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Positive pressure ventilation with the laryngeal mask airway in children
F Gursoy1, J T Algren, B S Skjonsby
1Department of Anesthesiology, Inonu University Medical School, Malatya, Turkey.
Insights
Positive pressure ventilation (PPV) with a size 2 laryngeal mask airway (LMA) is safe for children. Mild gastric distention may occur but is usually not clinically significant.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
Background:
- Positive pressure ventilation (PPV) is crucial in pediatric anesthesia.
- Laryngeal Mask Airway (LMA) use in children requires careful safety evaluation.
Purpose of the Study:
- To assess the safety and efficacy of size 2 LMA for PPV in pediatric patients.
- To evaluate respiratory changes and gastric distention during PPV with size 2 LMA.
Main Methods:
- Studied 46 children (ASA I/II) undergoing elective surgery using size 2 LMA for PPV.
- Inflated LMA cuff to achieve > or = 15 cm H2O cuff leak pressure.
- Measured abdominal circumference pre- and post-PPV, compared to a tracheal intubation control group.
Main Results:
- Successful PPV in 45/46 patients; one infant had a gas leak.
- Mean cuff leak pressure was 17 +/- 4 cm H2O.
- End-tidal CO2 decreased significantly (40 to 34 mm Hg).
- Abdominal circumference increased in 28 patients, similar to controls; one required orogastric tube insertion.
Conclusions:
- Size 2 LMA is an effective airway for PPV in children.
- Mild gastric distention is common but clinically significant distention is rare.
- PPV with size 2 LMA is relatively safe in children with appropriate precautions and monitoring.
Abstract:
We studied the safety of positive pressure ventilation (PPV) when using the size 2 laryngeal mask airway (LMA) in 46 ASA physical status I or II children (aged 38 +/- 21 mo) undergoing elective surgery. The LMA cuff was inflated in incremental steps to achieve a cuff leak pressure > or = 15 cm H2O. Abdominal circumference was measured before and after PPV in study patients, as well as in a control group managed with tracheal intubation. Cuff leak pressure was 17 +/- 4 cm H2O (range 12-34 cm H2O). Forty-five patients successfully underwent PPV. Gas leak around the LMA cuff prevented PPV in one infant. The only respiratory variable that changed significantly was end-tidal CO2, which decreased from 40 +/- 6 to 34 +/- 5 mm Hg. Abdominal circumference increased in 28 patients but was not associated with any complications. Change in abdominal circumference in the study group was not significantly different from that observed in the control group. However, abdominal circumference increased 8 cm in one study patient, prompting insertion of an orogastric tube. The size 2 LMA provides an effective airway for PPV. Mild gastric distention often occurs. The risk of clinically significant gastric distention appears to be small, but it warrants close monitoring. We conclude that with certain precautions described in the text, the size 2 LMA provides a relatively safe airway for PPV in children.