Sunder Rani A, Sinha Renu, Agarwal Anil, Perumal Bala Chandran Sundara, Paneerselvam Sakthi Rajan
Department of Anaesthesiology and Intensive Care, Rajendra Prasad Institute of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2012 Jul;28(3):322-5. doi: 10.4103/0970-9185.98324.
Supraglottic airway devices play an important role in ophthalmic surgery. The flexible laryngeal mask airway (LMA™) is generally the preferred airway device. However, there are no studies comparing it with the Cobra perilaryngeal airway (CobraPLA™) in pediatric ophthalmic procedures.
To analyze the intraoperative device stability and ability to maintain normocarbia of CobraPLA™ and compare it to that with flexible LMA™.
Ninety children of American Society for Anesthesiologists physical status 1 and 2, aged 3-15 years scheduled for elective ophthalmic surgeries were randomly assigned to either the CobraPLA™ or the flexible LMA™ group. After placement of each airway device, oropharyngeal leak pressure (OLP) was noted. Adequate seal of the devices was confirmed at an inspired pressure of 15 cm H(2)O and pressure-controlled ventilation was initiated. Device displacement was diagnosed if there was a change in capnograph waveform, audible or palpable gas leak, change in expired tidal volume to <8 ml/kg, end-tidal carbon-dioxide persistently >6 kPa, or need to increase inspired pressure to >18 cm H(2)O to maintain normocarbia.
Demographic data, duration, and type of surgery in both the groups were similar. A higher incidence of intraoperative device displacement was noted with the CobraPLA™ in comparison to flexible LMA™ (P < 0.001). Incidence of displacement was higher in strabismus surgery (7/12). Insertion characteristics and ventilation parameters were comparable. The OLP was significantly higher in CobraPLA™ group (28 ± 6.8 cm H(2)O) compared to the flexible LMA™ group (19.9 ± 4.5 cm H(2)O) (P < 0.001). Higher surgeon dissatisfaction (65.9%) was seen in the CobraPLA™ group.
The high incidence of device displacement and surgeon dissatisfaction make CobraPLA™ a less favorable option than flexible LMA™ in ophthalmic surgery.
声门上气道装置在眼科手术中发挥着重要作用。柔性喉罩气道（LMA™）通常是首选的气道装置。然而，尚无研究在小儿眼科手术中将其与Cobra喉周气道（CobraPLA™）进行比较。
分析CobraPLA™在术中的装置稳定性及维持正常碳酸血症的能力，并将其与柔性LMA™进行比较。
90例美国麻醉医师协会身体状况1级和2级、年龄3至15岁、计划行择期眼科手术的儿童被随机分为CobraPLA™组或柔性LMA™组。放置每种气道装置后，记录口咽漏气压（OLP）。在吸气压力为15 cm H₂O时确认装置密封良好，然后开始压力控制通气。若二氧化碳波形图出现变化、可闻及或可触及气体泄漏、呼出潮气量降至<8 ml/kg、呼气末二氧化碳持续>6 kPa，或需要将吸气压力提高至>18 cm H₂O以维持正常碳酸血症，则诊断为装置移位。
两组的人口统计学数据、手术时长和类型相似。与柔性LMA™相比，CobraPLA™术中装置移位的发生率更高（P < 0.001）。斜视手术中移位发生率更高（7/12）。插入特征和通气参数具有可比性。CobraPLA™组的OLP显著高于柔性LMA™组（28 ± 6.8 cm H₂O 对比 19.9 ± 4.5 cm H₂O）（P < 0.001）。CobraPLA™组外科医生的不满率更高（65.9%）。
在眼科手术中，装置移位的高发生率和外科医生的不满使得CobraPLA™不如柔性LMA™那样是一个理想的选择。
