RESUMEN
OBJECTIVES: Over half of general anesthetics in the UK involve supraglottic airway devices (SADs). The National Audit Project 4 undertaken by the Royal College of Anaesthetists demonstrated that aspiration was the most frequent complication relating to SAD use. SADs designed to reduce this risk (second-generation devices) are increasingly recommended in both adults and children. As well as routine use, SADs are recommended for use in cases of 'difficult airway'. This survey assessed current usage of SADs in routine practice and difficult airways. Sixteen questions, approved by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) survey committee, were distributed to all its members. RESULTS: Two hundred and forty-four members responded. Eighty-eight percent preferentially use first-generation rather than second-generation devices. The most important design feature was the availability of a complete range of sizes (84%). Seventy-seven percent felt that randomized controlled trials assessing SAD safety in children are needed. In cases of failed intubation, classically shaped SADs are preferred (79%). Three percent of responders intubate via an SAD routinely. Eighteen percent have employed this technique in an emergency. Thirty-six percent of responders have found an SAD to function poorly. CONCLUSION: Pediatric anesthesiologists appear slow to embrace second-generation SADs. The role of SADs in the management of difficult airways is widely accepted. Research currently has little influence over the choice of which SAD to use, which is more likely determined by personal choice and departmental preference. There is a risk that some SADs are unsafe.
Asunto(s)
Manejo de la Vía Aérea/instrumentación , Manejo de la Vía Aérea/normas , Anestesia/normas , Anestesiología/normas , Pediatría/normas , Niño , Competencia Clínica , Diseño de Equipo , Encuestas de Atención de la Salud , Humanos , Intubación Intratraqueal , Irlanda , Máscaras Laríngeas , Médicos , Sociedades Médicas , Reino UnidoRESUMEN
AIM: To evaluate the new pediatric Glidescope (Cobalt GVL Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope would perform as well as conventional laryngoscopy. BACKGROUND: A new pediatric Glidescope became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. METHODS: We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. RESULTS: We found no difference in time taken to tracheal intubation using the Glidescope or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope, respectively. However, only 34% of participants said that they would definitely use the Glidescope in an emergency compared with 66% who would be willing to use the Miller laryngoscope. CONCLUSIONS: The new Glidescope performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.
Asunto(s)
Anestesiología/normas , Competencia Clínica/normas , Intubación Intratraqueal/estadística & datos numéricos , Laringoscopios , Laringoscopía/estadística & datos numéricos , Obstrucción de las Vías Aéreas/terapia , Diseño de Equipo , Humanos , Lactante , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Maniquíes , Evaluación de Procesos y Resultados en Atención de Salud , Factores de TiempoRESUMEN
BACKGROUND: The ProSeal laryngeal mask airway (PLMA) has been available in pediatric sizes in the UK since 2007. Although several non-UK studies have evaluated PLMAs in children, there are little published data regarding their use in this country. Having decided to introduce the pediatric PLMA into our practice, we chose to prospectively audit the first 100 uses as part of our clinical governance. METHODS: We studied children undergoing elective surgery who were considered suitable for a supraglottic airway. We recorded patient, surgical and insertion details, device performance data and complications. Patient management was not altered by inclusion in this audit. RESULTS: Twenty size 1.5, 55 size 2.0, 15 size 2.5 and 10 size 3.0 PLMAs were inserted in 100 consecutive children [median age 2 years (range 2 months to 10 years) and median weight 15 kg (range 4.9-60 kg)]. The overall first attempt success rate was 93% (size 1.5, 100%; size 2.0, 100%; size 2.5, 87%; size 3.0, 90%) and overall successful insertion rate was 99%. Median leak pressure was 25 cmH(2)O. Outright failure was seen in one patient; complications were seen in another six patients (partial airway obstruction in five patients and mild laryngospasm in one patient), all of whom were transient and none of whom required intubation. No episodes of regurgitation were recorded. CONCLUSIONS: Even without prior experience and using nonconventional insertion, pediatric PLMAs (including size 1.5) can be easily inserted and provide an effective airway.