérieure—vision du larynx obstruée par l’épiglotte: >50%; 5, épiglotte repliée vers le bas et vision indirecte du larynx. On a mesuré les volumes courants inspiratoire et expiratoire (VT) et la pression des voies aériennes avec un pneumotachomètre et on a calculé le pourcentage de fuite (PF). Dans 79 cas, le ML a été utilisé pour maintenir la perméabilité des voies aériennes tout au long de l’intervention.
Résultats: La mise en place réussie du ML a été réalisée dans 98% des cas: trois échecs étaient liés à une insufflation gastrique. Les grades [médiane (intervalle)] de FB ont été, pour les ML 1, 1,5, 2 et 2,5 de 3(1–5), 3(1–5), 1(1–5) et 1(1–3) respectivement. Dans le cas des ML plus petits, le ballonnet couvrait fréquemment l’épiglotte (P<0,001). Le PF du ML 1 a été plus élevé que ceux des ML 1,5 et 2,5 (P<0,05); le PF du ML 2 a été plus élevé que celui du ML 2,5 (P<0,05). Parmi les 79 patients, plus la taille du ML était grande, moins nombreux étaient ceux qui présentaient des complications (P<0,05).
Conclusion: L’utilisation du ML chez les jeunes enfants entraine davantage d’obstruction des voies aériennes, des pressions ventilatoires plus élevées, une fuite inspiratoire plus grande et plus de complications que chez les enfants plus agés.
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Work undertaken in Seoul National University Hospital supported from departmental sources.
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Park, C., Bahk, JH., Ahn, WS. et al. The laryngeal mask airway in infants and children. Can J Anesth 48, 413–417 (2001). https://doi.org/10.1007/BF03014975
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DOI: https://doi.org/10.1007/BF03014975