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Journal of Anesthesia

, Volume 27, Issue 5, pp 657–662 | Cite as

Randomized evaluation of the size 2 laryngeal tube and classical laryngeal mask airway in different head and neck positions in children under positive pressure ventilation

  • Andreas Biedler
  • Marc Wrobel
  • Sven Schneider
  • Stefan Soltész
  • Stephan Ziegeler
  • Ulrich Grundmann
Original Article

Abstract

Purpose

The aim of this study was to evaluate the applicability of the laryngeal tube (LT) size 2 and the classical laryngeal mask airway (LMA) size 2 in different head–neck positions under positive pressure ventilation in children by measuring leak pressures, peak pressures and the achievable tidal volumes under positive pressure ventilation.

Methods

Forty children were randomized to receive airway management by either the LT or LMA as the primary device. Leak pressures, peak pressures and tidal volumes under positive pressure ventilation were measured in the neutral, anteflection, retroversion, left-rotation and right-rotation head–neck positions.

Results

In all head–neck positions, the leak pressures were significantly higher for the LT than for the LMA (neutral 25.9 ± 7.0 vs. 19.1 ± 5.7 cmH2O; anteflection 29.7 ± 7.1 vs. 24.2 ± 8.9 cmH2O; retroversion 24.1 ± 7.6 vs. 17.2 ± 6.9 cmH2O). In both devices, the peak ventilation pressures were higher in the anteflection position (LT 27.1 ± 6.3 cmH2O; LMA 17.8 ± 6.7 cmH2O) than in the retroversion position (LT 13.7 ± 3.9 cmH2O; LMA 12.7 ± 3.6 cmH2O). Compared to the respirator settings, lower tidal volumes were achieved in the anteflection position (LT 65 ± 48 vs. 129 ± 38 ml, LMA 100 ± 21 vs. 125 ± 29 ml) as compared to the other positions.

Conclusion

Based on our results, we suggest that in anaesthetized children, the size 2 LT, compared to the size 2 LMA, may be more suitable for positive pressure ventilation due to favorable leak and peak pressures. Both devices can be safely used in head–neck positions other than neutral. Most disadvantageous with regards to the measured parameters was the anteflection position, especially for the LT.

Keywords

Supraglottic Pediatric anesthesia Leak pressure Peak pressure Different head–neck positions 

References

  1. 1.
    Brain AI. The laryngeal mask—a new concept in airway management. Br J Anaesth. 1983;55:801–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Gravningsbraten R, Nicklasson B, Raeder J. Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy. Acta Anaesthesiol Scand. 2009;53:218–22.PubMedCrossRefGoogle Scholar
  3. 3.
    Mandel JE. Laryngeal mask airways in ear, nose, and throat procedures. Anesthesiol Clin. 2010;28:469–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Sierpina DI, Chaudhary H, Walner DL, Villines D, Schneider K, Lowenthal M, Aronov Y. Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy. Laryngoscope. 2012;122:429–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Park SH, Han SH, Do SH, Kim JW, Kim JH. The influence of head and neck position on the oropharyngeal leak pressure and cuff position of three supraglottic airway devices. Anesth Analg. 2009;108:112–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Xue FS, Mao P, Liu HP, Yang QY, Li CW, He N, Xu YC, Liao X. The effects of head flection on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway. Anaesthesia. 2008;63:979–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Lopez-Gil M, Brimacombe J, Keller C. A comparison of four methods for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA) in paediatric patients. Paediatr Anaesth. 2001;11:319–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Genzwuerker HV, Fritz A, Hinkelbein J, Finteis T, Schlaefer A, Schaeffer M, Thil E, Rapp HJ. Prospective, randomized comparison of the laryngeal tube and laryngeal mask airway in pediatric patients. Paediatr Anaesth. 2006;16:1251–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Ocker H, Wenzel V, Schmucker P, Steinfath M, Dörges V. A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures. Anesth Analg. 2002;95:1094–7.PubMedGoogle Scholar
  10. 10.
    Goldmann K, Roettger C, Wulf H. The size 1(½) ProSeal laryngeal mask airway in infants: a randomized, crossover investigation with the Classic laryngeal mask airway. Anesth Analg. 2006;102:405–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Keller C, Brimacombe J. The influence of head and neck position on oropharyngeal leak pressure and cuff position with the flexible and the standard laryngeal mask airway. Anesth Analg. 1999;88:913–6.PubMedGoogle Scholar
  12. 12.
    White MC, Cook TM, Stoddart PA. A critique of elective pediatric supraglottic airway devices. Paediatr Anaesth. 2009;19S1:55–65.CrossRefGoogle Scholar
  13. 13.
    Cook TM, McCormick B, Asai T. Randomized comparison of laryngeal tube with classic laryngeal mask airway for anaesthesia with controlled ventilation. Br J Anaesth. 2003;91:373–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Inagawa G, Okuda K, Miwa T, Hiroki K. Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients. Paediatr Anaesth. 2002;12:322–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Sanuki T, Uda R, Sugioka S, Daigo E, Son H, Akatsuka M, Kotani J. The influence of head and neck position on ventilation with the i-gel airway in paralysed, anaesthetised patients. Eur J Anaesthesiol. 2011;28:597–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim JT, Na HS, Bae JY, Kim HJ, Shin HY, Kim HS, Kim CS, Kim SD. Flexion compromises ventilation with laryngeal tube suction II in children. Paediatr Anaesth. 2009;19:153–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Keller C, Brimacombe J, Moriggl B, Lirk P, von Goedecke A. In cadavers, directly measured mucosal pressures are similar for the Unique and the Soft Seal laryngeal mask airway devices. Can J Anaesth. 2004;51:834–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT, Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology. 2010;112:652–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Wong JG, Heaney M, Chambers NA, Erb TO, von Ungern-Sternberg BS. Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Paediatr Anaesth. 2009;19:464–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Rokamp KZ, Secher NH, Møller AM, Nielsen HB. Tracheal tube and laryngeal mask cuff pressure during anaesthesia—mandatory monitoring is in need. BMC Anesthesiol. 2010;10:20.PubMedCrossRefGoogle Scholar
  21. 21.
    Ghai B, Sethi S, Ram J, Wig J. Cuff filling volumes for pediatric classic laryngeal mask airways: comparison of clinical end points versus adjusted cuff pressure. Paediatr Anaesth. 2013;23:122–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Amini A, Zand F, Sadeghi SE. A comparison of the disposable vs the reusable laryngeal tube in paralysed adult patients. Anaesthesia. 2007;62:1167–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Gasteiger L, Brimacombe J, Oswald E, Perkhofer D, Tomnin A, Keller C, Tiefenthaler W. LMA ProSeal vs. i-Gel in ventilated children: a randomised, crossover study using the size 2 mask. Acta Anaesthesiol Scand. 2012;56:1321–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Lopez-Gil M, Mantilla I, Blanco T, Teigell E, Hervias M, Fernandez-Lopez R. The size 1 ProSeal laryngeal mask airway in infants: a randomized, noncrossover study with the Classic laryngeal mask airway. Paediatr Anaesth. 2012;22:365–70.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Andreas Biedler
    • 1
  • Marc Wrobel
    • 2
  • Sven Schneider
    • 2
  • Stefan Soltész
    • 3
  • Stephan Ziegeler
    • 4
  • Ulrich Grundmann
    • 2
  1. 1.Klinik für Anästhesie und IntensivmedizinKatholisches Klinikum EssenEssenGermany
  2. 2.Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und SchmerztherapieUniversitätsklinikum des SaarlandesHomburg (Saar)Germany
  3. 3.Klinik für Anästhesie, Intensiv- und NotfallmedizinKreiskrankenhaus DormagenDormagenGermany
  4. 4.Klinik für Anästhesie, Operative Intensivmedizin, Schmerztherapie und Notfallmedizin Klinikum IbbenbürenIbbenbürenGermany

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