A prospective randomized trial comparing supraglottic airways for flexible bronchoscopy in children

• Published in: Pediatric anesthesia Vol. 20; no. 9; pp. 831 - 838
• Main Authors: BAKER, PAUL A., BRUNETTE, KATHARINE E.J., BYRNES, CATHERINE A., THOMPSON, JOHN M.D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2010
• Subjects: anesthesia; Anesthesia, General; anesthetic techniques; Bronchoscopes; bronchoscopy; Bronchoscopy - methods; Child; Child, Preschool; Female; fiberoptic; Glottis - injuries; Glottis - physiology; Humans; laryngeal mask airway; Laryngeal Masks; Lubrication; Male; Odds Ratio; pediatric; Postoperative Complications - epidemiology; Prospective Studies; Treatment Outcome
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2010.03362.x

Summary Objective:  A prospective randomized, controlled trial was conducted comparing supraglottic airways (SGA) for flexible bronchoscopy in 100 children. Background:  Pediatric flexible bronchoscopy is commonly performed using a SGA as both a ventilation device and a conduit for flexible bronchoscopy. We observed that some disposable SGAs were associated with increased resistance to bronchoscope manipulation compared to the LMA Classic™ (cLMA™). Methods:  We compared the cLMA™ to the Ambu® Aura Once™, Portex® Soft Seal™, Boss Systems disposable silicone laryngeal mask, and LMA Unique™. We recorded the subjective resistance of the bronchoscope manipulation within the SGA by linear analog score and measured the time to insert the bronchoscope from the proximal end of the SGA to the right upper lobe. We also scored the view of the larynx through the bronchoscope and measured SGA cuff pressures. Results:  Resistance to bronchoscope manipulation during pediatric flexible bronchoscopy was higher using polyvinyl chloride (PVC) disposable SGAs (Ambu®, Unique™, and Portex®) than the silicone re‐usable cLMA™ (P < 0.0001). The Unique™ and Ambu® laryngeal masks were clinically inferior to the cLMA™ at all levels of the airway (P < 0.0001). The Portex® Soft Seal™ was not different above the larynx but was significantly statistically inferior at (P < 0.04) and below the larynx (P < 0.006) and inferior overall (P < 0.007). Boss Systems single‐use laryngeal mask was as effective as the cLMA™. Conclusion:  In this trial, PVC single‐use laryngeal masks were inferior to the silicone cLMA™ and Boss Systems laryngeal masks for flexible bronchoscopy in children.