Positive Pressure Ventilation with the Laryngeal Mask Airway in Children

Gürsoy, Feray; Algren, John T.; Skjonsby, B. S.

doi:10.1097/00132586-199702000-00027

Cited by 12 publications

(20 citation statements)

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“…An increased P leak permits higher PIP during PPV. Therefore, the PLMA may be a better choice than the CLMA Differences for ease of placement: P Ͼ 0.05; differences in quality of initial airway: P Ͻ 0.001 in pediatric patients requiring PPV, a mode of ventilation that is increasingly being used with the CLMA in children (17,21). Although our study was performed in infants without pulmonary disease, this might be particularly valuable in patients with lowlung compliance or high airway resistance requiring high PIP, such as patients with bronchopulmonary dysplasia or reactive airway disease.…”

Section: Discussionmentioning

confidence: 99%

“…The mean P leak values for different size CLMAs vary in the literature depending on the study population, size of the LMA, P intracuff of the LMA, and fresh gas flow used during measurements (5,10,17). P leak values for the size 1½ PLMA have not been previously reported.…”

Section: Methodsmentioning

confidence: 99%

“…P leak values for the size 1½ PLMA have not been previously reported. Calculation of the required sample size was based on the finding of Gursoy et al's study (17). A 20% higher P leak for the PLMA was considered to be clinically relevant; a sample size of 22 patients was therefore calculated to detect a projected difference of 20% between the groups with respect to P leak for a type I error of 0.05 and a power of 0.9.…”

Section: Methodsmentioning

confidence: 99%

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The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

Goldmann

Roettger

Wulf

2006

Anesthesia &Amp; Analgesia

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Many problems with the Classic laryngeal mask airway (CLMA) in infants are believed to be related to its inadequate cuff design. One of the main limitations of the CLMA is that the resulting low-pressure seal can be inadequate for positive pressure ventilation (PPV). The ProSeal LMA (PLMA), a new laryngeal mask airway with a modified cuff, has been shown to form a more effective seal than the CLMA in children. The first infant size PLMA, size 1(1/2), became available recently. We studied 30 anesthetized, nonparalyzed infants aged 15 mo (2-30 mo) and weighing 9 kg (5-12 kg). The CLMA and PLMA were inserted in random order into each patient. Airway leak pressure and maximum tidal volume were measured. Ease of insertion, quality of initial airway, and fiberoptic position were also determined. Gastric tube placement was assessed for the PLMA. The mean airway leak pressure in neutral head position (26.7 versus 18.9 cm H2O), maximum flexion (35.6 versus 28.2 cm H2O), and the mean maximum tidal volume (312 versus 260 mL) were significantly higher for the PLMA (P < 0.01). Air entered the stomach in eight patients with the CLMA but did not with the PLMA. Gastric tube placement was possible in all but one patient. In three patients, the use of the PLMA led to some degree of clinically relevant compression of the larynx. The size 1(1/2) PLMA seems to be a more suitable device for airway maintenance in infants than the same size CLMA. The ability to insert a gastric tube at the same time, and a significantly higher airway leak pressure than with the CLMA, may have important implications for its use for PPV in infants.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

Goldmann

Roettger

Wulf

2006

Anesthesia &Amp; Analgesia

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“…No patient in our study had a peak inspiratory pressure higher than 15 cmH 2 O, the value considered critical to prevent gastric insufflation (22). Abdominal expansion may occur during ventilation with intermittent positive pressure through the LMA, but the risk of important gastric insufflation seems to be rare (23) and we found only one case with this complication in our study. An LMA prototype with a second cuff in a dorsal position to isolate the proximal oesophagus and to improve the seal of the glottis has been developed by Brain to allow a higher safe airway pressure (24).…”

Section: Discussionmentioning

confidence: 54%

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

Cebrían

Avellanal

Morales³

2000

Pediatric Anesthesia

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We studied the incidence of gastro-oesophageal reflux (GOR) during general anaesthesia with the laryngeal mask airway (LMA) in a paediatric population with two ventilatory regimes: spontaneous breathing and controlled mechanical ventilation (CMV). Thirty children between 6 months and 15 years, ASA I-II, for routine surgery, were randomly assigned in two groups: spontaneous ventilation (n=14), and CMV (n=16). A pH probe was situated in the central third of the oesophagus. Some 66% of the patients breathing spontaneously had GOR episodes vs. 92% of the patients with CMV (P < 0,01). Reflux took place mainly after LMA removal (21% vs. 68%; P < 0,01) and in the Postanaesthetic Care Unit (PACU) (29% vs. 43%; P < 0,05). There was a high incidence of GOR during general anaesthesia and in the PACU in paediatric patients anaesthetized with the LMA. GOR episodes were significantly more evident in the CMV group, mainly after LMA removal, but without clinical significance.

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“…In particular there are concerns that its low-pressure seal might be inadequate for positive pressure ventilation (PPV) so that there is a risk of gas leakage into the stomach with the subsequent risk of gastric distension and regurgitation (19,20). Because of the inability of the SLMA to protect against regurgitated gastric fluid it was traditionally used only in patients without an apparent risk of aspiration.…”

Section: Discussionmentioning

confidence: 99%

Prevention of aspiration under general anesthesia by use of the size 2½ ProSeal^TM laryngeal mask airway in a 6‐year‐old boy: a case report

Goldmann

Jakob

2005

Pediatric Anesthesia

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Positive Pressure Ventilation with the Laryngeal Mask Airway in Children

Cited by 12 publications

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The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

Prevention of aspiration under general anesthesia by use of the size 2½ ProSeal^TM laryngeal mask airway in a 6‐year‐old boy: a case report

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Positive Pressure Ventilation with the Laryngeal Mask Airway in Children

Cited by 12 publications

References 0 publications

The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

The Size 1½ ProSeal™ Laryngeal Mask Airway in Infants: A Randomized, Crossover Investigation with the Classic™ Laryngeal Mask Airway

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

Prevention of aspiration under general anesthesia by use of the size 2½ ProSealTM laryngeal mask airway in a 6‐year‐old boy: a case report

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Product

Resources

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Prevention of aspiration under general anesthesia by use of the size 2½ ProSeal^TM laryngeal mask airway in a 6‐year‐old boy: a case report