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Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48(4): 246-250
DOI: 10.1055/s-0033-1343759
Fachwissen
Topthema: Kinderanästhesie
© Georg Thieme Verlag Stuttgart · New York

Kinderanästhesie – Supraglottische Atemwege bei Säuglingen und Kleinkindern

Supraglottic airways in infants and children
Kai Goldmann
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Publication History

Publication Date:
30 April 2013 (online)

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Zusammenfassung

Die Entwicklung der LMA-ClassicTM hat die Praxis der Anästhesie revolutioniert, indem sich durch ihren weitverbreiteten Gebrauch neben dem klassischen Atemwegsmanagement mit der Gesichtsmaske oder dem Endotrachealtubus eine ganz eigene Form, das supraglottische Atemwegsmanagement, etabliert hat. So verwundert es nicht, dass es heute, 25 Jahre später, neben diesem Urtypen des „supraglottischen Atemwegs“ eine ganze Reihe konzeptionell unterschiedlicher Hilfsmittel gibt, mit deren Hilfe der Atemweg „oberhalb der Glottis“ gesichert werden kann. Nachdem primär Modelle für erwachsene Patienten vermarktet wurden, sind inzwischen von vielen Anbietern die meisten dieser supraglottischen Atemwege auch in Kindergrößen erhältlich. Ihr routinemäßiger Gebrauch außerhalb kontrollierter klinischer Studien muss allerdings kritisch betrachtet werden, da die existierende wissenschaftliche Evidenz, mit Ausnahme der LMA-ProSealTM, bezüglich einer Überlegenheit oder zumindest Gleichwertigkeit gegenüber der ursprünglichen LMA-Classic als unzureichend bewertet werden muss. In dem nachfolgenden Artikel wird eine kritische Beurteilung der aktuell für Säuglinge und Kinder zur Verfügung stehenden supraglottischen Atemwege vorgenommen.

Abstract

The development of the LMA-ClassicTM revolutionized anaesthesia practice as its wide-spread use led to the establishment of a unique form of airway management, the “supraglottic airway management”, besides the existing classical airway management with the face mask or endotrachel tube. Today, 25 years later, along with the original prototype of supraglottic airways quite a few numbers of different devices exist that can be used to secure the airway “above the glottis”. After initially primarily marketing adult sizes many suppliers offer paediatric sizes nowadays. However, the scientific evidence in terms of superiority or at a least equality to the original LMA-Classic( of any of these airway devices must be considered insufficient except for the LMA-ProSealTM. Consequently, the routine use of these devices outside controlled clinical studies must be considered questionable. The following article aims at providing a critical appraisal of currently available supraglottic airway devices for neonates and infants.

Kernaussagen

  • Die LMA-Classic (CLMA) als Prototyp der 1. Generation supraglottischer Atemwege gilt als das am besten wissenschaftlich untersuchte Produkt.

  • Die CLMA und LMA-Flexible (FLMA) gelten auch nach Einführung der 2. Generation supraglottischer Atemwege für diverse Eingriffe und Untersuchungen bei Säuglingen und Kindern als supraglottische Atemwege der Wahl.

  • Die LMA-ProSeal (PLMA) gilt als das am besten wissenschaftlich untersuchte Modell der 2. Generation und hat nachgewiesene Vorteile gegenüber der CLMA in Bezug auf kontrollierte Beatmungsverfahren und einem möglichen Aspirationsschutz.

  • Die vorteilhaften Designmerkmale der PLMA haben zu einer Ausweitung des Indikationsspektrums des supraglottischen Atemwegsmanagements bei Säuglingen und Kindern beigetragen.

  • Für die meisten kommerziell erhältlichen Kopien der CLMA existiert keinerlei wissenschaftlicher Nachweis ihrer Tauglichkeit und Sicherheit in Kindern unterschiedlicher Altersklassen.

  • Die meisten Modelle der 2. Generation sind derzeit nicht genügend wissenschaftlich untersucht, als dass man ihre Rolle im Atemwegsmanagement von Säuglingen und Kindern ausreichend beurteilen könnte.

  • Eine zunehmende Anzahl wissenschaftlicher Publikationen deutet darauf hin, dass die I-Gel im Atemwegsmanagment pädiatrischer Patienten in Zukunft eine Rolle spielen könnte.

  • Die vollkommen unzureichende wissenschaftliche Datenlage anderer 2. Generation-Modelle lässt ihren Einsatz außerhalb kontrollierter klinischer Studien höchst zweifelhaft erscheinen.

Schlüsselwörter:

Allgemeinanästhesie - Kehlkopfmasken - Atemweg - Säugling - Kind

Key words:

general anaesthesia - laryngeal masks - airway - infant - child

Ergänzendes Material

 

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