Comparing 3 ventilation modalities by measuring several respiratory parameters using the ProSeal laryngeal mask airway in children.
OBJECTIVE
To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in pediatric patients with a ProSeal laryngeal mask airway (PLMA).


METHODS
Randomized prospective study.


METHODS
Pediatric hospital of a tertiary care academic medical center.


METHODS
Thirty-three, American Society of Anesthesiologists classification 1-2, pediatric patients (12 months to 5 years).


METHODS
Three different ventilation strategies: spontaneous ventilation (SV), pressure support ventilation (PSV), and pressure-controlled ventilation (PCV) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 3 mg/kg and morphine 0.05 mg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O.


METHODS
We measured the differences in end-tidal CO2 (Etco2), tidal volume, and respiratory rate over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals.


RESULTS
Etco2 (mm Hg) was significantly higher in the SV vs PSV (P=.016) and vs PCV (P<.001). Tidal volume (mL/kg) was significantly lower in SV vs PSV (P<.001) and vs PCV (P<.001). Respiratory rate (breaths/min) was significantly higher in SV vs PSV (P<.001) and vs PCV (P=.005).


CONCLUSIONS
All 3 modes of ventilation using a PLMA were safely used. Our SV group was noted to have a significantly higher Etco2 when compared with PSV and PCV with a mean Etco2 over time in excess of 55 mm Hg. PSV and PCV were found to be more appropriate ventilation strategies to more optimally control Etco2 over time in these patients.
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
T Wesley
TW
Templeton
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
Lauren K
LK
Hoke
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
Jill
J
Yaung
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
Carol A
CA
Aschenbrenner
Division of Surgical Services, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Danielle M
DM
Rose
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
Leah B
LB
Templeton
Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA. Electronic address: yvonbryan@gmail.com.
Yvon F
YF
Bryan
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D019296:Capnography; D002245:Carbon Dioxide / Q000032:analysis* / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D009020:Morphine / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D011897:Random Allocation; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D056152:Respiratory Rate; D000077149:Sevoflurane; D013990:Tidal Volume / Q000502:physiology
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D009020:Morphine; D015742:Propofol
Airway devices; Outpatient; Pediatric; Techniques