ProSeal laryngeal mask airway in infants and toddlers with upper respiratory tract infections: a randomized control trial of spontaneous vs pressure control ventilation.
BACKGROUND
ProSeal LMA (PLMA), one of the advanced supraglottic devices has been successfully used to provide both spontaneous and controlled ventilation in children with upper respiratory tract infection (URTI). URTI does not imply restriction of disease to upper respiratory tract; it has been shown to produce pulmonary dysfunction. PEEP has been shown to improve oxygenation in such cases. This randomized prospective study was designed to compare postoperative adverse events associated with spontaneous respiration (SR) and pressure control ventilation (PCV) with PEEP in infants and toddlers with URTI when using PLMA as an airway device.


METHODS
In the present study, 90 children, 6 months-2 years, scheduled for infra umbilical surgery were randomized to receive either SR or PCV with PEEP of 5cm H2O. Patients with risk of aspiration, bronchial asthma, anticipated difficult airway, snoring, passive smoking, morbid obesity, coexisting pulmonary and cardiac disease, lower respiratory tract infection, fever > 38 degrees C and sneezing, were excluded. At emergence, airway secretions, coughing, breath holding, bronchospasm, upper airway obstruction or laryngospasm (LS) were assessed.


RESULTS
The adverse events were significantly higher in spontaneously breathing patients. Score of adverse events was 6.33 +/- 1.6 in PCV and 7.7 +/- 2.2 in SR group (P = 0.001). The mean SpO2 (%) in PACU was 96.5 +/- 2 in PCV and 94.4 +/- 1.37 in SR (P = 000).


CONCLUSIONS
Pressure control ventilation with PEEP using PLMA is associated with lower incidence of adverse events in comparison to spontaneous respiration in infants and toddlers with upper respiratory tract infection undergoing infra umbilical surgeries under general anesthesia.
Sinha
Aparna
A
Dept. of Anesthesia, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India. apsin@hotmail.com
Sharma
Bimla
B
Sood
Jayashree
J
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000628:therapy*