A comparison of supraglottic devices in pediatric patients
Received 21 June 2018
Accepted for publication 21 July 2018
Published 1 October 2018 Volume 2018:11 Pages 361—365
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Senthil G Krishna,1,2 Faizaan Syed,1 Mohammed Hakim,1 Mumin Hakim,3 Dmitry Tumin,1 Giorgio C Veneziano,1,2 Joseph D Tobias1,2
1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; 3Department of Surgery, Montefiore Medical Centre, Bronx, NY, USA
Background: When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q® laryngeal mask airway (LMA) and the i-gel® SGA, in pediatric patients.
Methods: Patients ≤18 years of age were prospectively randomized to receive either the Air-Q® LMA or the i-gel® SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmH2O were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen.
Results: Fifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q® LMA and i-gel® SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: − 2 to 7; P=0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: − 9 to 8; P=0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q® and 6 i-gel® supraglottic devices sealed the airway at 20 cmH2O.
Discussion: The time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q® LMA and the i-gel® SGA did not differ.
Keywords: supraglottic airways, bronchoscopic view, glottic aperture
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