Evaluation of Different Positive End-Expiratory Pressures Using Supreme™ Airway Laryngeal Mask during Minor Surgical Procedures in Children

Mascha O Fiedler, Elisabeth Schätzle, Marius Contzen, Christian Gernoth, Christel Weiß, Thomas Walter, Tim Viergutz, Armin Kalenka, Mascha O Fiedler, Elisabeth Schätzle, Marius Contzen, Christian Gernoth, Christel Weiß, Thomas Walter, Tim Viergutz, Armin Kalenka

Abstract

Background and objectives: The laryngeal mask is the method of choice for airway management in children during minor surgical procedures. There is a paucity of data regarding optimal management of mechanical ventilation in these patients. The Supreme™ airway laryngeal mask offers the option to insert a gastric tube to empty the stomach contents of air and/or gastric juice. The aim of this investigation was to evaluate the impact of positive end-expiratory positive pressure (PEEP) levels on ventilation parameters and gastric air insufflation during general anesthesia in children using pressure-controlled ventilation with laryngeal mask. Materials and Methods: An observational trial was carried out in 67 children aged between 1 and 11 years. PEEP levels of 0, 3 and 5 mbar were tested for 5 min in each patient during surgery and compared with ventilation parameters (dynamic compliance (mL/cmH2O), etCO2 (mmHg), peak pressure (mbar), tidal volume (mL), respiratory rate (per minute), FiO2 and gastric air (mL)) were measured at each PEEP. Air was aspirated from the stomach at the start of the sequence of measurements and at the end. Results: Significant differences were observed for the ventilation parameters: dynamic compliance (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001), peak pressure (PEEP 5 vs. PEEP 3: p < 0.0001, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001) and tidal volume (PEEP 5 vs. PEEP 3: p = 0.0048, PEEP 5 vs. PEEP 0: p < 0.0001, PEEP 3 vs. PEEP 0: p < 0.0001). All parameters increased significantly with higher PEEP, with the exception of etCO2 (significant decrease) and respiratory rate (no significant difference). We also showed different values for air quantity in the comparisons between the different PEEP levels (PEEP 5: 2.8 ± 3.9 mL, PEEP 3: 1.8 ± 3.0 mL; PEEP 0: 1.6 ± 2.3 mL) with significant differences between PEEP 5 and PEEP 3 (p = 0.0269) and PEEP 5 and PEEP 0 (p = 0.0209). Conclusions: Our data suggest that ventilation with a PEEP of 5 mbar might be more lung protective in children using the Supreme™ airway laryngeal mask, although gastric air insufflation increased with higher PEEP. We recommend the use of a laryngeal mask with the option of inserting a gastric tube to evacuate potential gastric air.

Keywords: PEEP; airway devices; gastric insufflation; laryngeal mask; paediatric anaesthesia; respiratory function.

Conflict of interest statement

The authors report no conflict of interest.

References

    1. Jain R.A., Parikh D.A., Malde A.D. Balasubramanium, B. Current practice patterns of supraglottic airway device usage in paediatric patients amongst anaesthesiologists: A nationwide survey. Indian J. Anaesth. 2018;62:269–279.
    1. Goyal R. Small is the new big: An overview of newer supraglottic airways for children. J. Anaesthesiol. Clin. Pharmacol. 2015;31:440–449. doi: 10.4103/0970-9185.169048.
    1. Jagannathan N., Sequera-Ramos L., Sohn L., Wallis B., Shertzer A., Schaldenbrand K. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br. J. Anaesth. 2014;112:742–748. doi: 10.1093/bja/aet411.
    1. Asai T., Nagata A., Shingu K. Awake tracheal intubation through the laryngeal mask in neonates with upper airway obstruction. Paediatr. Anaesth. 2008;18:77–80. doi: 10.1111/j.1460-9592.2007.02354.x.
    1. Gursoy F., Algren J.T., Skjonsby B.S. Positive pressure ventilation with the laryngeal mask airway in children. Anesth. Analg. 1996;82:33–38.
    1. Natalini G., Facchetti P., Dicembrini M.A., Lanza G., Rosano A., Bernardini A. Pressure controlled versus volume controlled ventilation with laryngeal mask airway. J. Clin. Anesth. 2001;13:436–439. doi: 10.1016/S0952-8180(01)00297-5.
    1. Von Goedecke A., Brimacombe J., Keller C., Hoermann C., Loeckinger A., Rieder J., Kleinsasser A. Positive pressure versus pressure support ventilation at different levels of PEEP using the ProSeal laryngeal mask airway. Anaesth. Intensive Care. 2004;32:804–808. doi: 10.1177/0310057X0403200612.
    1. Wirth S., Artner L., Bross T., Lozano-Zahonero S., Spaeth J., Schumann S. Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients. Respir. Physiol. Neurobiol. 2016;234:9–13. doi: 10.1016/j.resp.2016.08.008.
    1. Imberger G., McIlroy D., Pace N.L., Wetterslev J., Brok J., Moller A.M. Positive end-expiratory pressure (PEEP) during anaesthesia for the prevention of mortality and postoperative pulmonary complications. Cochrane Database Syst. Rev. 2010;9:CD007922. doi: 10.1002/14651858.CD007922.pub2.
    1. Von Ungern-Sternberg B.S., Regli A., Schibler A., Hammer J., Frei F.J., Erb T.O. The impact of positive end-expiratory pressure on functional residual capacity and ventilation homogeneity impairment in anesthetized children exposed to high levels of inspired oxygen. Anesth. Analg. 2007;104:1364–1368. doi: 10.1213/01.ane.0000261503.29619.9c.
    1. Drake-Brockman T.F., Ramgolam A., Zhang G., Hall G.L., Von Ungern-Sternberg B.S. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: A randomised controlled trial. Lancet. 2017;389:701–708. doi: 10.1016/S0140-6736(16)31719-6.
    1. Instructions for Use—LMA Supreme. [(accessed on 24 February 2015)];2015 Available online: .
    1. Choi K.W., Lee J.R., Oh J.T., Kim D.W., Kim M.S. The randomized crossover comparison of airway sealing with the laryngeal mask airway Supreme at three different intracuff pressures in children. Paediatr. Anaesth. 2014;24:1080–1087. doi: 10.1111/pan.12494.
    1. Sharma B., Sood J., Sahai C., Kumra V.P. Troubleshooting ProSeal LMA. Indian J. Anaesth. 2009;53:414–424.
    1. Feldman J.M. Optimal ventilation of the anesthetized pediatric patient. Anesth. Analg. 2015;120:165–175. doi: 10.1213/ANE.0000000000000472.
    1. Goldmann K. Clinical basics of supraglottic airway management in paediatric anaesthesia. Anasthesiol. Intensivmed. Notf. Schmerzther. 2013;48:252–257.
    1. Serafini G., Cornara G., Cavalloro F., Mori A., Dore R., Marraro G., Braschi A. Pulmonary atelectasis during paediatric anaesthesia: CT scan evaluation and effect of positive endexpiratory pressure (PEEP) Paediatr. Anaesth. 1999;9:225–228. doi: 10.1046/j.1460-9592.1999.00340.x.
    1. Goldmann K., Roettger C., Wulf H. 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. Br. J. Anaesth. 2005;95:831–834. doi: 10.1093/bja/aei246.
    1. Sinha A., Sharma B., Sood J. ProSeal laryngeal mask airway in infants and toddlers with upper respiratory tract infections: A randomized control trial of spontaneous vs pressure control ventilation. Middle East J. Anaesthesiol. 2009;20:437–442.
    1. Lagarde S., Semjen F., Nouette-Gaulain K., Masson F., Bordes M., Meymat Y., Cros A.M. Facemask pressure-controlled ventilation in children: What is the pressure limit? Anesth. Analg. 2010;110:1676–1679. doi: 10.1213/ANE.0b013e3181d8a14c.
    1. Bouvet L., Albert M.L., Augris C., Boselli E., Ecochard R., Rabilloud M., Chassard D., Allaouchiche B. Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients: A prospective, randomized, double-blind study. Anesthesiology. 2014;120:326–334. doi: 10.1097/ALN.0000000000000094.
    1. Jagannathan N., Sohn L., Sommers K., Belvis D., Shah R.D., Sawardekar A., Eidem J., DaGraca J., Mukherji I. A randomized comparison of the laryngeal mask airway supreme and laryngeal mask airway unique in infants and children: Does cuff pressure influence leak pressure? Paediatr. Anaesth. 2013;23:927–933. doi: 10.1111/pan.12145.
    1. Wahlen B.M., Heinrichs W., Latorre F. Gastric insufflation pressure, air leakage and respiratory mechanics in the use of the laryngeal mask airway (LMA) in children. Paediatr. Anaesth. 2004;14:313–317. doi: 10.1046/j.1460-9592.2003.01213.x.
    1. Bernardini A., Natalini G. Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: Analysis on 65 712 procedures with positive pressure ventilation. Anaesthesia. 2009;64:1289–1294. doi: 10.1111/j.1365-2044.2009.06140.x.

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