A prospective, randomized comparative study for use of proseal laryngeal mask airway as an alternative to endotracheal intubation for airway management in children under general anesthesia

Abstract

Introduction: Proseal laryngeal mask airway (PLMA) which is an upgraded modification of classic LMA, incorporating a gastric drainage tube lateral to the main airway tube which permits the regurgitated liquid gastric contents to bypass the glottis and prevents pulmonary aspiration. A prospective randomized interventional comparative study was performed to compare the efficiency of PLMA with a tracheal tube (TT) in pediatric patients with respect to number of attempts to placement of devices, hemodynamic responses and perioperative complications. Material and Methods: Sixty children, ASA physical status I and II weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective infraumblical surgeries of 30-60 minutes duration, randomly divided into two group of 30 patients each. All patients were premedicated with IV midazolam and glycopyrrolate. General anesthesia with caudal epidural analgesia was given in all cases. IV propofal and sevoflurane was used for inducing general anesthesia. PLMA was inserted in group I and tracheal tube (TT) in patients of group II. In all cases after PLMA / TT insertion; caudal epidural analgesia was given and general anesthesia (GA) was maintained with O2, N2O and sevoflurane. Results: Ease of insertion was comparable in both the groups. There were no significant differences in mean oxygen saturation SpO2 (%) and end tidal carbon dioxide (ETCO2)) levels recorded at different time intervals between the two groups. However, highly significant changes in hemodynamic parameters were observed in the TT group. Complications such as nausea and vomiting (3.33%), sore throat (2%) and coughing (26.66%) were observed in the TT group. Conclusion: We concluded that PLMA could be used as an effective and safe airway device in children alternative to TT undergoing general anesthesia. Keywords: General anesthesia, Hemodynamic response, Paediatric, Proseal laryngeal mask airway, Tracheal tube