The place of ultrasonography in confirming the position of the laryngeal mask airway in pediatric patients “an observational study”
O lugar da ultrassonografia na confirmação da posição da máscara laríngea em pacientes pediátricos: um estudo observacional
Sule Arican, Sevgi Pekcan, Gulcin Hacibeyoglu, Merve Yusifov, Sait Yuce, Sema Tuncer Uzun
Abstract
Background and objectives
Laryngeal mask airways are increasingly used as supraglottic devices during general anesthesia. Ultrasonography can provide a dynamic image simultaneous to placing the supraglottic airway device. In the current study, the incidence of suboptimal laryngeal mask airway position and replacement in children was evaluated using simultaneous ultrasonographic imaging.
Methods
A prospective observational study was conducted on 82 patients aged 3–15 years with American Society of Anesthesiologists physical status I or II. Patients under general anesthesia and with airway provided by a laryngeal mask airway were included. The position of the laryngeal mask airway was evaluated by ultrasonography on two planes. According to our scoring system, Grade I and Grade II were determined to indicate acceptable placement, while Grade III was determined to indicate unacceptable placement. Suboptimal laryngeal mask airway placement rates and the requirement of replacement were determined. Laryngeal mask airway placement optimized by ultrasonography was evaluated with both leak tests and a fiberoptic laryngoscope.
Results
The average age of the patients was 6.27 ± 4.66 years. After evaluation with ultrasonography, 65 (79.3%) of the laryngeal mask airways were found to be optimally positioned, while the position of 13 (15.9%) had to be corrected, and 4 (4.9%) had to be replaced. There was a moderate positive correlation between the ultrasonographic evaluation and leak test evaluation (p < 0.001; r = 0.628). Relocation of the laryngeal mask airway was determined to be an independent risk factor affecting the development of complications (OR = 2.961; p = 0.046; 95% Cl 2.850–30.745).
Conclusion
The use of ultrasonography to verify and relocate laryngeal mask airway placement is noninvasive and effective.
Keywords
Resumo
Justificativa e objetivos: As vias aéreas da máscara laríngea são cada vez mais utilizadas como dispositivos supraglóticos durante a anestesia geral. A ultrassonografia pode fornecer uma imagem dinâmica simultânea à colocação do dispositivo supraglótico para vias aéreas. No presente estudo, a incidência de posição subótima da máscara laríngea e substituição em crianças foi avaliada por meio de imagens ultrassonográficas simultâneas. Métodos: Um estudo observacional prospectivo foi conduzido em 82 pacientes com idades entre 3 e 15 anos com estado físico I ou II da American Society of Anesthesiologists (ASA). Pacientes sob anestesia geral e com via aérea fornecida por máscara laríngea foram incluídos. A posição da máscara laríngea foi avaliada por ultrassonografia em dois planos. De acordo com nosso sistema de pontuação, o Grau I e o Grau II foram determinados para indicar uma colocação aceitável, enquanto o Grau III foi determinado para indicar uma colocação inaceitável. Taxas de colocação de máscara laríngea abaixo do ideal e a necessidade de substituição foram determinadas. A colocação da máscara laríngea otimizada pela ultrassonografia foi avaliada com testes de vazamento e um laringoscópio de fibra óptica. Resultados: A idade média dos pacientes foi de 6,27 ± 4,66 anos. Após avaliação ultrassonográfica, 65 (79,3%) das vias aéreas da máscara laríngea estavam bem posicionadas, sendo que 13 (15,9%) tiveram que ser corrigidas e 4 (4,9%) trocadas. Houve correlação positiva moderada entre a avaliação ultrassonográfica e a avaliação do teste de vazamento (p <0,001; r = 0,628). A realocação da máscara laríngea foi considerada um fator de risco independente que afeta o desenvolvimento de complicações (OR = 2,961; p = 0,046; IC 95% 2,850-30,745). Conclusão: O uso da ultrassonografia para verificar e realocar a colocação da máscara laríngea nas vias aéreas é não-invasivo e eficaz.
Palavras-chave
References
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