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PEDIATRIC ANESTHESIOLOGY

A Prospective, Randomized Comparison of Cobra Perilaryngeal Airway and Laryngeal Mask Airway Unique in Pediatric Patients

Peter Szmuk, MD^*¶, Oscar Ghelber, MD, Maria Matuszczak, MD, Marry F. Rabb, MD, Tiberiu Ezri, MD^¶, and Daniel I. Sessler, MD^¶

From the *Department of Anesthesiology, University of Texas Southwestern Medical School and Children’s Medical Center at Dallas, Texas; Department of Anesthesiology, University of Texas Medical School at Houston, Texas; Department of Anesthesia, Wolfson Medical Center, Holon, Affiliated to Tel Aviv University, Israel; and Department of Outcomes Research, The Cleveland Clinic, Ohio; ¶Member Outcomes Research Consortium.

Address correspondence and reprint requests to Peter Szmuk, MD, Department of Anesthesiology, University of Texas Southwestern Medical School and Children’s Medical Center at Dallas, 1935, B3304, Motor St., Dallas, TX 75235. Address e-mail to peter.szmuk{at}utsouthwestern.edu.

Abstract

BACKGROUND: The Cobra Perilaryngeal Airway (PLA) provides better sealing pressure than the Laryngeal Mask Airway Unique (LMAU) during positive-pressure ventilation in adults. We compared the performance of the CobraPLA and LMAU in infants and children.

METHODS: Two-hundred pediatric patients were randomly assigned to a CobraPLA or an Laryngeal Mask Airway (LMA). We measured airway sealing at cuff inflation pressures of 40 and 60 cm H₂O; ease and time of insertion; device stability; efficacy of ventilation; number of insertion attempts; incidence of postoperative sore throat, dysphonia, laryngospasm, bronchospasm, and gastric gas insufflation. Steady-state end-tidal_CO2 was measured at the head of the CobraPLA and at the "Y-piece" piece of the anesthetic circuit. For the major outcomes, the airway groups were subdivided post hoc into small and large CobraPLA and small and large LMA subgroups. Results are presented as means ± sds; P < 0.05 was considered statistically significant.

RESULTS: Airway sealing pressure with the cuff inflated to 60 cm H₂O in the large CobraPLA subgroup (22 ± 7 cm H₂O) was significantly more than that of the small CobraPLA subgroup (18 ± 5 cm H₂O) and large LMA subgroup (16 ± 5 cm H₂O; P < 0.001). The CobraPLA was more stable than the LMA (same anatomic fit score before and after surgery) and produced less gastric insufflation. Head CobraPLA end-tidal_CO2 values were 6.4 ± 6 mm Hg more than those of the Y piece of the circle circuit.

CONCLUSIONS: The CobraPLA airway performed as well as the LMAU during anesthesia in pediatric patients for a large range of outcomes and was superior for some.

This article has been cited by other articles:

				The Cobra PLA vs. the LMA Unique in Children Journal Watch Emergency Medicine, December 5, 2008; 2008(1205): 2 - 2. [Full Text]

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