Pressure versus volume-controlled ventilation with a laryngeal mask airway™ in paediatric patients

Background: The utility of positive pressure ventilation with the laryngeal mask airway (LMA) in children was described previously, but the possibility of gastric insufflation, related to high peak airway pressure, continues to be a disadvantage. In this prospective study, inspiratory pressures, air leak and signs of gastric insufflation were compared between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) using an LMA. Methods: Thirty-two ASA I patients, aged 4.5 ± 4 years, who were scheduled for elective procedures under combined general anaesthesia and caudal analgesia, were enrolled. After inhalation induction and LMA insertion, each patient was randomly assigned to receive successively PCV and VCV. Peak pressures (PCV) and tidal volumes (VCV) were changed in order to achieve adequate ventilation [endtidal CO₂ 5-5.4 kPa (38-42 mmHg)]. Results: Peak airway pressures were significantly lower with PCV than VCV (14.1 ± 1.6 cmH₂O versus 16.7 ± 2.3 cmH₂O, P < 0.001). No patient ventilated with PCV required peak pressure higher than 20 cmH₂O compared with six patients ventilated with VCV (P < 0.05). Haemodynamic parameters, expiratory tidal volume and percent of leak were similar in both ventilatory modes and no signs of gastric insufflation were detected. Conclusions: During general anaesthesia in children using an LMA, PCV offers lower peak inspiratory airway pressures while maintaining equal ventilation compared with VCV. Although no signs of gastric insufflation were detected in both groups, the lower pressures might be significant in patients with reduced chest wall or lung compliance.