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

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.