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BJA Advance Access published online on September 30, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei246
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted August 15, 2005

Clinical Investigation

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

K. Goldmann 1*, C. Roettger 1, and H. Wulf 1

1 Department of Anaesthesia and Intensive Care Therapy, Philipps University Marburg, 35033 Marburg, Germany

* To whom correspondence should be addressed.
K. Goldmann, E-mail: kaigoldmann1{at}aol.com


  Abstract

Background. Tracheal intubation and positive end-expiratory pressure (PEEP) are frequently used in children to avoid airway closure and atelectasis during general anaesthesia. Also, the laryngeal mask airway (LMA{dagger}) is frequently used. However, one of the limitations with its use in children is that its low-pressure seal is often inadequate for positive pressure ventilation with PEEP. The ProSealTM LMA (PLMA) has been shown to form a more effective seal than the ClassicTM LMA. The ability to apply PEEP with the PLMA might improve gas exchange during positive pressure ventilation in children when the LMA is used.

Methods. Twenty anaesthetized, non-paralysed children aged 55 (range 27-89) months, weighing 18 (SD 3) kg, were randomly allocated into two groups. Anaesthesia management and positive pressure ventilation were standardized. Size 2 and 21/2 PLMA were used. Artificial ventilation in Group I was with pressure controlled ventilation (PCV) and PEEP=5 cm H2O, in Group II with PCV without PEEP. A FIO2=1.0 was used for 20 min during induction of anaesthesia. Sixty minutes after induction of anaesthesia an arterial blood gas sample was taken under a FIO2=0.3.

Results. Groups were comparable with respect to demographic data. PaO2 in Group I [22.1 (1.6) kPa] was significantly (P=0.001) higher than in Group II [19.2 (1.7) kPa].

Conclusions. The PLMA can be used for PCV with PEEP in paediatric patients. Application of PEEP improves gas exchange.

Keywords: anaesthesia, paediatric; equipment, laryngeal mask airway; ventilation, mechanical; ventilation, positive end-expiratory pressure.
{dagger}LMA® is the property of Intavent Ltd.
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