Clinical performance of five pediatric supraglottic airway d...

BACKGROUND AND RESEARCH Objective: Childhood glottic upper respiratory tract device (SAD) is usually marketed without independent clinical evaluation. In this test, we evaluated the performance of three standard SAD (i-gel, Ambu AuraOnce, LMA Supreme) and two kinds of cannula SAD (Air-Q, Ambu Aura-i). The main assumption is that the 95% confidence interval (CI) of mean airway leakage pressure (ALP) is 18 to 22 cmH 2 O

Materials and Methods: This prospective controlled observational cohort study was approved by the local IRB for 400 children scheduled for local anesthesia with selective surgery and SAD and standard positive pressure ventilation (No. 12-011 ). Part of the data from the cohort of i-gel and Ambu AuraOnce comes from previously published papers as a comparison of the past. (1) The main result is ALP. Secondary outcome parameters include initial trials and overall success rate, and insertion time. Data were analyzed using SPSS version 21.0. Kruskal-Wallis test, chi-square test and Fisher strict test, and multiple comparison using Bonferroni correction

Results and Discussion: So far, a total of 351 children are included (at the ESA conference we will provide a complete dataset). Average ALP is lower than that of adults (16 to 21 cmH 2 O), which may affect pediatric ventilation judgment. It has significant differences between devices, and i-gel shows the highest value (see table). The initial success rate was 87 to 100%, the overall success rate was about 90% or more. Only LMA Supreme and Ambu Aura-i have achieved an ideal success rate of 95%. Insertion time within clinically acceptable range

Conclusion: Most of the SADs tested showed lower ALP than expected, but positive pressure ventilation is still possible. Intubation SAD performance is usually bad

Based on earlier studies, we estimate that the leak pressure of the second generation of upper glottis airway devices in pediatrics is about 20 cm H 2 O. Our main assumption is that the average airway leakage pressure of each SGA tested is 20 cm H 2 O ± 10%. More specifically, this means that the 95% confidence interval (CI) of the mean airway leak pressure for each test SGA is within 20 cm H 2 O ± 10% (18 to 22 cm H 2 O). In light of these expectations, the calculation of the sample size had a bilateral alpha level of 0.05 and a power of 0.9, which required 63 patients per group. To compensate for missing or lost data, we plan to include 80 patients per group.

There are many glottis upper respiratory rescue equipment areas. Combitube, Laryngeal Mask Airway (LMA), King Laryngeal Tube (LT) are devices commonly used in North America. Conceptually, the function of the airway over the glottis is to occlude the esophagus and preferentially ventilate the trachea while establishing a seal in the upper pharynx or the posterior pharynx to allow positive pressure ventilation. When a conventional endotracheal tube is infeasible, the LMA functions as a respiratory airway device to ventilate the patient. LMA is a cuff device that provides an adequate seal for positive pressure ventilation. It is particularly useful in circumstances where laryngoscope field of view, such as trauma, is not optimally placed on the patient's neck. Although LMA can make ventilation easier, it does not protect the airway like the side ETT, so you need to transition to ETT with cuff as soon as possible.