Nasopharyngeal Airway Versus Laryngeal Mask Airway During Diagnostic Flexible Fiber-Optic Bronchoscope in Children

Aktham Adel Shoukry,Amr Gaber Sayed Sharaf

doi:10.2174/2589645801812010001

Abstract

Background: Pediatric fibreoptic diagnostic bronchoscope under general anesthesia using Supraglottic devices as Laryngeal Mask Airway (LMA) and nasopharyngeal airway (NPA) are one of the variable techniques used for patient’s ventilation during this procedure. Objective: We studied the effect of both devices on hypoxemia, the duration of the procedure, recovery time and the overall propofol consumption. Methods: Ninety patients of both sexes, aged 5-10 years, American society of Anesthesiology class I & II scheduled for diagnostic fibreoptic bronchoscope under general anesthesia were divided randomly into two equal groups; LMA group & NPA group, during the procedure: heart rate, non invasive blood pressure, peripheral arterial oxygen saturation (SpO2), arterial partial pressure of carbon dioxide(PaCO2), time of procedure, recovery time and total dose of propofol were measured and compared for each patient in both groups. Results: Hypoxemia & desaturation incidence was more in LMA group than NPA group with high significant difference (p-value 0.005). Also the duration of procedure, recovery time in PACU, and total dose of propofol consumed were significantly less in the NPA group (p< 0.001). With no difference in hemodynamic status and PaCO2. Conclusion: The use of NPA as supraglottic ventilating device for children undergoing diagnostic flexible fibreoptic bronchoscopy is considered a good alternative for shortening the bronchoscopy time with less incidence of hypoxemia and better recovery time compared to LMA.

Highlights

Pediatric bronchoscopy is defined as an endoscopic procedure to visualize the inside of the airway for diagnostic and therapeutic purposes
Sample size calculation was calculated using PS, based upon the assumption that using nasopharyngeal airway as a supraglottic ventilating device will decrease the incidence of desaturation and hypoxemia by 20% and taking power 0.8 and alpha error 0.05, a minimum sample size of 45 patients was calculated for each group
We studied the effect of ventilation on the change in PaCO2 during the procedure by measuring a baseline PaCO2 and another sample at the end of the procedure, and it was observed that the change was higher in laryngeal mask airway (LMA) group than in nasopharyngeal airway (NPA) group, but no statistically significant difference was found between both groups (p-value 0.086) (Table 4)

Summary

Introduction

Pediatric bronchoscopy is defined as an endoscopic procedure to visualize the inside of the airway for diagnostic and therapeutic purposes. It is most often performed in children at the preschool age. Various methods of airway management have been used to maintain and secure the airway, ranging from nasal canula, facemask to supraglottic devices and endotracheal tube, but choosing the most adequate method, considering the pathology and site of the lesion, the interventional procedure and the possible risks, is a major concern especially in children [3]. Supraglottic devices as laryngeal mask airway (LMA) and nasopharyngeal airway (NPA) provides the possibility of positive pressure ventilation. Pediatric fibreoptic diagnostic bronchoscope under general anesthesia using supraglottic devices as Laryngeal Mask Airway (LMA) and Nasopharyngeal Airway (NPA) are one of the variable techniques used for patient’s ventilation during this procedure

Methods

Results

Discussion

Conclusion