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The purpose of this research study is to compare difference between breathing by oneself or with the partial help from an anesthesia machine in children under general anesthesia.
The laryngeal mask airway (LMA) is a breathing device that sits above the vocal cords and allows the patient to breathe in and out adequately under general anesthesia (GA). The ProSeal™ LMA (PLMA™) is a specialized type of LMA with a design that permits the delivery of higher pressures to help the patient breathe in and out (ventilate) and also contains a channel to suction the stomach.
Children under GA may breathe through a PLMA in different ways. Spontaneous ventilation consists of the children breathing on their own through a PLMA™. Pressure support ventilation allows the patient to breathe on their own with additional help from the anesthesia machine. Pressure control ventilation allows the patient to breathe with the help of an anesthesia machine.
A child undergoing surgery requires a deep level of general anesthesia which negatively affects their ability to ventilate. Thus, children may not breathe in oxygen and carbon dioxide out adequately at this level of anesthesia and it may be beneficial to provide some level of support to enhance carbon dioxide exchange and to avoid hypoventilation.
This study will attempt to determine whether pressure support ventilation improves ventilation in children undergoing outpatient surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Spontaneous ventilation | Experimental | Pt's will be allowed to breathe spontaneously through the PLMA during surgery without the assistance of positive pressure ventilation. |
|
| Pressure support ventilation | Experimental | Pt's will receive positive pressure assistance with each spontaneous breath through the PLMA. |
|
| Pressure control ventilation | Active Comparator | Pt.'s will be placed on the ventilator and ventilated with pressure control. through the PLMA. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Spontaneous ventilation | Procedure | The patient will breathe spontaneously (on their own)while under general anesthesia throughout the duration of the surgery. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Differences in End-tidal Carbon Dioxide Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. | Differences in End-tidal Carbon Dioxide Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups will be calculated by subtracting the mean of End-tidal Carbon Dioxide from the PSV group to the SV group | up to 90 minutes |
| Differences Tidal Volume Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. | Tidal Volume Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. Measured in mL/Kg and will be calculated by subtracting the mean of tidal volume from the PSV group to the SV group | up to 90 minutes |
| Mean Values of ETCO2 in SV and PCV Groups | Mean Values of ETCO2 in SV and PCV groups reported in mmHg | up to 90 minutes |
| Mean Tidal Volume Values Compared Between SV and PCV Groups | Mean Tidal Volume Values compared between SV and PCV Groups. Measured in mL/kg | up to 90 minutes |
| Mean Values of ETCO2 Between the PSV and PCV Groups | Mean Values of ETCO2 between the PSV and PCV Groups. Measured in mmHg | up to 90 minutes |
| Mean Values of Tidal Volume Between the PSV and PCV Groups | Mean Values of Tidal Volume Between the PSV and PCV Groups. Measured in mL/kg | up to 90 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Differences in Respiratory Rates Between Spontaneous Ventilation and Pressure Support Ventilation Groups. | Differences in respiratory rates between spontaneous ventilation and pressure support ventilation groups will be calculated by subtracting the mean of from the respiratory rates PSV group to the SV group. | up to 90 minutes |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Thomas W Templeton, M.D. | Wake Forest University Health Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Wake Forest University Health Sciences | Winston-Salem | North Carolina | 27157 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 4003736 | Background | Brain AI, McGhee TD, McAteer EJ, Thomas A, Abu-Saad MA, Bushman JA. The laryngeal mask airway. Development and preliminary trials of a new type of airway. Anaesthesia. 1985 Apr;40(4):356-61. | |
| 2100990 | Background | Mason DG, Bingham RM. The laryngeal mask airway in children. Anaesthesia. 1990 Sep;45(9):760-3. doi: 10.1111/j.1365-2044.1990.tb14449.x. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Spontaneous Ventilation | Pt's will be allowed to breathe spontaneously through the PLMA during surgery without the assistance of positive pressure ventilation. Spontaneous ventilation: The patient will breathe spontaneously (on their own)while under general anesthesia throughout the duration of the surgery. |
| FG001 | Pressure Support Ventilation | Pt's will receive positive pressure assistance with each spontaneous breath through the PLMA. Pressure support Ventilation: The patient will breathe on their own and with a little assistance from the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
| FG002 | Pressure Control Ventilation | Pt.'s will be placed on the ventilator and ventilated with pressure control. through the PLMA. Pressure control ventilation: The patient's ventilation will be completely supported by the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Spontaneous Ventilation | Pt's will be allowed to breathe spontaneously through the PLMA during surgery without the assistance of positive pressure ventilation. Spontaneous ventilation: The patient will breathe spontaneously (on their own)while under general anesthesia throughout the duration of the surgery. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Differences in End-tidal Carbon Dioxide Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. | Differences in End-tidal Carbon Dioxide Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups will be calculated by subtracting the mean of End-tidal Carbon Dioxide from the PSV group to the SV group | Posted | Mean | Standard Deviation | mmHg | up to 90 minutes |
|
up to 90 minutes
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Spontaneous Ventilation | Pt's will be allowed to breathe spontaneously through the PLMA during surgery without the assistance of positive pressure ventilation. Spontaneous ventilation: The patient will breathe spontaneously (on their own)while under general anesthesia throughout the duration of the surgery. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Thomas Templeton, MD | Wake Forest University Health Sciences | 336-716-4285 | ttemplet@wakehealth.edu |
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| ID | Term |
|---|---|
| D053120 | Respiratory Aspiration |
| ID | Term |
|---|---|
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Pressure support Ventilation | Device | The patient will breathe on their own and with a little assistance from the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
|
| Pressure control ventilation | Device | The patient's ventilation will be completely supported by the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
|
| Mean Values of Respiratory Rate Compared Between the Spontaneous Ventilation and Pressure Control Ventilation Groups. |
| up to 90 minutes |
| Mean Values of Respiratory Rate Compared Between Pressure Support Ventilation and Pressure Control Ventilation Groups. | up to 90 minutes |
| 15298876 | Background | Shimbori H, Ono K, Miwa T, Morimura N, Noguchi M, Hiroki K. Comparison of the LMA-ProSeal and LMA-Classic in children. Br J Anaesth. 2004 Oct;93(4):528-31. doi: 10.1093/bja/aeh238. Epub 2004 Aug 6. |
| 18166745 | Background | Lardner DR, Cox RG, Ewen A, Dickinson D. Comparison of laryngeal mask airway (LMA)- Proseal and the LMA-Classic in ventilated children receiving neuromuscular blockade. Can J Anaesth. 2008 Jan;55(1):29-35. doi: 10.1007/BF03017594. |
| 12060328 | Background | Bagshaw O. The size 1.5 laryngeal mask airway (LMA) in paediatric anaesthetic practice. Paediatr Anaesth. 2002 Jun;12(5):420-3. doi: 10.1046/j.1460-9592.2002.00887.x. |
| 18647269 | Background | Licina A, Chambers NA, Hullett B, Erb TO, von Ungern-Sternberg BS. Lower cuff pressures improve the seal of pediatric laryngeal mask airways. Paediatr Anaesth. 2008 Oct;18(10):952-6. doi: 10.1111/j.1460-9592.2008.02706.x. Epub 2008 Jul 21. |
| 16490094 | Background | Wheeler M. ProSeal laryngeal mask airway in 120 pediatric surgical patients: a prospective evaluation of characteristics and performance. Paediatr Anaesth. 2006 Mar;16(3):297-301. doi: 10.1111/j.1460-9592.2005.01788.x. |
| 15920181 | Background | Goldmann K, Jakob C. A randomized crossover comparison of the size 2 1/2 laryngeal mask airway ProSeal versus laryngeal mask airway-Classic in pediatric patients. Anesth Analg. 2005 Jun;100(6):1605-1610. doi: 10.1213/01.ANE.0000152640.25078.90. |
| 8984875 | Background | Lopez-Gil M, Brimacombe J, Alvarez M. Safety and efficacy of the laryngeal mask airway. A prospective survey of 1400 children. Anaesthesia. 1996 Oct;51(10):969-72. doi: 10.1111/j.1365-2044.1996.tb14968.x. |
| 11696145 | Background | Keidan I, Berkenstadt H, Segal E, Perel A. Pressure versus volume-controlled ventilation with a laryngeal mask airway in paediatric patients. Paediatr Anaesth. 2001 Nov;11(6):691-4. doi: 10.1046/j.1460-9592.2001.00746.x. |
| 10597550 | Background | Lopez Gil ML, Brimacombe J, Clar B. Sevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children. Paediatr Anaesth. 1999;9(6):485-90. doi: 10.1046/j.1460-9592.1999.00404.x. |
| 18042854 | Background | Garcia-Fernandez J, Tusman G, Suarez-Sipmann F, Llorens J, Soro M, Belda JF. Programming pressure support ventilation in pediatric patients in ambulatory surgery with a laryngeal mask airway. Anesth Analg. 2007 Dec;105(6):1585-91, table of contents. doi: 10.1213/01.ane.0000287674.64086.f1. |
| Pressure Support Ventilation |
Pt's will receive positive pressure assistance with each spontaneous breath through the PLMA. Pressure support Ventilation: The patient will breathe on their own and with a little assistance from the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
| BG002 | Pressure Control Ventilation | Pt.'s will be placed on the ventilator and ventilated with pressure control. through the PLMA. Pressure control ventilation: The patient's ventilation will be completely supported by the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
| BG003 | Total | Total of all reporting groups |
| Months |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| ASA Status | A grade I is a normal healthy patient and a grade II is a patient with severe systemic disease | Count of Participants | Participants |
|
Pt's will receive positive pressure assistance with each spontaneous breath through the PLMA. Pressure support Ventilation: The patient will breathe on their own and with a little assistance from the anesthesia machine while under general anesthesia throughout the duration of the surgery. |
|
|
|
| Primary | Differences Tidal Volume Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. | Tidal Volume Compared Between the Spontaneous Ventilation and Pressure Support Ventilation Groups. Measured in mL/Kg and will be calculated by subtracting the mean of tidal volume from the PSV group to the SV group | Posted | Mean | Standard Deviation | mL/kg | up to 90 minutes |
|
|
|
|
| Primary | Mean Values of ETCO2 in SV and PCV Groups | Mean Values of ETCO2 in SV and PCV groups reported in mmHg | Posted | Mean | Standard Deviation | mmHg | up to 90 minutes |
|
|
|
| Primary | Mean Tidal Volume Values Compared Between SV and PCV Groups | Mean Tidal Volume Values compared between SV and PCV Groups. Measured in mL/kg | Posted | Mean | Standard Deviation | mL/kg | up to 90 minutes |
|
|
|
| Primary | Mean Values of ETCO2 Between the PSV and PCV Groups | Mean Values of ETCO2 between the PSV and PCV Groups. Measured in mmHg | Posted | Mean | Standard Deviation | mmHg | up to 90 minutes |
|
|
|
| Primary | Mean Values of Tidal Volume Between the PSV and PCV Groups | Mean Values of Tidal Volume Between the PSV and PCV Groups. Measured in mL/kg | Posted | Mean | Standard Deviation | mL/kg | up to 90 minutes |
|
|
|
| Secondary | Differences in Respiratory Rates Between Spontaneous Ventilation and Pressure Support Ventilation Groups. | Differences in respiratory rates between spontaneous ventilation and pressure support ventilation groups will be calculated by subtracting the mean of from the respiratory rates PSV group to the SV group. | Posted | Mean | Standard Deviation | breath/min | up to 90 minutes |
|
|
|
|
| Secondary | Mean Values of Respiratory Rate Compared Between the Spontaneous Ventilation and Pressure Control Ventilation Groups. | Posted | Mean | Standard Deviation | breath/min | up to 90 minutes |
|
|
|
| Secondary | Mean Values of Respiratory Rate Compared Between Pressure Support Ventilation and Pressure Control Ventilation Groups. | Posted | Mean | Standard Deviation | breath/min | up to 90 minutes |
|
|
|
| 0 |
| 10 |
| 0 |
| 10 |
| 0 |
| 10 |
| EG001 | Pressure Support Ventilation | Pt's will receive positive pressure assistance with each spontaneous breath through the PLMA. Pressure support Ventilation: The patient will breathe on their own and with a little assistance from the anesthesia machine while under general anesthesia throughout the duration of the surgery. | 0 | 10 | 0 | 10 | 0 | 10 |
| EG002 | Pressure Control Ventilation | Pt.'s will be placed on the ventilator and ventilated with pressure control. through the PLMA. Pressure control ventilation: The patient's ventilation will be completely supported by the anesthesia machine while under general anesthesia throughout the duration of the surgery. | 0 | 11 | 0 | 11 | 0 | 11 |
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