Bussolin L, Busoni P
Department of Anaesthesiology and Intensive Care, Meyer Children Hospital, Florence, Italy.
Paediatr Anaesth. 2002 Jan;12(1):43-7. doi: 10.1046/j.1460-9592.2002.00760.x.
The cuffed oropharyngeal airway (COPA) is a device which has already been demonstrated to be suitable for anaesthetized adult patients undergoing either spontaneous or mechanical ventilation. There are few reports on the use of the COPA in children. In this study, the authors assessed the COPA in paediatric patients undergoing minor surgery.
The same anaesthesiologist inserted the COPA in 40 consecutive paediatric patients, ASA I and II, aged 1.8-15.3 years. (7.4 +/- 3.9), after induction of anaesthesia with N2O/O2/sevoflurane. COPA size was chosen by measuring the distal tip of the device at the angle of the jaw with the COPA perpendicular to the patient's bed. The proper positioning of the COPA was assessed by observing thoracoabdominal movements, regular capnograph trace, the reservoir bag movements and SpO2 > 94% with a fraction of inspired oxygen of 0.5. Anaesthesia was maintained with 1 MAC halothane, sevoflurane, or isoflurane in N2O/O2 (50%) and the patients were spontaneously breathing. The stability of the COPA following changes in head, neck and body position was tested. We recorded the duration time for COPA insertion, the side-effects of placement of the COPA and during the intraoperative period, the number of attempts, the type of manipulation in order to provide an effective airway and postoperative symptoms, such as the presence of blood on the device, sore throat, neckache, jaw pain and PONV.
Successful COPA insertion at the first attempt was 90% and at the second attempt in the remaining 10%. The most frequent airway manipulations were head tilt in 27.5% (obtained by a pillow under shoulders) and chin lift in 5%. No complications both at COPA placement nor during the intraoperative period were observed. On the basis of weight and age, the COPA size was no. 8 in 50%, no. 9 in 30%, no. 10 in 12.5%, and no. 11 in 7.5%. The COPA demonstrated stability after changes in head, neck and body position. Postoperative complications were the presence of blood stains in one case and PONV in six cases (15%).
The COPA is an extratracheal airway device suitable in paediatric patients undergoing general anaesthesia with spontaneous ventilation for minor surgery and other painful procedures. This study shows that for paediatric patients: (i) complications seem to be rare; (ii) the COPA allows hands free anaesthesia; (iii) specific indication for the COPA could be obese patients with a small mouth; and (iv) COPA sizing can be easily established by the weight or age of the patients.
带套囊口咽气道（COPA）已被证明适用于接受自主呼吸或机械通气的成年麻醉患者。关于COPA在儿童中的应用报道较少。在本研究中，作者评估了COPA在接受小手术的儿科患者中的应用情况。
同一位麻醉医生连续为40例年龄在1.8 - 15.3岁（平均7.4 ± 3.9岁）的ASA I级和II级儿科患者在使用N₂O/O₂/七氟醚诱导麻醉后插入COPA。通过将COPA垂直于患者病床，在颌角处测量器械远端尖端来选择COPA尺寸。通过观察胸腹部运动、正常的二氧化碳波形图、贮气囊运动以及在吸入氧分数为0.5时SpO₂ > 94%来评估COPA的正确位置。使用1 MAC的氟烷、七氟醚或异氟醚在N₂O/O₂（50%）中维持麻醉，患者自主呼吸。测试了头、颈和身体位置改变后COPA的稳定性。我们记录了COPA插入的持续时间、放置COPA时及术中的副作用、尝试次数、为建立有效气道所进行的操作类型以及术后症状，如器械上有血迹、咽痛、颈部疼痛、颌部疼痛和术后恶心呕吐（PONV）。
首次尝试成功插入COPA的比例为90%，其余10%在第二次尝试时成功。最常见的气道操作是头部倾斜（27.5%，通过肩部下方垫枕头实现）和抬颏（5%）。在放置COPA时及术中均未观察到并发症。根据体重和年龄，50%的患者使用8号COPA，30%使用9号，12.5%使用10号，7.5%使用11号。头、颈和身体位置改变后COPA显示出稳定性。术后并发症为1例出现血迹，6例（15%）出现PONV。
COPA是一种适用于接受全身麻醉且自主呼吸的儿科小手术及其他疼痛性操作患者的气管外气道装置。本研究表明，对于儿科患者：（i）并发症似乎很少见；（ii）COPA可实现免手控麻醉；（iii）COPA的特定适应证可能是小嘴的肥胖患者；（iv）可根据患者的体重或年龄轻松确定COPA尺寸。
