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Interdisziplinär konsentierte Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin

Larynxmaske ist State-of-the-art

Interdisciplinary consensus statement on alternative airway management with supraglottic airway devices in pediatric emergency medicine

Laryngeal mask is state of the art

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An Erratum to this article was published on 28 January 2016

This article has been updated

Zusammenfassung

Hintergrund

Dem Atemwegsmanagement mit supraglottischen Atemwegshilfen (SGA) bei lebensbedrohlichen Kindernotfällen kommt zunehmende Bedeutung zu. Hierbei kommen die Larynxmaske (LM) und der Larynxtubus (LT) zum Einsatz. Auf der Basis einer umfassenden Literaturauswertung sollte eine interdisziplinär konsentierte Stellungnahme zum Einsatz von SGA bei Kindernotfällen erstellt werden.

Material und Methoden

Literaturrecherche über die Datenbank Pubmed und Einordnung der Studien analog den Kriterien des Oxford Centre for Evidence-based Medicine – Levels of Evidence.

Ergebnisse

Die Evidenz zu erfolgreichen Anwendungen der LM im Kindesalter ist auf nationalem und internationalem Niveau im Vergleich zum LT deutlich größer. Erfolgreiche Anwendungen des LT beschränken sich derzeit hingegen auf wenige Arbeitsgruppen und Zentren, die mutmaßlich über eine entsprechende Expertise bezüglich der routinemäßigen Anwendung des LT verfügen. Vor allem für Kinder unter 10 kgKG erscheint eine Anwendung des LT aufgrund der aktuellen Studienlage nicht sicher durchführbar und kann daher derzeit nicht empfohlen werden. Eine notfallmäßig verwendete SGA sollte über die Möglichkeit einer Magendrainage verfügen.

Diskussion

Unter Berücksichtigung der wissenschaftlichen Datenlage und der großen klinischen Erfahrung mit der LM in der Elektiv- und Notfallanwendung bei Kindern kann derzeit zum alternativen Atemwegsmanagement im Kindesalter von den SGA nur die LM empfohlen werden. Die LM sollte sowohl prä- als auch innerklinisch in allen verfügbaren Größen (1, 1,5, 2, 2,5, 3, 4 und 5) vorgehalten und in der Anwendung regelmäßig geschult werden.

Abstract

Background

Airway management with supraglottic airway devices (SGA) in life-threatening emergencies involving children is becoming increasingly more important. The laryngeal mask (LM) and the laryngeal tube (LT) are devices commonly used for this purpose. This article presents a literature review and consensus statement by various societies on the use of SGA in pediatric emergency medicine.

Material and methods

Literature search in the database PubMed and classification of studies according to the criteria of the Oxford Centre for Evidence-based Medicine levels of evidence.

Results

The evidence for successful application of the various types of LM is significantly higher than for LT application. Reports of smaller series of successful applications of LT are currently limited to selected research groups and centers. Insufficient evidence currently exists for the successful application of the LT especially for children below 10 kg body weight and, therefore, its routine use cannot currently be recommended. SGAs used for emergencies should have a possibility for gastric drainage.

Discussion

Considering the scientific data and the large clinical experience with the LM in medical routine and emergency situations in children, currently only the LM can be recommended for alternative (i.e. non-intubation) airway management in children. If alternative airway management is part of a local emergency strategy, the LM should be provided in all pediatric sizes (1, 1.5, 2, 2.5, 3, 4 and 5) for prehospital and in-hospital emergency use and all users should be regularly trained in its application.

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Change history

  • 28 January 2016

    An erratum to this article has been published.

Literatur

  1. Bernhard M, Helm M, Luiz T, Biehn G, Kumpch M, Hainer C, Meyburg J, Gries A (2011) Pädiatrische Notfälle in der prähospitalen Notfallmedizin – Implikationen für die Notarztqualifikation. Notfall Rettungsmed 14:554–566

    Article  Google Scholar 

  2. Bernhard M, Mohr S, Weigand MA, Martin E, Walther A (2012) Developing the skill of endotracheal intubation: implication for emergency medicine. Acta Anaesthesiol Scand 56:164–171

    Article  CAS  PubMed  Google Scholar 

  3. Bernhard M, Beres W, Timmermann A, Stepan R, Greim CA, Kaisers XA, Gries A (2014) Prehospital airway management using the laryngeal tube – an emergency department point of view. Anaesthesist 63:589–596

    Article  CAS  PubMed  Google Scholar 

  4. Beveridge ME (1989) Laryngeal Mask anaesthesia for repair of cleft palate. Anaesthesia 44:656–657

    Article  CAS  PubMed  Google Scholar 

  5. Maconochie IK, Bingham R, C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D; Paediatric life support section Collaborators (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 95:223–248.

  6. Bortone L, Ingelmo PM, De Ninno G, Tosi M, Caffini L, Trenchi J, Mergoni M, Martorana F (2006) Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients. Paediatr Anaesth 16:251–257

    Article  PubMed  Google Scholar 

  7. Brain AL (1989) Further developments of the laryngeal mask. Anaesthesia 44:530

    Article  CAS  PubMed  Google Scholar 

  8. Byhahn C, Schalk R, Russo SG (2014) Präklinische Atemwegssicherung – ein Drama in 5 Akten. Anaesthesist 63:543–545

    Article  CAS  PubMed  Google Scholar 

  9. Eich C, Roessler M, Nemeth M, Russo SG, Heuer JF, Timmermann A (2009) Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians. Resuscitation 80:1371–1377

    Article  PubMed  Google Scholar 

  10. Esmail N, Saleh M, Ali A (2002) Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Egypt J Anaesth 18:115–121

    Google Scholar 

  11. Feroze F, Khuwaja A, Masood N, Malik FI (2008) Neonatal resuscitation: the use of laryngeal mask airway. Professional Med J 15:148–152

    Google Scholar 

  12. Gandini, D, Brimacombe JR (1999) Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anesth Analg 89:642–643

    CAS  PubMed  Google Scholar 

  13. Genzwuerker HV, Hohl ECh, Rapp HJ (2005) Ventilation with the laryngeal tube in pediatric patients undergoing elective ambulatory surgery. Paediatr Anaesth 15:385–390

    Article  PubMed  Google Scholar 

  14. Genzwuerker HV, Fritz A, Hinkelbein J, Finteis T, Schlaefer A, Schaeffer M, Thil E, Rapp HJ (2006) Prospective, randomized comparison of laryngeal tube and laryngeal mask airway in pediatric patients. Paediatr Anaesth 16:1251–1256

    Article  CAS  PubMed  Google Scholar 

  15. Goldmann K (2013) Kinderanästhesie – Supraglottische Atemwege bei Säuglingen und Kleinkindern. Anasthesiol Intensivmed Notfallmed Schmerzther 48:246–250

  16. Jagannathan N, Sequera-Ramos L, Sohn L, Wallis B, Shertzer A, Schaldenbrand K (2014) Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth 112:742–248

    Article  CAS  PubMed  Google Scholar 

  17. Jagannathan N, Ramsey MA, White MC, Sohn L (2015) An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth 25:334–345

    Article  PubMed  Google Scholar 

  18. Kaya G, Koyuncu O, Turan N, Turan A (2008) Comparison of the laryngeal mask (LMA) and laryngeal tube (LT) with the perilaryngeal airway (cobraPLA) in brief paediatric surgical procedures. Anaesth Intensive Care 36:425–430

    CAS  PubMed  Google Scholar 

  19. Kim MS, Lee JH, Han SW, Im YJ, Kang HJ, Lee JR (2015) A randomized comparison of the i-gel with the self-pressurized air-Q intubating laryngeal airway in children. Paediatr Anaesth 25:405–412

    Article  PubMed  Google Scholar 

  20. Landsleitner B, Eich C, Weiss M, Nicolai T (2011) Präklinisches Atemwegsmanagement bei Kindern. Notfall Rettungsmed 14:526–534

    Article  Google Scholar 

  21. Lee-Jayaram JJ, Yamamoto LG (2014) Alternative airways for the pediatric emergency department. Pediatr Emerg Care 30:191–199

    Article  PubMed  Google Scholar 

  22. Martinon C, Duracher C, Blanot S, Escolano S, De Agostini M, Périé-Vintras AC, Orliaguet G, Carli PA, Meyer PG (2011) Emergency tracheal intubation of severely head-injured children: changing daily practice after implementation of national guidelines. Pediatr Crit Care Med 12:65–70

    Article  PubMed  Google Scholar 

  23. Mathis MR, Haydar B, Taylor EL, Morris M, Malviya SV, Christensen RE, Ramachandran SK, Kheterpal S (2013) Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the pediatric surgical patient: a study of clinical predictors and outcomes. Anesthesiology 119:1284–1295

    Article  PubMed  Google Scholar 

  24. Pant D, Koul A, Sharma B, Sood J (2015) A comparative study of Laryngeal Mask Airway size 1 vs. i-gel size 1 in infants undergoing daycare procedures. Paediatr Anaesth 25:386–391

    Article  PubMed  Google Scholar 

  25. Patel R, Lenczyk M, Hannallah RS, McGill WA (1994) Age and the onset of desaturation in apnoeic children. Can J Anaesth 41:771–774

    Article  CAS  PubMed  Google Scholar 

  26. Ramesh S, Jayanthi R (2011) Supraglottic airway devices in children. Indian J Anaesth 55:476–482

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Richebé P, Semjen F, Cros AM, Maurette P (2005) Clinical assessment of the laryngeal tube in pediatric anesthesia. Paediatr Anaesth 15:391–396

    Article  PubMed  Google Scholar 

  28. Schalk R, Scheller B, Peter N, Rosskopf W, Byhahn C, Zacharowski K, Meininger D (2011) Laryngeal tube II: alternative airway for children? Anaesthesist 60:525–533

    Article  CAS  PubMed  Google Scholar 

  29. Schalk R, Seeger FH, Mutlak H, Schweigkofler U, Zacharowski K, Peter N, Byhahn C (2014) Complications associated with the prehospital use of laryngeal tubes–a systematic analysis of risk factors and strategies for prevention. Resuscitation 85:1629–1632. doi:10.1016/j.resuscitation.2014.07.014

    Article  PubMed  Google Scholar 

  30. Scheller B, Schalk R, Byhahn C, Peter N, L’Allemand N, Kessler P, Meininger D (2009) Laryngeal tube suction II for difficult airway management in neonates and small infants. Resuscitation 80:805–810

    Article  PubMed  Google Scholar 

  31. Schmölzer GM, Agarwal M, Kamlin CO, Davis PG (2013) Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation 84(6):722–730

    Article  PubMed  Google Scholar 

  32. Singh R, Mohan C, Taxak S (2005) Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesth Clin Pharmacol 21:303–306

    Google Scholar 

  33. Theiler LG, Kleine-Brueggeney M, Kaiser D, Urwyler N, Luyet C, Vogt A, Greif R, Unibe MMC (2009) Crossover comparison of the laryngeal mask supreme and the i-gel in simulated difficult airway scenario in anesthetized patients. Anesthesiology 111:55–62.

  34. Timmermann A, Byhahn C, Wenzel V, Eich C, Piepho T, Bernhard M, Dörges V (2012) Handlungsempfehlung für das präklinische Atemwegsmanagement. Für Notärzte und Rettungsdienstpersonal. Anästh Intensivmed 53:294–308

    Google Scholar 

  35. Trevisanuto D, Cavallin F, Mardegan V, Loi NN, Tien NV, Linh TD, Chien TD, Doglioni N, Chiandetti L, Moccia L (2014) LMA Supreme for neonatal resuscitation: study protocol for a randomized controlled trial. Trials 15:285

    Article  PubMed  PubMed Central  Google Scholar 

  36. VBM Medizintechnik. Herstellerhinweis Cuffdruckmessung. http://www.vbm-medical.de/cms/files/f303_2.0de_gb_01.15_herstellerhinweis_cuffdruckmessung_.pdf. Zugegriffen: 29. April 2015

  37. Weiss M, Schmidt J, Eich C, Stelzner J, Trieschmann U, Müller-Lobeck L, Philippi-Höhne C, Becke K, Jöhr M, Strauß J (2011) Handlungsempfehlung zur Prävention und Behandlung des unerwartet schwierigen Atemwegs in der Kinderanästhesie. Anästh Intensivmed 52:54–63

    Google Scholar 

  38. White MC, Cook TM, Stoddart PA (2009) A critique of elective pediatric supraglottic airway devices. Paediatr Anaesth 19(Suppl 1):55–65

    Article  PubMed  Google Scholar 

  39. Xue FS, Luo LK, Tong SY, Liao X, Deng XM, An G (1996) Study of the safe threshold of apneic period in children during anesthesia induction. J Clin Anesth 8:568–574

    Article  CAS  PubMed  Google Scholar 

  40. Zanardo V, Weiner G, Micaglio M, Doglioni N, Buzzacchero R, Trevisanuto D (2010) Delivery room resuscitation of near-term infants: role of the laryngeal mask airway. Resuscitation 81:327–330

    Article  PubMed  Google Scholar 

  41. Zhu XY, Lin BC, Zhang QS, Ye HM, Yu RJ (2011) A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation 82(11):1405–1409

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Lindwurmstr. 4, 80337, München, Deutschland

    J. Keil, B. Urban &  F. Hoffmann

  2. Sektion „Pädiatrische Intensiv- und Notfallmedizin“, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland

    P. Jung, C. Eich &  F. Hoffmann

  3. Ärztlicher Leiter Rettungsdienst Bayern (ÄLRD Bayern), Bayern, Deutschland

    A. Schiele, A. Parsch & B. Matsche

  4. Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland

    C. Eich, K. Becke, B. Landsleitner & S.G. Russo

  5. Wissenschaftlicher Arbeitskreis „Notfallmedizin“, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland

    M. Bernhard

  6. Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI), Frankfurt am Main, Deutschland

    T. Nicolai

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Correspondence to F. Hoffmann.

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J. Keil, P. Jung, A. Schiele, B. Urban, A. Parsch, B. Matsche, C. Eich, K. Becke, B. Landsleitner, S.G. Russo, M. Bernhard, T. Nicolai und F. Hoffmann geben an, dass kein Interessenkonflikt besteht.

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Ein Erratum zu diesem Beitrag ist unter https://doi.org/10.1007/s00101-015-0132-5 zu finden.

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Keil, J., Jung, P., Schiele, A. et al. Interdisziplinär konsentierte Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin. Anaesthesist 65, 57–66 (2016). https://doi.org/10.1007/s00101-015-0107-6

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