Programming pressure support ventilation in pediatric patients in ambulatory surgery with a laryngeal mask airway.
BACKGROUND
Anesthesia workstations with pressure support ventilation (PSV) are available, but there are few studies published on how to program flow-triggered PSV using a laryngeal mask airway (LMA) under general anesthesia in pediatric patients.


METHODS
We studied 60 ASA I and II patients, from 2 mo to 14 yr, scheduled for ambulatory surgery under combined general and regional anesthesia with a LMA. Patients were classified according to their body weight as follows: Group A < or =10 kg, Group B 11-20 kg, and Group C >20 kg. All were ventilated in PSV using the following settings: positive end-expiratory pressure of 4 cm H2O, the minimum flow-trigger without provoking auto-triggering, and the minimum level of pressure support to obtain 10 mL/kg of tidal volume.


RESULTS
The flow-trigger most frequently used in our study was 0.4 L/min, ranging from 0.2 to 0.6 L/min. We found no correlation between the flow-trigger setting and the patient's age, weight, compliance, resistance, or respiratory rate. There was a good correlation between the level of pressure support (Group A = 15 cm H2O, Group B = 10 cm H2O and Group C = 9 cm H2O) and age (P < 0.001), weight (P < 0.001), dynamic compliance (P < 0.001), and airway resistances (P < 0.001).


CONCLUSIONS
PSV with a Proseal LMA in outpatient pediatric anesthesia can be programmed simply using the common clinical noninvasive variables studied. However, more studies are needed to estimate the level of pressure support that may be required in other clinical situations (respiratory pathology, endotracheal tubes, or other types of surgeries) or with other anesthesia workstations.
Pediatric Anesthesiology and Postsurgical Critical Care Department, La Paz Universitary Hospital, Madrid, Spain. jgarciaf.hulp@madrid.salud.org
Javier
J
Garcia-Fernandez
Gerardo
G
Tusman
Fernando
F
Suarez-Sipmann
Julio
J
Llorens
Marina
M
Soro
Javier F
JF
Belda
D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017214:Laryngeal Masks / Q000592:standards; D008297:Male; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods* / Q000592:standards