Impact of spontaneous vs. controlled ventilation with laryngeal mask airway in pediatric cataract surgery

Abstract

Background & objective: Anesthetic management of pediatric cataract surgery is special as most of these surgeries have to be completed under general anesthesia, and airway management and adequate ventilation take precedence and special care. We compared spontaneous ventilation vs. controlled ventilation, using laryngeal mask airway (LMA) with or without muscle relaxation showing their impact on different parameters in pediatric cataract surgery. Methodology: This prospective study included 150 ASA-I and II children, who underwent elective cataract surgery. The patients were randomly divided into three groups: Group-A, B and C to receive spontaneous ventilation, unparalyzed controlled and paralyzed controlled ventilation through LMA, respectively. Evaluation of the effect of ventilation on position of the eyes during surgery in relation to depth of anesthesia, intra-ocular pressure (IOP), surgeon's satisfaction, consumption of sevoflurane, emergence agitation, respiratory parameters and intra-operative hemodynamic stability were the main outcome measures registered. Results: Pressure-controlled ventilation using laryngeal mask improved dynamic compliance with statistically significant lower incidence of eye movements (p = 0.001) and lower IOP measurements despite decreased sevoflurane consumption and higher BIS values (p < 0.001). It led to better surgeon satisfaction and less postoperative agitation (p < 0.001) without any statistically significant differences in hemodynamic parameters or EtCO2, in comparison to spontaneous ventilation. Conclusion: Pressure-controlled ventilation through laryngeal mask airway with low-dose muscle relaxants and titrated anesthesia under bispectral index monitoring is an acceptable safe clinical practice. However, ventilation without neuromuscular blockade could be an alternative with adequate monitoring.