Use of the ProSeal™ laryngeal mask airway for pressure-controlled ventilation with and without positive end-expiratory pressure in paediatric patients: a randomized, controlled study

Goldmann, K.; Roettger, C.; Wulf, Hinnerk

doi:10.1093/bja/aei246

Cited by 27 publications

(19 citation statements)

References 17 publications

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“…In einer Untersuchung an gesunden Kindern, die bekanntermaßen zum verstärkten Kollaps der kleinen Atemwege neigen, konnte dies bereits gezeigt werden [9]. Für erwachsene Patienten ist diese Fragestellung bisher weder für Gesunde noch für Patienten mit bestimmten Risikofaktoren, wie z.…”

Section: Grundlagenunclassified

ProSeal®-Kehlkopfmaske in normalgewichtigen und adipösen Patienten

2011

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The application of PEEP when PCV is used with the PLMA results in improved oxygenation in obese patients with a BMI ≥30 and <36 kg/m(2) but not in normal weight patients. Alveolar recruitment produced by seal pressure measurements below 30 cm H(2)O was sufficient to produce a clinically significant improvement in oxygenation in most obese patients and there was a significant improvement of oxygenation with PEEP=5 cmH(2)O. Both findings are in contrast to findings of studies using an ETT which suggests that higher pressures (40 cmH(2)O) are needed for recruitment of collapsed alveoli and higher PEEP (10 cmH(2)O) is needed to produce a clinically significant improvement in oxygenation in obese patients. The results of this study support data showing that the consequences of bronchopulmonary airway reactions known to occur with an ETT are less pronounced or absent when an LMA is used.

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Section: Grundlagenunclassified

ProSeal®-Kehlkopfmaske in normalgewichtigen und adipösen Patienten

2011

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“…Evidence from the literature shows that higher inspired pressures are possible in children when using the LMA Proseal TM compared with using the LMA Classic TM , including the use of moderate levels of positive end-expiratory pressure. 14 This development has allowed its use to be considered in a wider variety of operative settings where positive pressure would be used routinely. 15 The extent to which the esophageal vent can protect against aspiration is not yet clear.…”

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confidence: 99%

Supraglottic airways in children: past lessons, future directions

Cox

Lardner

2009

Can J Anesth/J Can Anesth

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The first prototype of the laryngeal mask airway (LMA TM ) was used clinically in the summer of 1981 at Ashford, Kent, UK, by Dr. Archie Brain. Dr. Brain followed in the worthy footsteps of Clover, O'Dwyer, Shipway, Leech, and others in developing a supraglottic airway to facilitate the delivery of anesthetic gases via a reliable supraglottic airway. 1 The LMA TM was released in the UK in 1988 and in the USA in 1992. Since the original range of pediatric LMAs TM was soon found to be inadequate to address all children's sizes, half-sizes (1.5 and 2.5) were developed. As with adult practice, the LMA TM and other supraglottic airways have radically changed pediatric anesthesia practice and have become a key component of airway management in children, both in the operating room and in remote anesthesia locations. These devices have increasingly been advocated for emergency airway control in the field, in the emergency department, and in the delivery suite. So what have we learned about pediatric supraglottic airways over the past two decades and where does the future lie with respect to these devices?Much of the published research in this area relates to the LMA Classic TM . From the clinical anesthesiologist's perspective, the following questions relating to the LMA Classic TM are important: When should it be used (patient and procedure related factors), how should it be used, and when should an alternative device be used?Indications for the use of the LMA Classic TM are extensive, and it is often the airway of choice in routine general anesthesia for minor procedures in children. In a prospective study of 1,400 children who had LMA TM -based anesthesia conducted by supervised trainees, the device was found to be highly effective for a broad range of surgical procedures, and there was no instance where the LMA TM had to be replaced with an endotracheal tube (ETT). 2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.Pediatric anesthesia is increasingly being delivered in areas outside the operating room where the LMA TM has been proven to be particularly valuable. For instance, the LMA TM has been used for radiotherapy, 5 magnetic resonance imaging, 6 fibreoptic bronchoscopy, 7 and upper gastrointestinal endoscopy. 8 Its relative stability combined with the ease of respiratory monitoring and the relative lack of airway complications are distinct advantages in these remote locations.One clinical scenario of particular interest is the difficult pediatric airway. Here the LMA TM has proven to be invaluable both as a rescue airway device in the child with a difficult airway and as a conduit for fibreoptic bronchoscopy and endotracheal intubation. 7 Consequently, the LMA TM has a role in both anticipated and unanticipated difficu...

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“…The ProSeal laryngeal mask airway (PLMA) (Laryngeal Mask Co., Henley-on-Thames, U.K.) is a relatively new supraglottic airway device with a drain tube to minimize the risk of gastric insufflation and aspiration. Although the PLMA has been shown to form a more effective seal than the classic LMA [13], obtaining high inspiratory pressures with an LMA remains very difficult.…”

Section: Anesthetic Concernsmentioning

confidence: 99%