Abstract
Background: Laryngeal mask airways (LMAs) are widely used in paediatric anaesthesia. However, LMA use in neonatal age groups (younger than seven days) is limited because many anaesthesiologists prefer to use endotracheal tube in neonates. In this study, we compared the ProSeal LMA and endotracheal tube by measuring their performance, including ease of insertion via number of attempts for placement of device, total effective time for intubation and extubation, hemodynamic responses and perioperative complications.Methods: In this prospective randomized study, 70 patients (neonates) weighing >2.5 kg, with American Society of Anaesthesiologists (ASA) classification grade 4 requiring emergency surgery for anorectal malformation were enrolled and divided into two groups. After induction, patients' airways were secured with either ProSeal LMA size 1 (Group I) or endotracheal tube (Group II). Anaesthesia was maintained on oxygen and sevoflurane with muscle relaxant atracurium.Results: Demographic and surgical data were similar between the two groups. The ProSeal LMA insertion time was shorter than endotracheal intubation. Hemodynamic variations were less in the ProSeal LMA group as compared to the endotracheal tube group. The total time for removal of airway devices from the end of surgery for the ProSeal group was lower than that for the endotracheal intubation group. Postoperative complications were less in the ProSeal group as compared to the endotracheal group.Conclusions: The ProSeal LMA can be a better alternative to the endotracheal tube in neonates due to the ease of insertion, lesser changes in hemodynamic parameters and minimal postoperative complications.
Highlights
Children have been the earliest patrons of anaesthesiology from its earliest clinical applications of surgical anaesthesia [1]
The airway was secured in 98% of patients in the first attempt and in only 2% in the second attempt in the ProSeal Laryngeal mask airways (LMAs) group, while in the endotracheal intubation group, 88% of patients had the airway secured in the first attempt and 12% in the second attempt (Table 1)
They observed that the time required to secure the airway as well as the number of attempts made to insert the airway device in the ProSeal group were less as compared to the endotracheal tube group, and the results were consistent with present study where the insertion time of the ProSeal LMA was less as compared to endotracheal intubation
Summary
Children have been the earliest patrons of anaesthesiology from its earliest clinical applications of surgical anaesthesia [1]. In comparison to older children, adolescents and adults, anatomy of neonatal upper airway structures is different and endotracheal intubation becomes a challenge. To avoid such adverse complications associated with endotracheal intubation, the first supraglottic airway device, the laryngeal mask airway (LMA), was designed in 1981 by Dr Archie Brain [2]. In 2000, the ProSeal LMA, a second-generation supraglottic airway device was introduced. It is the modified form of the classic LMA. It consists of a wire-reinforced airway tube and a parallel drainage tube. We compared the ProSeal LMA and endotracheal tube by measuring their performance, including ease of insertion via number of attempts for placement of device, total effective time for intubation and extubation, hemodynamic responses and perioperative complications
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