Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway with the cuffed oropharyngeal airway.
BACKGROUND
The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA).


METHODS
Seventy children of school age (7-16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used.


RESULTS
Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group.


CONCLUSIONS
The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short-term assisted manual ventilation.
Mamaya
Biruta
B
Department of Anaesthesiology and Reanimatology, Latvian Medical Academy, Riga, Latvia. biruta@gailes.lv
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000293:Adolescent; D000402:Airway Obstruction / Q000188:drug therapy*; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006221:Halothane / Q000627:therapeutic use; D006801:Humans; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000627:therapeutic use; D009960:Oropharynx; D015742:Propofol / Q000627:therapeutic use; D012119:Respiration
D000759:Adjuvants, Anesthesia; D000777:Anesthetics; D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide; D008874:Midazolam; D005283:Fentanyl; D006221:Halothane; D015742:Propofol