Sinha Aparna, Sharma Bimla, Sood Jayashree
Dept. of Anesthesia, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Middle East J Anaesthesiol. 2009 Oct;20(3):437-42.
ProSeal LMA (PLMA), one of the advanced supraglottic devices has been successfully used to provide both spontaneous and controlled ventilation in children with upper respiratory tract infection (URTI). URTI does not imply restriction of disease to upper respiratory tract; it has been shown to produce pulmonary dysfunction. PEEP has been shown to improve oxygenation in such cases. This randomized prospective study was designed to compare postoperative adverse events associated with spontaneous respiration (SR) and pressure control ventilation (PCV) with PEEP in infants and toddlers with URTI when using PLMA as an airway device.
In the present study, 90 children, 6 months-2 years, scheduled for infra umbilical surgery were randomized to receive either SR or PCV with PEEP of 5cm H2O. Patients with risk of aspiration, bronchial asthma, anticipated difficult airway, snoring, passive smoking, morbid obesity, coexisting pulmonary and cardiac disease, lower respiratory tract infection, fever > 38 degrees C and sneezing, were excluded. At emergence, airway secretions, coughing, breath holding, bronchospasm, upper airway obstruction or laryngospasm (LS) were assessed.
The adverse events were significantly higher in spontaneously breathing patients. Score of adverse events was 6.33 +/- 1.6 in PCV and 7.7 +/- 2.2 in SR group (P = 0.001). The mean SpO2 (%) in PACU was 96.5 +/- 2 in PCV and 94.4 +/- 1.37 in SR (P = 000).
Pressure control ventilation with PEEP using PLMA is associated with lower incidence of adverse events in comparison to spontaneous respiration in infants and toddlers with upper respiratory tract infection undergoing infra umbilical surgeries under general anesthesia.
ProSeal喉罩气道（PLMA）是一种先进的声门上气道装置，已成功用于患有上呼吸道感染（URTI）的儿童的自主通气和控制通气。URTI并不意味着疾病仅限于上呼吸道；已证明它会导致肺功能障碍。在这种情况下，呼气末正压通气（PEEP）已被证明可改善氧合。本随机前瞻性研究旨在比较在使用PLMA作为气道装置时，患有URTI的婴幼儿在自主呼吸（SR）和使用PEEP的压力控制通气（PCV）情况下的术后不良事件。
在本研究中，90名计划进行脐下手术的6个月至2岁儿童被随机分为接受SR或使用5cm H2O PEEP的PCV。排除有误吸风险、支气管哮喘、预期气道困难、打鼾、被动吸烟、病态肥胖、并存肺部和心脏疾病、下呼吸道感染、体温>38摄氏度以及打喷嚏的患者。在苏醒时，评估气道分泌物、咳嗽、屏气、支气管痉挛、上气道梗阻或喉痉挛（LS）情况。
自主呼吸患者的不良事件明显更高。PCV组不良事件评分为6.33±1.6，SR组为7.7±2.2（P = 0.001）。术后麻醉恢复室（PACU）的平均脉搏血氧饱和度（SpO2）（%）在PCV组为96.5±2，SR组为94.4±1.37（P = 0.00）。
对于接受全身麻醉下脐下手术的患有上呼吸道感染的婴幼儿，与自主呼吸相比，使用PLMA进行带PEEP的压力控制通气不良事件发生率更低。
