A comparison of 3 ventilation strategies in children younger than 1 year using a Proseal laryngeal mask airway: a randomized controlled trial.

STUDY OBJECTIVE: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in patients younger than 1 year with a ProSeal laryngeal mask airway (PLMA). DESIGN: Randomized prospective study. SETTING: Tertiary care pediatric hospital. PATIENTS: Thirty-nine American Society Anesthesiologists classifications 1 to 2, pediatric patients younger than 1 year. INTERVENTIONS: Three different ventilation strategies (spontaneous ventilation [SV], pressure support ventilation [PSV], and pressure-controlled ventilation [PCV]) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 2 mg/kg and fentanyl 2 µg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O. MEASUREMENTS: We measured the differences in end-tidal CO2 (etco2), tidal volume (TV), and respiratory rate (RR) over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals. MAIN RESULTS: etco2 (mm Hg) was not significantly higher in the SV vs PSV (P=2.11) and SV vs PCV (P=.24). TV (mL/kg) was significantly lower in SV vs PSV (P<.005) and SV vs PCV (P<.005). RR was not significantly higher in SV vs PSV (P=.43), but was significantly higher in SV vs PCV (P<.005). Three patients in the SV group and 1 patient in the PSV group failed to initiate SV and required PCV and were thus excluded from analysis. CONCLUSIONS: All 3 modes of ventilation using a PLMA were safe in children younger than 1 year. Although we did not observe a statistically significant increase in etco2, differences in TV and RR, and the small but significant incidence of apnea may make PSV or PCV more optimal ventilation strategies in children younger than 1 year when using a PLMA.

Comparing 3 ventilation modalities by measuring several respiratory parameters using the ProSeal laryngeal mask airway in children.

STUDY OBJECTIVE: To determine quantitative differences in several routinely measured ventilation parameters using a standardized anesthetic technique and 3 different ventilation modalities in pediatric patients with a ProSeal laryngeal mask airway (PLMA). DESIGN: Randomized prospective study. SETTING: Pediatric hospital of a tertiary care academic medical center. PATIENTS: Thirty-three, American Society of Anesthesiologists classification 1-2, pediatric patients (12 months to 5 years). INTERVENTIONS: Three different ventilation strategies: spontaneous ventilation (SV), pressure support ventilation (PSV), and pressure-controlled ventilation (PCV) were randomly applied to patients who underwent a standardized mask induction with sevoflurane/oxygen and propofol 3 mg/kg and morphine 0.05 mg/kg administered intravenously followed by PLMA insertion. Patients were maintained on sevoflurane and N2O. MEASUREMENTS: We measured the differences in end-tidal CO2 (Etco2), tidal volume, and respiratory rate over time between SV, PSV, and PCV. These data were recorded at 5-minute intervals. MAIN RESULTS: Etco2 (mm Hg) was significantly higher in the SV vs PSV (P=.016) and vs PCV (P<.001). Tidal volume (mL/kg) was significantly lower in SV vs PSV (P<.001) and vs PCV (P<.001). Respiratory rate (breaths/min) was significantly higher in SV vs PSV (P<.001) and vs PCV (P=.005). CONCLUSIONS: All 3 modes of ventilation using a PLMA were safely used. Our SV group was noted to have a significantly higher Etco2 when compared with PSV and PCV with a mean Etco2 over time in excess of 55 mm Hg. PSV and PCV were found to be more appropriate ventilation strategies to more optimally control Etco2 over time in these patients.

A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans.

OBJECTIVES: We compared three primary outcomes of pausing the magnetic resonance imaging (MRI) scan, emergence quality and respiratory complications. AIM: To measure and compare the quality between sevoflurane and propofol in children undergoing MRI scans. BACKGROUND: No randomized controlled trial exists comparing the quality between sevoflurane and propofol for MRI. METHODS/MATERIALS: Two hundred unpremedicated children (18 months to 7 years) scheduled for brain MRI scans were recruited. After induction with sevoflurane, children were randomized to receive sevoflurane [general anesthesia with sevoflurane (GAS)] via laryngeal mask airway (LMA) or propofol [general anesthesia with propofol (GAP)] bolus and infusion for their scan. The three primary outcomes of pausing the MRI scan (P), agitation (A), and respiratory complications (R) were compared. Timeliness of care was also measured. RESULTS: No MRI scan pauses were found in 92% and 80% in the GAS and GAP groups. The median and interquartile A scores were 3 (0, 7) in GAS and 0 (0, 4) in GAP groups respectively. There was no difference in respiratory complications between GAS and GAP (P = 0.62). The median and interquartile postanesthesia care unit (PACU) times were 25 (18, 34) for GAS and 31 (25, 44) for GAP (P = 0.0001). The median and interquartile total times were 78 (69, 90) for GAS and 88 (78, 100) for GAP (P = 0.0002). CONCLUSION: Our study compared the three primary outcomes of pausing, agitation, and respiratory complications between the two groups, and we found no difference in respiratory complications. However, the GAP group had more pausing and less agitation than the GAS group.