Krishna Senthil G, Syed Faizaan, Hakim Mohammed, Hakim Mumin, Tumin Dmitry, Veneziano Giorgio C, Tobias Joseph D
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA,
Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA,
Med Devices (Auckl). 2018 Oct 1;11:361-365. doi: 10.2147/MDER.S177866. eCollection 2018.
When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q laryngeal mask airway (LMA) and the i-gel SGA, in pediatric patients.
Patients ≤18 years of age were prospectively randomized to receive either the Air-Q LMA or the i-gel SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmHO were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen.
Fifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q LMA and i-gel SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: - 2 to 7; =0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: - 9 to 8; =0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q and 6 i-gel supraglottic devices sealed the airway at 20 cmHO.
The time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q LMA and the i-gel SGA did not differ.
在处理困难气道患者时，声门上气道（SGA）已被用作抢救设备或作为气管插管的通道。本研究比较了在儿科患者中使用两种SGA（Air-Q喉罩气道（LMA）和i-gel SGA）时的各种临床结果，包括声门的支气管镜视野。
将年龄≤18岁的患者前瞻性随机分组，分别接受Air-Q LMA或i-gel SGA。在放置SGA后，通过SGA插入一根可弯曲的纤维支气管镜以观察声门。比较获得支气管镜视野和放置SGA所需的时间，以及在20 cmH₂O压力下密封气道的能力。获得的支气管镜视野分级如下：1）声门裂完全可见；2）声门裂部分可见，视野遮挡<50%；3）声门裂可见，但视野遮挡>50%；4）声门裂不可见。
共纳入50例患者，48例（男22例/女26例）纳入分析。中位年龄为13岁（四分位间距：7，16），中位体重为49 kg（四分位间距：25，70）。Air-Q LMA组和i-gel SGA组在设备放置时间（中位数分别为19秒和21秒；中位数差值的95%置信区间：-2至7；P = 0.331）、获得声门纤维镜视野的时间（中位数分别为25秒和21秒；差值的95%置信区间：-9至8；P = 0.489）或气道支气管镜视野分级方面无差异。8个Air-Q和6个i-gel声门上设备在20 cmH₂O压力下密封了气道。
成功放置SGA所需的时间、获得支气管镜视野所需的时间以及通过Air-Q LMA和i-gel SGA获得的支气管镜视野质量无差异。
