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A comparison of the breathing apparatus deadspace associated with a supraglottic airway and endotracheal tube using volumetric capnography in young children

대한마취과학회지 2021년 74권 3호 p.218 ~ 225
Goenaga-Diaz Eduardo Javier, Smith Lauren Daniela, Pecorella Shelly Harrell, Smith Timothy Earl, Russell Gregory B., Johnson Kathleen Nicole, Downard Martina Gomez, Ririe Douglas Gordon, Hammon Dudley Elliott, Hodges Ashley Sloan, Templeton Thomas Wesley,
소속 상세정보
 ( Goenaga-Diaz Eduardo Javier ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Smith Lauren Daniela ) - Wake Forest University School of Medicine Department of Anesthesiology
 ( Pecorella Shelly Harrell ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Smith Timothy Earl ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Russell Gregory B. ) - Wake Forest School of Medicine Department of Biostatistics and Data Sciences
 ( Johnson Kathleen Nicole ) - George Washington University School of Medicine
 ( Downard Martina Gomez ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Ririe Douglas Gordon ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Hammon Dudley Elliott ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Hodges Ashley Sloan ) - Wake Forest School of Medicine Department of Anesthesiology
 ( Templeton Thomas Wesley ) - Wake Forest School of Medicine Department of Anesthesiology

Abstract


Background: Supraglottic airway (SGA) devices including the air-Q® are being used with increasing frequency for anesthesia in infants and younger pediatric patients. To date, there is minimal research documenting the potentially significant airway deadspace these devices may contribute to the ventilation circuit when compared to an endotracheal tube (ETT). The aim of this study was to evaluate the airway apparatus deadspace associated with an air-Q® versus an ETT in young children.

Methods: In a prospective cohort study, 59 patients between 3 months and 6 years of age, weighing between 5 and 20 kg, scheduled for outpatient urologic or general surgery procedures were recruited. An air-Q® or ETT was inserted at the discretion of the attending anesthesiologist, and tidal volume, positive end expiratory pressure, respiratory rate, and end-tidal CO2 were controlled according to protocol. Airway deadspace was recorded using volumetric capnography every 2 min for 10 min.

Results: Groups were similar in demographics. There was a significant difference in weight-adjusted deadspace volume between the air-Q® and ETT groups, 4.1 ± 0.8 ml/kg versus 3.0 ± 0.7 ml/kg, respectively (P < 0.001). Weight-adjusted deadspace volume (ml/kg) increased significantly with decreasing weight for both the air-Q® and ETT groups.

Conclusions: In healthy children undergoing positive pressure ventilation for elective surgery, the air-Q® SGA introduces significantly greater airway deadspace than an ETT. Additionally, airway deadspace, and minute ventilation required to maintain normocarbia, appear to increase with decreasing patient weight irrespective of whether a SGA or ETT is used.

키워드

Airway management; Capnography; Child; General anesthesia; Laryngeal mask airway; Positive pressure respiration; Ventilation

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