Objective To assess the effectiveness and safety of laryngeal mask airway (LMA) and endotracheal tube (ETT) for airway management in pediatric general anesthesia. Methods Randomized controlled trials were collected through electronic searches of the PubMed, The Cochrane Library, EMbase, CBM, WanFang Data, VIP, CNKI from the date of establishment to November 2010. All the related data that matched the standards were abstracted by two reviewers independently. The quality of the included trials was evaluated according to the Cochrane Handbook 5.0. RevMan 5.0 software was used for meta-analysis of the complications, success of insertion on the first attempt and hemodynamic changes. Results A total of 39 trials involving 2 612 patients were included. The results of meta-analyses showed that LMA was superior to ETT in terms of less cough (RR=0.21, 95%CI 0.15 to 0.28, Plt;0.000 01), laryngospasm or bronchospasm (RR=0.37, 95%CI 0.18 to 0.77, P=0.008) and agitation (RR=0.14, 95%CI 0.09 to 0.22, Plt;0.000 01) during emergency. The incidence of postoperative sore throat (RR=0.32, 95%CI 0.19 to 0.55, Plt;0.000 1), hoarse voice (RR=0.09, 95%CI 0.03 to 0.27, Plt;0.000 1), nausea and vomiting (RR=0.46, 95%CI 0.26 to 0.80, P=0.006) was significantly lower in the LMA group. The hemodynamic changes during insertion and extraction of LMA were more stable than ETT, such as the heart rate changes in insertion, extraction and post-extraction period (SMD= –1.18, 95%CI –1.59 to –0.77, Plt;0.000 01; SMD= –1.29 95%CI –1.72 to –0.86, Plt;0.000 01; and SMD= –1.51 95%CI –2.15 to –0.87, Plt;0.000 01, respectively) and the MAP changes in insertion, extraction and post-extraction period (SMD= –1.21, 95%CI –1.39 to –1.02, Plt;0.000 01; SMD= –1.31, 95%CI –1.77 to –0.85, Plt;0.000 01; and SMD= –0.85, 95%CI –1.24 to –0.46, Plt;0.000 1, respectively); but no significant differences in postoperative regurgitation and aspiration (RR=3.00, 95%CI 0.62 to 14.61, P=0.17) and successful insertion on the first attempt (RR=0.99, 95%CI 0.94 to 1.05, P=0.84) were found between the LMA and ETT groups. Conclusion Current evidence indicates that the laryngeal mask airway is superior to endotracheal tube in terms of fewer complications during emergency and after operation as well as stable hemodynamic changes. So, it is a selective, safe and effective airway management for children.
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.