Micaglio Massimo, Doglioni Nicoletta, Parotto Matteo, Zanardo Vincenzo, Ori Carlo, Trevisanuto Daniele
Department of Pharmacology and Anesthesiology, School of Medicine, University of Padua, Padua, Italy.
Paediatr Anaesth. 2006 Oct;16(10):1028-31. doi: 10.1111/j.1460-9592.2006.01921.x.
Neonatal resuscitation is a mandatory skill for healthcare professionals involved in maternity suites. For ethical reasons, it is impossible to teach and practice airway management skills on neonates, and manikins are used for this purpose. The Classic Laryngeal Mask Airway TM (cLMA) is accepted as an effective device for airway management during neonatal resuscitation. A neonatal size of the LMA-ProSeal (PLMA) was recently produced, but there are no comparative data on its performance. We describe the comparison of the performances of the neonatal cLMA and the neonatal PLMA when used by different healthcare professionals in a dedicated airway management manikin.
Thirty-five healthcare professionals, were given a brief description of the two devices followed by 15 min of supervised insertions on a single manikin. Every trainee was then instructed to insert both devices four times. The time from insertion to the first inflation of the artificial lungs (insertion time, IT) was recorded by a single unblinded observer.
No failed insertions were recorded. The success rates of the first attempt were higher with the PLMA than the cLMA (97.1% vs 92.1%; P<0.01). The mean+/-sd (range) IT was significantly lower with the cLMA compared with the PLMA [10.47+/-2.85 (6-22) s vs 11.34+/-2.5 (7-18) s; P<0.01]. The mean+/-sd (range) IT of the cLMA was 12.31+/-3.54 (7-22) s for the first positioning and 9.2+/-2.34 (6-16) s for the fourth (P<0.01). The mean+/-sd (range) IT of the PLMA was 12.71+/-2.52 (8-18) s for the first positioning and 10.17+/-2.28 (7-14) s for the fourth (P<0.01). There were no significant differences among groups.
Both LMAs are easy to insert by different delivery-room workers. PLMA (with the introducer tool) has a higher success rate at first attempt than cLMA. Manikin ventilation was established equally without difference in performance among doctors, nurses, midwives. A brief manikin-training reduces the IT significantly. The longer IT of PLMA vs cLMA is without clinical relevance.
新生儿复苏是产房医护人员必须掌握的技能。出于伦理原因，无法在新生儿身上教授和练习气道管理技能，因此使用人体模型来进行此项训练。经典喉罩气道TM（cLMA）被公认为是新生儿复苏期间气道管理的有效设备。最近生产出了新生儿尺寸的喉罩气道双管型（PLMA），但其性能尚无对比数据。我们描述了不同医护人员在专用气道管理人体模型上使用新生儿cLMA和新生儿PLMA时的性能比较。
向35名医护人员简要介绍了这两种设备，然后在单个模型上进行15分钟的监督插入操作。随后，指导每位学员对两种设备各插入4次。由一名未设盲的观察者记录从插入到人工肺首次充气的时间（插入时间，IT）。
未记录到插入失败的情况。PLMA首次尝试的成功率高于cLMA（97.1%对92.1%；P<0.01）。与PLMA相比，cLMA的平均±标准差（范围）IT显著更低[10.47±2.85（6 - 22）秒对11.34±2.5（7 - 18）秒；P<0.01]。cLMA首次定位时的平均±标准差（范围）IT为12.31±3.54（7 - 22）秒，第四次为9.2±2.34（6 - 16）秒（P<0.01）。PLMA首次定位时的平均±标准差（范围）IT为12.71±2.52（8 - 18）秒，第四次为10.17±2.28（7 - 14）秒（P<0.01）。各小组之间无显著差异。
两种喉罩气道均易于不同产房工作人员插入。PLMA（带导入工具）首次尝试的成功率高于cLMA。在医生、护士、助产士之间，建立人体模型通气的情况相同，性能无差异。简短的人体模型训练可显著缩短插入时间。PLMA与cLMA相比插入时间更长，但无临床相关性。
