Lin Zixin,Hu Jing,Liu Heqi,et al.Comparison of laryngeal mask airway combined with bronchial blocker versus endotracheal tube combined with bronchial blocker in pediatric thoracoscopic surgery[J].Journal of Clinical Pediatric Surgery,,():888-893.[doi:10.3760/cma.j.cn101785-202410024]
Comparison of laryngeal mask airway combined with bronchial blocker versus endotracheal tube combined with bronchial blocker in pediatric thoracoscopic surgery
- Abstract:
- Objective This study aimed to investigate whether a laryngeal mask airway combined with a bronchial blocker provides a superior airway management strategy compared with an endotracheal tube combined with a bronchial blocker.Methods This was a prospective randomized controlled trial.A total of 43 pediatric patients who underwent elective thoracoscopic mediastinal tumor resection at Beijing Children’s Hospital,Capital Medical University,between November 2023 and August 2024 were enrolled.Patients were randomly assigned to:laryngeal mask airway combined with bronchial blocker group (Group L),and endotracheal tube combined with bronchial blocker group (Group T).Peak airway pressure (Ppaw) and end-tidal carbon dioxide partial pressure (PetCO2) were recorded at:10 minutes after airway device placement (T1),30 minutes after initiation of one-lung ventilation (T2),and 10 minutes after resumption of two-lung ventilation (T3).The oxygenation index (OI) and arterial-to-end-tidal carbon dioxide partial pressure difference (P(a-et)CO2) were calculated.Postoperative laryngeal injury was assessed by the incidence of hoarseness immediately after extubation and on postoperative day 1.Results At T1,Group L showed higher OI[(546.8±12.9) mmHg vs.(524.6±10.4) mmHg],lower P(a-et)CO2[(8.4±1.7) mmHg vs.(9.9±1.3) mmHg],and lower Ppaw[(13.7±1.1) cmH2O vs.(15.5±1.4) cmH2O]compared with Group T (all P<0.05).At T2,Group L had lower OI[(167.3±3.2) mmHg vs.(205.7±2.7) mmHg],higher P(a-et)CO2[(15.7± 3.7) mmHg vs.(12.8± 2.3) mmHg],and higher Ppaw[(27.7±4.7) cmH2O vs.(21.4±2.9) cmH2O](all P<0.05).At T3,Group L had lower OI[(355.3±7.7) mmHg vs.(379.4±7.3) mmHg]and higher P(a-et)CO2[(14.0± 2.9) mmHg vs.(11.0±2.4) mmHg](all P<0.05).The incidence of hoarseness was significantly lower in Group L both immediately after extubation (1 vs.7 cases) and on postoperative day 1 (0 vs.4 cases) (P< 0.05).There were no significant differences between the two groups in Ppaw at T3[(15.8±1.3) cmH2O vs.(16.3±1.1) cmH2O]or in PetCO2 at T1-T3[(36.7±4.2) mmHg vs.(36.7±4.6) mmHg,(47.4± 11.2) mmHg vs.(42.5±7.0) mmHg,(38.2±6.0) mmHg vs.(35.4±5.6) mmHg](all P>0.05).Conclusions In pediatric thoracoscopic surgery,the use of a laryngeal mask airway combined with a bronchial blocker can effectively reduce the incidence of hoarseness.However,with prolonged one-lung ventilation,the laryngeal mask airway may adversely affect pulmonary function.Therefore,this technique is recommended primarily for short-duration thoracoscopic procedures.
References:
[1] Templeton TW,Piccioni F,Chatterjee D.An update on one-lung ventilation in children[J].Anesth Analg,2021,132(5):1389-1399.DOI:10.1213/ANE.0000000000005077.
[2] 王坤，王玉，王国年.气管插管全麻后声音嘶哑的原因与防治[J].国际麻醉学与复苏杂志，2012，33（8）:562-564，568.DOI:10.3760/cma.j.issn.1673-4378.2012.08.015.Wang K,Wang Y,Wang GN.Causes of hoarseness after general anesthesia with tracheal intubation and its prevention and treatment[J].Int J Anesthesiol Resusc,2012,33(8):562-564,568.DOI:10.3760/cma.j.issn.1673-4378.2012.08.015.
[3] Menna C,Fiorelli S,Massullo D,et al.Laryngeal mask versus endotracheal tube for airway management in tracheal surgery:a case-control matching analysis and review of the current literature[J].Interact Cardiovasc Thorac Surg,2021,33(3):426-433.DOI:10.1093/icvts/ivab092.
[4] Mao SS,Du XJ,Ma J,et al.A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure[J].J Thorac Dis,2018,10(6):3216-3224.DOI:10.21037/jtd.2018.05.74.
[5] Brodsky MB,Akst LM,Jedlanek E,et al.Laryngeal injury and upper airway symptoms after endotracheal intubation during surgery:a systematic review and meta-analysis[J].Anesth Analg,2021,132(4):1023-1032.DOI:10.1213/ANE.0000000000 005276.
[6] Assefa B,Samuel H,Fentie F,et al.Effect of tracheal tube cuff inflation with alkalinized lidocaine versus air on hemodynamic responses during extubation and post-operative airway morbidities in children:prospective observational cohort study,Ethiopia[J].BMC Anesthesiol,2022,22(1):337.DOI:10.1186/s12871-022-01868-2.
[7] Kannan S,Harsoor SS,Sowmiya L,et al.Comparison of ventilatory efficacy and airway dynamics between ProSeal laryngeal mask airway and endotracheal tube in adult patients during general anesthesia[J].J Anaesthesiol Clin Pharmacol,2015,31(4):517-521.DOI:10.4103/0970-9185.169081.
[8] Luo K,Chen KM,Li Y,et al.Clinical evaluation of laryngeal mask airways in video-assisted thoracic surgery:a meta-analysis of randomized controlled trials[J].J Cardiothorac Surg,2024,19(1):361.DOI:10.1186/s13019-024-02840-6.
[9] Xu KK,Zhang Y,Cui Y,et al.Patient-reported outcomes of laryngeal mask anesthesia in thoracoscopic pulmonary wedge resection:a randomized controlled study[J].Thorac Cancer,2022,13(22):3192-3199.DOI:10.1111/1759-7714.14675.
[10] 李晓玲，张小敏.喉罩联合支气管封堵器单肺通气对学龄患儿呼吸功能的影响[J].临床麻醉学杂志，2020，36（6）:571-573.DOI:10.12089/jca.2020.06.012.Li XL,Zhang XM.Effects of laryngeal mask airway with endobronchial blocker on respiratory mechanics in children during one-lung ventilation[J].J Clin Anesthesiol,2020,36(6):571-573.DOI:10.12089/jca.2020.06.012.
Memo
收稿日期:2024-10-12。
通讯作者:张建敏,Email:zjm428@sina.com