Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

Abstract

We studied the incidence of gastro-oesophageal reflux (GOR) during general anaesthesia with the laryngeal mask airway (LMA) in a paediatric population with two ventilatory regimes: spontaneous breathing and controlled mechanical ventilation (CMV). Thirty children between 6 months and 15 years, ASA I-II, for routine surgery, were randomly assigned in two groups: spontaneous ventilation (n=14), and CMV (n=16). A pH probe was situated in the central third of the oesophagus. Some 66% of the patients breathing spontaneously had GOR episodes vs. 92% of the patients with CMV (P < 0,01). Reflux took place mainly after LMA removal (21% vs. 68%; P < 0,01) and in the Postanaesthetic Care Unit (PACU) (29% vs. 43%; P < 0,05). There was a high incidence of GOR during general anaesthesia and in the PACU in paediatric patients anaesthetized with the LMA. GOR episodes were significantly more evident in the CMV group, mainly after LMA removal, but without clinical significance.

Controversies in Pediatric Perioperative Airways

“…The rate of reported aspiration appears to be very low although silent gastroesophageal reflux can often occur. It appears that, in reported cases, the diagnosis of reflux had no clinical consequences and compared to facemask ventilation and anesthesia with intubation, the incidence was similar [ 85 , 86 ]. Laryngeal masks have been used for airway management during adenotonsillectomy, tonsillectomy, and adenoidectomy [ 87 ], laparoscopic surgeries (with comparable intragastric pressure to ETT [ 88 ]), during fibreoptic bronchoscopy [ 89 , 90 ], eye surgery [ 91 ], during difficult airway management as a conduit for ETT placement [ 92 , 93 ], and during resuscitation (also in neonates) with no documented difference in outcome compared to ETT use.…”

Gastro-oesophageal reflux during anaesthesia in the kitten: comparison between use of a laryngeal mask airway or an endotracheal tube

“…1995; Roux et al. 1999; Cebrian et al. 2000) although other studies demonstrated reflux of gastric contents, at least into the middle or upper oesophagus, to be extremely rare (Joshi et al.…”

Randomized controlled trial comparing the laryngeal tube and the laryngeal mask in pediatric patients

“…Its large internal diameter allows the use of the fiberoptic bronchoscope without a significant increase in airway resistance (5,6). However, LMA causes gastric insufflations and may produce gastroesophageal reflux (7).…”