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PEDIATRIC ANESTHESIOLOGY

Programming Pressure Support Ventilation in Pediatric Patients in Ambulatory Surgery with a Laryngeal Mask Airway

Javier Garcia-Fernandez, MD, PhD^*, Gerardo Tusman, MD, Fernando Suarez-Sipmann, MD, Julio Llorens, MD, PhD, Marina Soro, MD, PhD, and Javier F. Belda, MD, PhD

From the *Pediatric Anesthesiology and Postsurgical Critical Care Department, La Paz Universitary Hospital, Madrid, Spain; Anesthesiology Department, La Comunidad Hospital, Mar de Plata, Argentina; Intensive Care Department, Fundación Jiménez Díaz-Capio, Madrid, Spain; Anesthesiology Department, Clinical Universitary Hospital, University of Valencia, Valencia, Spain.

Address correspondence and reprint requests to Garcia-Fernandez J, MD, PhD, Hospital La Paz, P^o de la Castellana, 261, Servicio de Anestesiologia y Reanimación Pediátrica, 28046-Madrid, Spain. Address e-mail to jgarciaf.hulp{at}madrid.salud.org.

Abstract

BACKGROUND: Anesthesia workstations with pressure support ventilation (PSV) are available, but there are few studies published on how to program flow-triggered PSV using a laryngeal mask airway (LMA) under general anesthesia in pediatric patients.

METHODS: We studied 60 ASA I and II patients, from 2 mo to 14 yr, scheduled for ambulatory surgery under combined general and regional anesthesia with a LMA. Patients were classified according to their body weight as follows: Group A 10 kg, Group B 11–20 kg, and Group C >20 kg. All were ventilated in PSV using the following settings: positive end-expiratory pressure of 4 cm H₂O, the minimum flow-trigger without provoking auto-triggering, and the minimum level of pressure support to obtain 10 mL/kg of tidal volume.

RESULTS: The flow-trigger most frequently used in our study was 0.4 L/min, ranging from 0.2 to 0.6 L/min. We found no correlation between the flow-trigger setting and the patient’s age, weight, compliance, resistance, or respiratory rate. There was a good correlation between the level of pressure support (Group A = 15 cm H₂O, Group B = 10 cm H₂O and Group C = 9 cm H₂O) and age (P < 0.001), weight (P < 0.001), dynamic compliance (P < 0.001), and airway resistances (P < 0.001).

CONCLUSIONS: PSV with a Proseal^TM LMA in outpatient pediatric anesthesia can be programmed simply using the common clinical noninvasive variables studied. However, more studies are needed to estimate the level of pressure support that may be required in other clinical situations (respiratory pathology, endotracheal tubes, or other types of surgeries) or with other anesthesia workstations.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999