Efficacy of laryngeal mask airway for airway management during surgical correction of congenital heart disease in pediatric patients with airway stenosis

Abstract

Objective To evaluate the efficacy of laryngeal mask airway (LMA)for airway management during surgical correction of congenital heart disease in the pediatric patients with airway stenosis. Methods Sixteen pediatric patients of both sexes with airway stenosis, of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged 4 months-5 yr, weighing 6-14 kg, scheduled for elective surgical correction of congenital heart disease under cardiopulmonary bypass, were enrolled.LMA was inserted, and combined intravenous-inhalational anesthesia was performed in all the pediatric patients.The time of LMA insertion, and airway resistance and air leakage of LMA at 20 min of mechanical ventilation were recorded.At 5 min after LMA insertion (T1), 10 min after termination of cardiopulmonary bypass (T2), and 5 min after removal of LMA (T3), blood gas analysis was performed, and the pH value, partial pressure of arterial carbon dioxide and lactic acid level were recorded.The indices such as the time of removal of LMA, damage to the laryngeal mucosa during removal of LMA, occurrence of postsurgical re-intubation, nausea and vomiting, and regurgitation of gastric contents, duration of intensive care unit stay, and postsurgical discharge time were recorded. Results Five cases with airway stenosis were confirmed by computed tomography before surgery, and 11 cases with airway stenosis were found when intubated during surgery.The time of LMA insertion was(1.3±0.4) min, and no air leakage was observed after LMA insertion.The airway resistance was (15±4)cmH2O at 20 min of mechanical ventilation.All the pediatric patients were extubated successfully, the time of extubation was(8.1±1.3)min, and the damage to the laryngeal mucosa, nausea and vomiting, and regurgitation of gastric contents were not observed.The duration of intensive care unit stay was 20 (31)h, postsurgical discharge time was 7 (1)d, and no patients required re-intubation after surgery.Compared with the value at T1, the pH value was significantly decreased at T3, partial pressure of arterial carbon dioxide was significantly increased at T2, 3, and the lactic acid level was significantly increased at T2 (P<0.05=. Conclusion LMA can be safely and effectively used for airway management during surgical correction of congenital heart disease in the pediatric patients with airway stenosis. Key words: Laryngeal masks; Heart defects, congenital; Airway obstruction; Respiration, artificial