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Comparison of cuffed, uncuffed tracheal tubes and laryngeal mask airways in low flow pressure controlled ventilation in children
Author(s) -
ENGELHARDT THOMAS,
JOHNSTON GRAHAM,
KUMAR MANISHA M.
Publication year - 2006
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2005.01709.x
Subject(s) - medicine , tracheal tube , anesthesia , fresh gas flow , ventilation (architecture) , mechanical ventilation , elective surgery , laryngeal mask airway , intubation , leak , surgery , airway , mechanical engineering , sevoflurane , environmental engineering , engineering
Summary Background : The use of low flow circle systems necessitates a ‘leak free’ breathing system which is commonly achieved by using a cuffed tracheal tube (TT). We hypothesized that low flow circle system anesthesia can equally effectively be achieved by using the LMA in pediatric anesthesia. Methods : Following local ethics committee approval we randomly recruited 45 patients scheduled for elective surgery and requiring mechanical ventilation into three groups (cuffed TT, uncuffed TT and LMA group, n = 15). The size of the TT was determined by means of the formula (age/4) + 4.5 for uncuffed and (age/4) + 4 for cuffed TT whereas the size of the LMA size was dependent on weight. Following induction of anesthesia and muscle paralysis patients were ventilated with pressure controlled ventilation through a pediatric circle system and the lowest fresh gas flow (FGF) determined. Results : The FGF achieved were (median and range) 0.20 (0.2–0.25) l·min −1 for the LMA group, 0.20 (0.2–0.4) l·min −1 for the cuffed TT group and 1.15 (0.2–4.75) l·min −1 for the uncuffed group. The differences between the LMA and cuffed TT compared with the uncuffed TT were significant ( P < 0.0001 and P = 0.0002, respectively). The difference in FGF between LMA and cuffed TT was not significant. Conclusion : We conclude that pressure controlled ventilation using an LMA is an alternative to a cuffed TT during low flow circle system anesthesia in children. Low FGF is unlikely to be achieved consistently using an uncuffed TT because of a substantial leak.