A prospective randomized trial comparing supraglottic airways for flexible bronchoscopy in children

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Paul A Baker1, Katharine E J Brunette, Catherine A Byrnes

  • 1Department of Paediatric Anaesthesia, Starship Children's Health, Auckland, New Zealand. pbaker@adhb.govt.nz

Paediatric Anaesthesia
|August 19, 2010
PubMed

Insights

For pediatric flexible bronchoscopy, single-use polyvinyl chloride supraglottic airways (SGA) showed higher resistance than reusable silicone SGAs. The silicone LMA Classic and Boss Systems masks were most effective for bronchoscope manipulation.

Area of Science:

  • Pediatric Anesthesiology
  • Respiratory Medicine
  • Medical Device Engineering

Background:

  • Supraglottic airways (SGAs) are standard for pediatric flexible bronchoscopy, serving as ventilation and conduit devices.
  • Some disposable SGAs present higher resistance to bronchoscope manipulation than reusable LMA Classic (cLMA).

Purpose of the Study:

  • To compare the performance of different SGAs during pediatric flexible bronchoscopy.
  • To evaluate bronchoscope manipulation resistance, insertion time, and visualization across various SGAs.

Main Methods:

  • A prospective randomized controlled trial involving 100 children.
  • Comparison of cLMA, Ambu Aura Once, Portex Soft Seal, Boss Systems, and LMA Unique.
  • Assessment of subjective resistance (linear analog scale), insertion time, laryngeal view, and cuff pressures.

Main Results:

  • Polyvinyl chloride (PVC) disposable SGAs (Ambu, Unique, Portex) exhibited significantly higher resistance to bronchoscope manipulation than the silicone cLMA (P < 0.0001).
  • Ambu and Unique SGAs were clinically inferior to cLMA across all airway levels.
  • Portex Soft Seal showed inferiority below the larynx (P < 0.006) and overall (P < 0.007).
  • Boss Systems single-use laryngeal mask demonstrated comparable effectiveness to the cLMA.

Conclusions:

  • Single-use PVC laryngeal masks are inferior to the silicone cLMA and Boss Systems masks for pediatric flexible bronchoscopy.
  • Silicone-based SGAs, like cLMA and Boss Systems, offer superior performance in terms of reduced resistance and better manipulation during the procedure.
Abstract

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