Laryngeal mask airway facilitated fibreoptic bronchoscopy in infants. 1997

H P Bandla, and D E Smith, and M P Kiernan
Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana, USA.

OBJECTIVE To assess the efficacy of the laryngeal mask airway (LMA) for fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in infants. METHODS Observations were made in 19 consecutive infants undergoing FOB under general anaesthesia (GA) plus topical local anaesthesia. Anaesthesia was induced with N2O, O2, and halothane or sevoflurane except in two patients who received propofol and one who received thiopentone. Anaesthesia was maintained with oxygen and either sevoflurane, halothane, desflurane, or propofol infusion. No neuromuscular blockers were used. Size #1 or #2 LMAs were used through which a 3.5 mm fibreoptic bronchoscope was introduced. ECG, noninvasive blood pressure, pulse oximetry and, PETCO2 were measured. Intra- and post-procedural complications were recorded. RESULTS Mean age was 6 months; mean weight was 6.6 kg. Chronic wheezing was the indication for FOB in eight patients. Minor complications occurred in five patients: difficult LMA placement in one patient required changing size from #2 to #1; two patients had laryngospasm and bronchospasm that resolved with deepened anaesthesia and nebulised bronchodilator; one patient had transient arterial O2 desaturation, responding to increased FIO2, and one patient required tracheal intubation because ventilation via LMA became inadequate. CONCLUSIONS The minor complications observed were similar to other series and did not result in morbidity or mortality. We feel that GA via LMA facilitates safe FOB in infants. It affords excellent airway management, a quiet patient, and passage of a large fibreoptic bronchoscope for better imaging and suction channel required for BAL.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D001992 Bronchoalveolar Lavage Fluid Washing liquid obtained from irrigation of the lung, including the BRONCHI and the PULMONARY ALVEOLI. It is generally used to assess biochemical, inflammatory, or infection status of the lung. Alveolar Lavage Fluid,Bronchial Lavage Fluid,Lung Lavage Fluid,Bronchial Alveolar Lavage Fluid,Lavage Fluid, Bronchial,Lavage Fluid, Lung,Pulmonary Lavage Fluid,Alveolar Lavage Fluids,Bronchial Lavage Fluids,Bronchoalveolar Lavage Fluids,Lavage Fluid, Alveolar,Lavage Fluid, Bronchoalveolar,Lavage Fluid, Pulmonary,Lavage Fluids, Alveolar,Lavage Fluids, Bronchial,Lavage Fluids, Bronchoalveolar,Lavage Fluids, Lung,Lavage Fluids, Pulmonary,Lung Lavage Fluids,Pulmonary Lavage Fluids
D001999 Bronchoscopy Endoscopic examination, therapy or surgery of the bronchi. Bronchoscopic Surgical Procedures,Surgical Procedures, Bronchoscopic,Bronchoscopic Surgery,Surgery, Bronchoscopic,Bronchoscopic Surgeries,Bronchoscopic Surgical Procedure,Bronchoscopies,Surgeries, Bronchoscopic,Surgical Procedure, Bronchoscopic
D004825 Epiglottis A thin leaf-shaped cartilage that is covered with LARYNGEAL MUCOSA and situated posterior to the root of the tongue and HYOID BONE. During swallowing, the epiglottis folds back over the larynx inlet thus prevents foods from entering the airway. Epiglottic Cartilage,Cartilage, Epiglottic,Cartilages, Epiglottic,Epiglottic Cartilages
D005260 Female Females
D005336 Fiber Optic Technology The technology of transmitting light over long distances through strands of glass or other transparent material. Fiber Optic Technologies,Optic Technologies, Fiber,Optic Technology, Fiber,Technologies, Fiber Optic,Technology, Fiber Optic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000758 Anesthesia A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.
D017214 Laryngeal Masks A type of oropharyngeal airway that provides an alternative to endotracheal intubation and standard mask anesthesia in certain patients. It is introduced into the hypopharynx to form a seal around the larynx thus permitting spontaneous or positive pressure ventilation without penetration of the larynx or esophagus. It is used in place of a facemask in routine anesthesia. The advantages over standard mask anesthesia are better airway control, minimal anesthetic gas leakage, a secure airway during patient transport to the recovery area, and minimal postoperative problems. Laryngeal Mask Airway,Airway, Laryngeal Mask,Airways, Laryngeal Mask,Laryngeal Mask,Laryngeal Mask Airways,Mask, Laryngeal,Masks, Laryngeal

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