jueves, 11 de diciembre de 2014

i-gel en pediatría/Pediatric i-gel

Comparación de supraglóticos i-gel y ML-proseal en niños con ventilación controlada 

Comparison of i-gel supraglottic airway and LMA-ProSeal™ in pediatric patients under controlled ventilation.
Saran S, Mishra SK, Badhe AS, Vasudevan A, Elakkumanan LB, Mishra G.
J Anaesthesiol Clin Pharmacol. 2014 Apr;30(2):195-8. doi: 10.4103/0970-9185.130013.
BACKGROUND: i-gel™ and the ProSeal™ laryngeal mask airway (PLMA) are two supraglottic airway devices with gastric channel used for airwaymaintenance in anesthesia. This study was designed to evaluate the efficacy of i-gel compared with PLMA for airway maintenance in pediatric patients under general anesthesia with controlled ventilation. MATERIALS AND METHODS: A total of 60 American Society of Anesthesiologists physical status 1 and 2 patients were included in the study and randomized to either i-gel or PLMA group. After induction of anesthesia using a standardized protocol for all the patients, one of supraglottic airwaydevices was inserted. Insertion parameters, ease of gastric tube insertion and fiber-optic scoring of the glottis were noted. Airway parameters such as end-tidal carbon dioxide (EtCO2), peak airway pressures and leak airway pressures were noted. Patients were observed for any complications in the first 12 h of the post-operative period. RESULTS: Both groups were comparable in terms of ease of insertion, number of attempts and other insertion parameters. Ease of gastric tube insertion, EtCO2, airway pressures (peak and leak airway pressure) and fiber-optic view of the glottis were comparable in both groups. There were no clinically significant complications in the first 12 h of the post-operative period. CONCLUSION: i-gel is as effective as PLMA in pediatric patients under controlled ventilation.
KEYWORDS: Controlled ventilation; ProSeal™ laryngeal mask; fiber-optic view of glottis; leak airway pressure; peak airway pressure; pediatric i-gel airway


Comparación de supraglóticos i-gel versus ML clásica en niños pequeños

A comparison of supraglottic airway i-gel™ vs. classic laryngeal mask airway in small children.
Lee JH, Cho HS, Shin WJ, Yang HS.
Korean J Anesthesiol. 2014 Feb;66(2):127-30. doi: 10.4097/kjae.2014.66.2.127. Epub 2014 Feb 28.
BACKGROUND: i-gel™ is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to compare the usefulness of i-gel™ versus a classic laryngeal mask airway (cLMA) in small children. METHODS: Sixty-three children (age range : 4-72 months) were randomly assigned to an i-gel™ or cLMA group. We evaluated hemodynamic data,airway sealing ability, the success rate of insertion, and adverse events including an inadvertent sliding out during ventilation. RESULTS: Demographic data and hemodynamic data obtained immediately after the insertion of these devices did not differ between the two groups. The success rates for insertion on the first attempt were 77 and 84% for i-gel™ and cLMA, respectively (P = 0.54), and the overall success rates were 87 and 100% respectively (P = 0.14). There were no significant differences in terms of airway leak pressure. The inserted i-gel™ inadvertently slid out in 8 of 31 patients but only one sliding out case occurred in the cLMA group (P = 0.02). There were no differences between the groups in terms of other side effects (e.g., coughing, bleeding) associated with the use of i-gel™ and cLMA (P = 0.75 and 0.49, respectively). CONCLUSIONS: Oropharyngeal leak pressure and insertion success rate of i-gel™ are similar to those of cLMA. However, i-gel™ is prone to inadvertent sliding out of the mouth in small children. Therefore, it is recommended that the i-gel™ should be secured more tightly to avoid displacement of the device.
KEYWORDS: Laryngeal mask airway; i-gel™


Comparación de la administración de surfactante através de mascarilla i-gel y del tubo endotraqueal en síndrome de distres respiratorio en recién nacidos con más de 2000 grs

A comparison of surfactant administration through i-gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams.
Sadeghnia A, Tanhaei M, Mohammadizadeh M, Nemati M.
Adv Biomed Res. 2014 Jul 31;3:160. doi: 10.4103/2277-9175.137875. eCollection 2014.
BACKGROUND: Surfactant administration together with nasal Continuous Positive Airway Pressure (nCPAP) administration is considered to be the basis for Newborn's Respiratory Distress Syndrome (RDS) management. This study evaluated the method of directing the surfactant to the lungs in newborns affiliated with RDS through i-gel (i-gel surfactant administration/i-gelSA) compared to the standard care INSURE method, in a clinical trial. MATERIALS AND METHODS: This randomized control trial (RCT) was done on newborns weighing ≥2000 g, with RDS, while being supported with Bubble-CPAP. Newborns, which required FiO2 ≥0.3 under Continuous Distending Pressure (CDP) ≥5 cm H2O for more than 30 minutes to maintain SpO2 in the range of 89 - 95%, were given 100 mg/kg of Survanta. In the interventional group or the i-gelSA (i-gel Surfactant Administration) group, 35 newborns experienced surfactant administration with i-gel and 35 newborns in the control or INSURE group. The average a/APO2 before and after surfactant administration, repeated need for surfactant administration, average nCPAP duration, need for invasive mechanical ventilation, pneumothorax, and the average duration of hospitalization in the Neonatal Intensive Care Unit (NICU) were compared. RESULTS: Although the average a/APO2 showed no significant difference before the procedure; in the i-gelSA group, this average was meaningfully higher after the administration of the surfactant (P = 0.001). The other factors showed no significant difference. CONCLUSION: According to the results of this study, the surfactant administration using i-gel was more successful in oxygenation improvement than the INSURE method, and the i-gel method could even be promoted to the standard care position. However, more research is needed in this area.
KEYWORDS: INSURE; i-gel; nCPAP; newborns respiratory distress syndrome


Anestesiología y Medicina del Dolor
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