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Prospective randomized comparative study of use of PLMA and ET tube for airway management in children under general
Mamta G Patel1, Vn Swadia, Geetika Bansal
1Department of Anesthesiology, Medical College and S.S.G. Hospital, Jail road, Vadodara 390001, Gujarat, India.
Insights
The ProSeal Laryngeal Mask Airway (PLMA) is a safe and effective airway device for children undergoing general anesthesia. It showed fewer complications compared to the Endotracheal Tube (ETT).
Area of Science:
- Anesthesiology
- Pediatric Airway Management
- Medical Devices
Background:
- The ProSeal Laryngeal Mask Airway (PLMA), introduced in 2004, features a drainage tube to prevent gastric regurgitation and pulmonary aspiration.
- Classic Laryngeal Mask Airway (CLMA) lacks this protective feature.
Purpose of the Study:
- To compare the efficacy and safety of the ProSeal Laryngeal Mask Airway (PLMA) versus the Endotracheal Tube (ETT) in pediatric patients.
- To evaluate airway management outcomes in children aged 3-10 years undergoing general anesthesia.
Main Methods:
- A randomized prospective study involving 60 ASA I/II pediatric patients (3-10 years old).
- Patients received oral Midazolam and Glycopyrollate premedication, general anesthesia with Sevoflurane, and caudal epidural analgesia.
- Participants were randomly assigned to PLMA insertion (Group P) or Endotracheal Tube (ETT) insertion (Group I); muscle relaxants were not used.
Main Results:
- Both PLMA and ETT insertion were successful on the first attempt, with comparable ease and conditions.
- Hemodynamic parameter changes were significantly greater in the ETT group.
- The ETT group experienced higher rates of sore throat (13.33%), coughing (40%), vomiting (3.33%), and hypoxia (3.33%); no gastric insufflation or regurgitation occurred in either group.
Conclusions:
- The ProSeal Laryngeal Mask Airway (PLMA) is an effective and safe alternative to the Endotracheal Tube (ETT) for pediatric patients undergoing general anesthesia.
- PLMA use in children is associated with fewer postoperative airway complications compared to ETT.
Abstract:
ProSeal(TM) Laryngeal Mask Airway (PLMA) for children had been introduced in 2004, by Dr. Archie Brain. It has, in addition to Classic Laryngeal Mask Airway (CLMA), a drainage tube for providing a bypass channel for gastric contents to prevent regurgitation and pulmonary aspiration. A randomized prospective study was performed comprising of 60 ASA - I/II patients, between the age groups of 3 and 10 years, of either sex. All the patients were premedicated with oral Midazolam and Glycopyrollate. General anaesthesia with caudal epidural analgesia was given in all the cases. Inhalation with 8% Sevoflurane was used as a sole induction agent in all the patients. They were randomly divided into two groups. PLMA was inserted in patients of Group P and Endotracheal Tube (ETT) in patients of Group I. In all cases, after PLMA / ETT insertion; caudal epidural analgesia was given and general anaesthesia (GA) using Sevoflurane was provided for maintenance of anaesthesia. Muscle relaxant was not used in our study. We studied parameters such as number of attempts, ease of insertion and conditions during insertion, haemodynamic parameters, changes in SpO(2), EtCO(2), gastric insufflation, regurgitation, pulmonary aspiration, postoperative airway complications and so on. We found that insertion of PLMA as well as ETT was performed in the first attempt in all the patients. Ease of insertion and conditions during insertion were comparable in both the groups. Changes in SpO(2) and EtCO(2) were comparable. However, highly significant changes in haemodynamic parameters were observed in the ETT group. Complications such as sore throat (13.33% cases), coughing (40% cases), vomiting (3.33% cases) and hypoxia (3.33% cases) were observed in the ETT group. No gastric insufflation or regurgitation was noted in our study. Thus, we concluded that PLMA could be used as an effective and safe airway device in children compared to ETT undergoing general anaesthesia.
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