Abstract
Purpose
To assess the efficacy of the laryngeal mask airway (LMA) for fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in infants.
Methods
Observations were made in 19 consecutive infants undergoing FOB under general anaesthesia (GA) plus topical local anaesthesia. Anaesthesia was induced with N2O, O2, and halothane or sevoflurane except in two patients who received propofol and one who received thiopentone. Anaesthesia was maintained with oxygen and either sevoflurane, halothane, desflurane, or propofol infusion. No neuromuscular blockers were used. Size #1 or #2 LMAs were used through which a 3.5 mm fibreoptic bronchoscope was introduced. ECG, noninvasive blood pressure, pulse oximetry and, PETCO2 were measured. Intra-and post-procedural complications were recorded.
Results
Mean age was 6 months; mean weight was 6.6 kg. Chronic wheezing was the indication for FOB in eight patients. Minor complications occurred in five patients: difficult LMA placement in one patient required changing size from #2 to #1; two patients had laryngospasm and bronchospasm that resolved with deepened anaesthesia and nebulised bronchodilator; one patient had transient arterial O2 desaturation responding to increased FIO2, and one patient required tracheal intubation because ventilation via LMA became inadequate.
Conclusion
The minor complications observed were similar to other series and did not result in morbidity or mortality. We feel that GA via LMA facilitates safe FOB in infants. It affords excellent airway management, a quiet patient, and passage of a larger fibreoptic bronchoscope for better imaging and suction channel required for BAL.
Résumé
Objectif
Évaluer, en pédiatrie, l’efficacité du masque laryngé (ML) pour la bronchofibroscopie (BOF) et la lavage bronchoalvéolaire (LBA).
Méthodes
Les observations ont porté sur 19 BOF réalisées chez des enfants sous anesthésie générale (AG) complétée par une anesthésie topique. L’anesthésie générale était induite avec du N2O, de l’O2 et de l’halothane ou du sévoflurane à l’exception de deux patients qui ont reçu du propofol et un patient, du thiopental. L’anesthésie était maintenue avec de l’oxygène associé soit à du sévoflurane, de l’halothane, du desflurane, ou une perfusion de propofol. Aucun myorelaxant n’a été administré. On insérait un ML de taille 1 ou 2 par lequel un bronchofibroscope de 3,5 mm était introduit. LÉCG, l’oscillométrie automatisée, l’oxymétrie de pouls et la PETCO2 étaient enregistrés. On notait les complications peret postopératoires.
Résultats
Huit patients ont subi la BOF pour du wheezing. Des complications mineures sont survenues chez cinq patients: chez un patient, l’insertion laborieuse du ML a nécessité un changement de masque de taille 2 à taille 1: deux patients ont présenté un laryngospasme et un bronchospasme maîtrisés par l’approfondissement de l’anesthésie et la nébulisation d’un bronchodilatateur; un patient a présenté une désaturation arténelle transitoire résolue par l’augmentation de la FiO2 et un patient a dû être intubé à cause de l’incapacité de ventiler sous ML.
Conclusion
Les complications mineures observées étaient les mêmes que celles notées dans d’autres études et n’ont provoqué ni morbidité ni mortalité. Nous croyons que l’AG par ML facilite la BOF chez les enfants. Cette méthode procure un excellent contrôle des voies aériennes, l’immobilité du patient et permet l’introduction d’un bronchofibroscope de plus grand calibre pour faciliter une meilleure visualisation et l’aspiration pendant le LBA.
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Supported by Maternal Child Health Bureau MCJ-229163.
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Bandla, H.P.R., Smith, D.E. & Kiernan, M.P. Laryngeal mask airway facilitated fibreoptic bronchoscopy in infants. Can J Anaesth 44, 1242–1247 (1997). https://doi.org/10.1007/BF03012770
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DOI: https://doi.org/10.1007/BF03012770