Comparison of Spontaneous Ventilation, Pressure Control Ventilation and Pressure Support Ventilation in Pediatric Patients Undergoing Infraumbilical Surgery Using ProSeal Laryngeal Mask Airway

Abstract

Background: Pediatric infraumbilical surgeries are often performed under general anaesthesia using different modes of ventilation through Laryngeal Mask Airway .Although controlled ventilation has been successfully used, very less studies have been done to compare them with spontaneous ventilation for short duration surgeries. Aims: We tried to measure quantitave differences in haemodynamic and respiratory parameters and assess the recovery profile between controlled and spontaneous ventilation using Proseal LMA. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) classes I and II pediatric patients posted for infra umbilical surgery. Materials and Methods: 90 paediatric patients undergoing infraumbilical surgeries were included. Three different ventilation strategies: spontaneous , pressure support and pressure-controlled ventilation were applied depending on attending anaesthesiologist's preference. Haemodynamic and respiratory parameters were recorded during the procedure. Post procedure parameters including need for supplementary oxygen, recovery time, complications were recorded. Statistical Methods: Analysis of variance (ANOVA) was employed for inter group analysis and for multiple comparisons, least significant difference (LSD) test was applied. Chi-square test or Fisher's exact test, whichever appropriate, was used for comparison of categorical variables. Results: The mean time interval between end of surgery and removal of LMA was significantly higher in PCV group in comparison to SV and PSV groups. In SV group lesser number of patients required oxygen supplementation and had shorter stay in recovery than PCV group. Conclusion: We conclude that spontaneous mode of ventilation can be used as safely as controlled /assist ventilation mode in short duration surgeries in high turn over settings.

Effects of laryngeal mask ventilation on postoperative atelectasis in children undergoing day surgery: a randomized controlled trial

“…In addition, at normal functional residual capacity, the inward alveolar retraction force is in equilibrium with the elastic expansion force of the chest wall, which does not usually change in patients without chest wall disease, and the inward alveolar retraction force is correlated with tidal volume [ 16 ]. In this study, we found that the exhaled tidal volume was significantly lower in the spontaneous breathing group than mechanical ventilation group, which was consistent with the results of Lim B et al [ 6 – 9 ]. The children in the spontaneous breathing group were more susceptible to atelectasis because they had smaller tidal volumes, which meant that their inward retraction forces were larger than those of the mechanical breathing group.…”

Safety and Efficacy of the Use of Supraglottic Airway Devices in Children and Adolescents Undergoing Adenotonsillectomy—A Systematic Review and Meta-Analysis

“…In a systematic review and meta-analysis investigating the safety and efficacy of LMA in pediatric laparoscopic hernia surgeries, Yang et al concluded that the use of LMA is safe and leads to lesser anesthesia and recovery time and hence is an appropriate option when compared to ETT [ 28 ]. The use of a non-depolarizing muscle for placing LMA is not necessary and depends on the type of surgery and the comfort of the anesthesiologist [ 29 , 30 ]. However, Wu et al suggested the use of non-depolarizing muscle relaxants can improve surgical conditions and reduce the incidence of adverse events like laryngospasm and bronchospasm [ 31 ].…”

Choice of airway device and the incidence and severity of postoperative pulmonary complications in older patients

“…Yang et al showed that there was a reduced incidence of postoperative pulmonary complications following the use of a supraglottic airway device when compared with tracheal intubation [10]; however, it is unclear why outcomes were worse in patients whose tracheas were there is no difference in overall patient outcomes [17,18].…”

“…These have included lung‐protective ventilation strategies [15] and the use of positive end‐expiratory pressure (PEEP) [16], but results have been inconclusive. In addition, comparisons between controlled and spontaneous ventilation in patients with supraglottic airway devices have shown that, although the gas exchange is more effective in controlled ventilation with improved oxygen saturations and end‐tidal carbon dioxide values, there is no difference in overall patient outcomes [17, 18].…”