RESUMO
We prospectively compared free-handed and air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age. Eighty healthy children were enrolled and randomly assigned to a technique (free-handed or air-Q assisted) and operator (trainee or attending). Time, number of attempts and manoeuvres required were assessed. There was no difference in median (IQR [range]) time to successful tracheal intubation between the free-handed (52.2 (34.8-67.7 [19.7-108.0]) s), and the air-Q assisted (60.3 (45.5-75.1 [28.1-129.0]) s; p = 0.13) groups, or the number of attempts needed. The air-Q assisted group required fewer manoeuvres to optimise the laryngeal view (median (IQR [range]) 0 (0-1 [0-2])) than the free-handed group (1 (1-1 [0-3]); p < 0.001). In conclusion, fibreoptic-guided tracheal intubation times were similar with and without the use of the air-Q, but supraglottic airway devices may be a consideration for their other practical advantages.
Assuntos
Tecnologia de Fibra Óptica , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Desenho de Equipamento , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
We describe a four-step method for fibreoptic-guided, rapid-sequence tracheal intubation through the air-Q intubating laryngeal airway in infants with severe airway obstruction. Our step-wise process provides an organised and controlled approach to safely securing the airway.
Assuntos
Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal/instrumentação , Feminino , Tecnologia de Fibra Óptica , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
We conducted a randomised trial comparing the self-pressurised air-Q™ intubating laryngeal airway (air-Q SP) with the LMA-Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air-Q SP (12 (10-15 [5-18])) s than with the LMA-Unique (14 (12-17 [6-22]) s; p=0.05). There were no statistically significant differences between the air-Q SP and LMA-Unique in initial airway leak pressures (16 (14-18 [10-29]) compared with 18 (15-20 [10-30]) cmH2 O, p=0.12), an airway leak pressures at 10 min (19 (16-22 [12-30]) compared with 20 (16-22 [10-30]) cmH2 O, p=0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air-Q SP is an alternative to the LMA-Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.
Assuntos
Manuseio das Vias Aéreas/instrumentação , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Pressão do Ar , Manuseio das Vias Aéreas/métodos , Anestesia , Capnografia , Criança , Pré-Escolar , Feminino , Tecnologia de Fibra Óptica , Humanos , Insuflação , Complicações Intraoperatórias/epidemiologia , Intubação Intratraqueal/métodos , Laringe/anatomia & histologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estômago/fisiologia , Resultado do TratamentoRESUMO
We conducted a randomised trial comparing the size-2 LMA Supreme™ with the LMA ProSeal™ in 60 children undergoing surgery. The outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement, quality of the airway during anaesthetic maintenance and complications. There were no statistically significant differences between the LMA Supreme and LMA ProSeal in median (IQR [range]) insertion time (12 (10-15 [7-18]) s vs 12 (10-13 [8-25]) s; p = 0.90), airway leak pressures (19 (16-21 [12-30]) cmH(2) O vs 18 (16-24 [10-34]) cmH(2) O; p = 0.55), fibreoptic position of the airway or drain tube, ease of gastric access and complications. Both devices provided effective ventilation requiring minimal airway manipulation. The LMA Supreme can be a useful alternative to the LMA ProSeal when single-use supraglottic devices with gastric access capabilities are required.
Assuntos
Máscaras Laríngeas , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Anestesia Geral , Anestesia por Inalação , Criança , Pré-Escolar , Equipamentos Descartáveis , Drenagem , Tecnologia de Fibra Óptica , Humanos , Lactente , Insuflação , Complicações Intraoperatórias/epidemiologia , Intubação Gastrointestinal/métodos , Máscaras Laríngeas/efeitos adversos , Laringoscopia , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial , Volume de Ventilação PulmonarRESUMO
We conducted a randomised controlled trial comparing the laryngeal mask airway Supreme(™) with the laryngeal mask airway Unique(™) in children. Fifty children presenting for elective surgery were randomly assigned to receive either the laryngeal mask airway Supreme or laryngeal mask airway Unique. The outcomes measured were airway leak pressure, ease and time for insertion, insertion success rate, fibreoptic examination, incidence of gastric insufflation, ease of gastric tube placement through the laryngeal mask airway Supreme, quality of airway during anaesthetic maintenance and complications. Median (IQR [range]) time to successful device placement was shorter with the laryngeal mask airway Unique, 14.5 [13.5-16.3 (10.0-23.6)] s than with the laryngeal mask airway Supreme, 17.4 [14.8-19.8 (11.5-29.2)] s; p = 0.007. Median (IQR [range]) airway leak pressures for the laryngeal mask airway Supreme and laryngeal mask airway Unique were 20 [16-21 (12-22)] cmH(2)O and 15 [14-18 (10-24)] cmH(2)O, respectively (p = 0.001). The incidence of gastric insufflation was lower with the laryngeal mask airway Supreme (zero vs six patients), p = 0.01. In conclusion, the laryngeal mask airway Supreme performed as well as the laryngeal mask airway Unique and is a useful alternative for airway maintenance, particularly in children who require evacuation of gastric contents during anaesthesia.
