Einfluss verschiedener endexspiratorischer Drücke auf den Gasaustausch von pädiatrischen und erwachsenen Patienten unter Verwendung der ProSeal®-Kehlkopfmaske für die kontrollierte Beatmung in der Allgemeinanästhesie

Background Tracheal intubation and positive end-expiratory pressure (PEEP) are frequently used to avoid airway closure and atelectasis during general anaesthesia. Also, the laryngeal mask airway (LMAy ) is frequently used. However, one of the limitations with its use is that its low-pressure seal is often inadequate for positive pressure ventilation with PEEP. The ProSealTM LMA (PLMA) has been shown to form a more effective seal than the ClassicTM LMA. The ability to apply PEEP with the PLMA might improve gas exchange during positive pressure ventilation in children and in adults when the LMA is used. Methods Twenty anaesthetized, non-paralysed children aged 55 (range 27–89) months, weighing 18 kg, were randomly allocated into two groups. Anaesthesia management and positive pressure ventilation were standardized. Size 2 and 2½ PLMA were used. Artificial ventilation in Group II was with pressure controlled ventilation (PCV) and PEEP=5 cm H2O, in Group I with PCV without PEEP. A Fio2=1.0 was used for 20 min during induction of anaesthesia. Sixty minutes after induction of anaesthesia an arterial blood gas sample was taken under a Fio2 = 0.3%. In Addition 74 anaesthetized, non-paralysed adults aged 37 (range 18–69) years, with normal weightning (BMI=24)and without any cordiopulmonay desease, were randomly allocated into four groups. Anaesthesia management and positive pressure ventilation were also standardized. Size 4 and 5 PLMA were used. Artificial ventilation in Group I was with pressure controlled ventilation (PCV) and without PEEP, in Group II and III with PCV and PEEP=5 cm H2O. Artificial ventilation in Group IV was with pressure controlled ventilation (PCV) and PEEP= 8 cm H2O A Fio2=1.0 was used for 20 min during induction of anaesthesia. Fivtey minutes after induction of anaesthesia an arterial blood gas sample was taken under a Fio2 = 0.3%. Results Groups were comparable with respect to demographic data. It was possible to ventilate all patients on the randomised PEEP-level. In paediatric patientsPao2 in Group II [166 ± 12 mmHg] was significantly (P=0.001) higher than in Group I [143 ± 13 mmHg]. In adult patients there was no significantly difference between the groups EEP PaO2 PaCO2 [cm H20] [mmHg] [mmHg] Group 1 (n = 9) 0 139 ± 28 42 ± 5 Group 2 (n = 9) 5 145 ± 21 41 ± 2 Group 3 (n = 23) 5 131 ± 24 43 ± 3 Group 4 (n = 22) 8 139 ± 24 41 ± 3 Conclusions The PLMA can be used for PCV with PEEP in paediatric and adult patients. Application of PEEP improves gas exchange in paediatric patients used for 20 min during induction of anaesthesia. Sixty minutes after induction of anaesthesia an arterial blood gas sample was taken under a . Groups were comparable with respect to demographic data. in Group I [22.1 (1.6) kPa] was significantly (P=0.001) higher than in Group II [19.2 (1.7) kPa].