title: A comparison of 3 ventilation strategies in children younger than 1 year using a Proseal laryngeal mask airway: a randomized controlled trial.
abstract: OBJECTIVE
  To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA).
  
  
  METHODS
  Randomized prospective study.
  
  
  METHODS
  Tertiary care pediatric hospital.
  
  
  METHODS
  Thirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year.
  
  
  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 2 mg/kg and fentanyl 2 μg/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 (TV), and respiratory rate (RR) over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals.
  
  
  RESULTS
  etco2(mm Hg) was not significantly higher in the SV vs PSV (P=2.11) and SV vs PCV (P=.24). TV (mL/kg) was significantly lower in SV vs PSV (P<.005) and SV vs PCV (P<.005). RR was not significantly higher in SV vs PSV (P=.43), but was significantly higher in SV vs PCV (P<.005). Three patients in the SV group and 1 patient in the PSV group failed to initiate SV and required PCV and were thus excluded from analysis.
  
  
  CONCLUSIONS
  All 3 modes of ventilation using a PLMA were safe in children younger than 1 year. Although we did not observe a statistically significant increase in etco2, differences in TV and RR, and the small but significant incidence of apnea may make PSV or PCV more optimal ventilation strategies in children younger than 1 year when using a PLMA.
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1009. Electronic address: ttemplet@wakehealth.edu.
authors.forename: T Wesley
authors.initials: TW
authors.lastname: Templeton
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1009.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Hoke
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1009.
authors.forename: Leah B
authors.initials: LB
authors.lastname: Templeton
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1009.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Ririe
authors.affiliation: Division of Surgical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Rose
authors.affiliation: Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1009.
authors.forename: Yvon F
authors.initials: YF
authors.lastname: Bryan
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks; D008297:Male; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D012129:Respiratory Function Tests / Q000379:methods / Q000706:statistics & numerical data; D056152:Respiratory Rate; D013990:Tidal Volume
keywords: Airway; PLMA; Pediatric anesthesia; Ventilation