Details
Category: Volume 08 Issue 09 September 2020
Hits: 1089

Title: Pro-Seal Laryngeal Mask Airway versus Endotracheal Intubation in Paediatric Patients

Authors: Dr Yogesh A, Gaikwad, Dr Ranjeeta M. Tambey, Dr Darshana V. Kumbhre, Dr Naresh G. Tirpude

 DOI: https://dx.doi.org/10.18535/jmscr/v8i9.23

Abstract

Background: The management of airway in a paediatric patient is an important concern of anesthesiologist. Endotracheal tube (ET) is always considered a gold standard but it has several demerits. Recently ProSeal LMA (PLMA) was introduced to clinical practice with additional advantages over ET and LMA. Hence the present study was undertaken to compare PLMA with ET for airway management in paediatric patients requiring elective surgery under general anaesthesia in terms of attempts of insertion, haemodynamic parameters and perioperative complications.

Method: A total 90 patients of either sex, of ASA grade I/II, age between 2-10 years were enrolled and randomly allocated to Group P (n=45)- PLMA used to establish airway (Size 2) and Group E (n=45)- Endotracheal intubation done to establish airway.

Results:  The 1st attempt success rate for placement of airway device was 95.56% in group P and 97.78% in group E, (p>0.05). In group P, the first attempt success rate for insertion of feeding tube was found to be 91.11%, it was not tried in group E. Haemodynamic changes were comparable and found no significant difference between two groups. SpO2 and ETCO2 in both groups were comparable and clinically acceptable. The incidence of coughing, sore throat, hoarseness and vomiting was more in group E than group P whereas the incidence of trauma was more in group P.

Conclusion: Proseal LMA is a safe and suitable alternative airway device to ETT in pediatric patients as judged by comparable success rate of insertion, stable hemodynamics, good oxygenation, adequate ventilation and lesser incidence of postoperative complications.

Keywords: Paediatric, Endotracheal tube, ProSeal LMA, Anaesthesia, Haemodynamic.

References

  1. Cox RG, Lardner DR. Supraglottic airways in children: past lessons, future directions. Can J Anesth. 2009;56:636–42.
  2. Dave NM, Iyer HR, Dudhedia U, Makwana J. An evaluation of the ProSeal laryngeal mask airway in paediatric laparoscopy. J Anaesth Clin Pharmacol. 2009;25 (1):71–3.
  3. Misra MN, Ramamurthy B. The Pro-Seal LMA and the tracheal tube: a comparison of events at insertion of the airway device. Internet J Anesthesiol. 2008;16:2.
  4. Shah K. ProSeal laryngeal mask airway as an alternative to standard endotracheal tube in securing upper airway in the patients undergoing beating-heart coronary artery bypass grafting. Annals of cardiac anaesthesia. 2017;20(1):61.
  5. Kanthed P, Sharma B, Sood J, Kumra VP. Comparison of LMA-ProSealTM with LMA Classic TM in Anaesthetised Paralysed Children. Indian J Anaesth. 2008;52:44–8.
  6. Kapoor D, Jindal S, Gombar S, Bajaj N, Atter P, Dalal UR. Comparative Evaluation of ProSeal LMA vs. Cuffed Endotracheal Tube in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia. Archives of Anesthesiology and Critical Care. 2018;4(4):527-34.
  7. Tracheal Tubes and Associated Equipment. In: Jerry A. Dorsch, editor. Understanding Anaesthesia Equipments, 5th ed. New Delhi: Wolter kluwer publishers;2008. P. 584.
  8. Heinrich S, Birkholz T, Ihmsen H, Irouschek A, Ackermann A, Schmidt J. Incidence and predictors of difficult laryngoscopy in 11,219 pediatricanesthesia procedures. Paediatr Anaesth2012;22:729-36.
  9. Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J CritIllnInj Sci 2014;4:65-70.
  10. Lalwani J, Dubey KP, Sahu BS, Shah PJ. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures. Indian J Anaesth2010;54:541-5.
  11. Dar SA, Deka S,Dasand N, Mir MA,Mir AA. Proseal LMA versus endotracheal tube a clinical comparative study of its different effects in paediatric patients undergoing lower abdominal surgeries. International Journal of Contemporary Medical Research 2016;3(5):1301-05.
  12. Patel MG, Swadia VN, Bansal G. Prospective randomized comparative study of use of PLMA and ET tube for airway management in children under general anaesthesia. Indian journal of anaesthesia. 2010;54(2):109.
  13. Sinha A, Sharma B, Sood J. ProSeal as an alternative to endotracheal intubation in pediatriclaparoscopy. PaediatrAnaesth. 2007;17(4):327-32.
  14. Agrawal G, Agarwal M, Taneja S. A randomized comparative study of intraocular pressure and hemodynamic changes on insertion of proseal laryngeal mask airway and conventional tracheal intubation in pediatric patients. J Anaesthesiol Clin Pharmacol. 2012;28: 326–9.
  15. Patodi V, Singh M, Sethi SK, Depal VN, Jain N, Kumar V. A comparative study between ProSeal laryngeal mask airway and endotracheal tube for ease of insertion and haemodynamic changes in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Int J Res Med Sci 2016;4:5334-40.
  16. Saraswat N, Kumar A, Mishra A, Gupta A, Saurabh G, Srivastava U. The comparison of Proseal laryngeal maskairway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia. Indian J Anaesth.2011;55:129-34.

Corresponding Author

Dr Ranjeeta M. Tambey

Associate Professor, Dept. of Anaesthesiology, GMC Nagpur