Comparação de via aérea por máscara laríngea Supreme e via aérea por máscara laríngea ProSeal para trauma laringofaríngeo e morbidade pós-operatória em crianças

Comparison of Intracuff Pressure and Postoperative Sore Throat Following Use of Laryngeal Mask Airway Protector With or Without Nitrous Oxide Anesthesia

PURPOSE

In general anesthesia, the laryngeal mask airway (LMA) is a frequently used effective option. The effect of nitrous oxide on intracuff pressure of the LMA and postoperative sore throat is well known; however, there are no studies related to the second-generation LMA Protector. The purpose of this study was to determine the differences in intracuff pressure and postoperative sore throat, depending on the use of nitrous oxide during general anesthesia using the LMA Protector.

DESIGN

This randomized double-blind prospective study was conducted among 88 patients aged 20 to 70 years.

METHODS

The cuff pressure started with a baseline of 40 cm H₂O and was measured using a digital cuff pressure manometer for 30 minutes. Postoperative sore throat, dysphonia, dysphagia, and numeric rating scale scores were also recorded.

FINDINGS

Over time, the intracuff pressure of the nitrous oxide group increased significantly compared with that of the air group. Furthermore, postoperative sore throat and pharyngolaryngeal complications were not significantly different between the two groups.

CONCLUSIONS

Intracuff pressure of the LMA Protector increased during anesthesia using nitrous oxide. When the anesthesia time was less than 2 hours, however, there was no difference in postoperative sore throat.

The impact of laryngeal mask versus other airways on perioperative respiratory adverse events in children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Increasing studies have shown that the use of laryngeal mask airways (LMAs) improved the perioperative respiratory adverse events (PRAEs) in children. However, the results of some of these studies still remained controversial as their sample sizes were small. A systematic review and meta-analysis was designed to evaluate the impact of LMAs in decreasing PRAEs in children.

METHODS

We searched the Cochrane Library, PubMed, EMBASE and Web of Science up to May 29, 2018 to identify relevant randomized controlled trials (RCTs) which analyzed and evaluated the impact of LMAs in decreasing PRAEs in children. Participants were randomly assigned to receive LMAs (the intervention group) or other airways (the control group). We studied PRAEs which included breath apnea, laryngospasm, desaturation, cough, fever, pulmonary rales and pulmonary infection. Risk ratio (RR) with 95% confidence intervals (CIs) were estimated to compare the outcomes of the groups. We also performed subgroup analysis and sensitivity analysis to evaluate the impact of LMAs on further decreasing PRAEs. Two reviewers assessed the trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in the Review Manager 5.2.

RESULTS

Twelve RCTs (N = 1577 participants) were identified. Comparing with other airways, significant reduction were found in the overall PRAEs (RR 0.52, 95% CI 0.39-0.70; P < 0.0001), major PRAEs (RR 0.47, 95% CI 0.29-0.79; P = 0.004) as well as minor PRAEs (RR 0.57, 95% CI 0.45-0.74; P < 0.0001) in patients managed with LMAs. When compared with endotracheal tubes (ETTs), LMAs also significantly reduced PRAEs. Further analysis also found that LMAs reduced the incidences of postoperative cough (RR 0.44, 95% CI 0.31-0.63; P < 0.00001), pulmonary rales (RR 0.62, 95% CI 0.44-0.87; P = 0.006) and infections (RR 0.28, 95% CI 0.13-0.61; P = 0.001) in children.

CONCLUSIONS

LMAs reduced the incidences of many PRAEs in children and should be used as one of anaesthesia methods for children.

Comparison of the Supreme™ and ProSeal™ laryngeal mask airways in infants: a prospective randomised clinical study

Background

The Supreme™ and ProSeal™ laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia; however, LMA use in infants is limited because many anaesthesiologists prefer to use tracheal intubation in infants.

In this study, we compared the Supreme and ProSeal LMAs in infants by measuring their performance characteristics, including insertion features, ventilation parameters, induced changes in haemodynamics and rates of postoperative complications.

Methods

Infants of ASA physical status I scheduled for elective, minor, lower abdominal surgery were divided into two groups: the Supreme LMA group and the ProSeal LMA group. Times and ease of LMA insertion were noted. The percentages of tidal volume leakage as well as peak, mean and leakage pressures for all infants were measured. Heart rate (HR), oxygen saturation (SpO2) and end tidal carbon dioxide (EtCO2) values were recorded before and after LMA insertion and before and after extubation. After extubation, complications and adverse effects were noted.

Results

Demographic and surgical data were similar between the two groups. LMA insertion times were shorter for the ProSeal group than for the Supreme group (P < 0.002). The mean HR value for the ProSeal group was lower than for the Supreme group (P < 0.011). Both the peak pressure and the leakage percentage for the ProSeal group were statistically lower than for the Supreme group. The leakage pressure for the ProSeal group was statistically higher than for the Supreme group (P < 0.001).

Conclusions

The ProSeal LMA is superior to the Supreme LMA for use in infants due to the ease of insertion, high oropharyngeal leakage pressure and fewer induced changes in haemodynamics.

Trial registration

ClinicalTrial.gov, NCT03251105, retrospectively registered on 15 Aug 2017.

An update on newer pediatric supraglottic airways with recommendations for clinical use

Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.

Application of the LMA-Supreme™ and i-gel™ laryngeal masks during pelvic operations in adults

OBJECTIVE

The aim of this study was to evaluate the practical application and safety of the i-gel and LMA-Supreme laryngeal masks for airway management during pelvic operations in adults.

METHODS

Ninety patients undergoing general anesthesia for elective pelvic operations (ASA Grades I-II) were randomly divided into two groups, the i-gel group and the Supreme group. The laryngeal mask was inserted after induction, and the relevant examination grading indexes were recorded.

RESULTS

The Supreme group required less time for laryngeal mask insertion and gastric tube indwelling time. Gastric tube indwelling was easier, compared with those in the i-gel group (p = 0.03), but the i-gel group had fewer complications (p = 0.03). There were no significant differences in the degree of difficulty in insertion, airway sealing pressure, PETCO2, Ppeak, and laryngeal mask alignment accuracy between the two groups (p > 0.05). There was no statistically significant difference in fibrobronchoscopy grading between the two groups (p > 0.05).

CONCLUSION

The i-gel and LMA-Supreme laryngeal masks are safe and effective for airway management in patients during pelvic operations.