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Usefulness Of Respiratory Sound Within Respiratory Circuit Monitoring For Detecting Laryngeal Narrowing In Anesthetized Children Managed With Supraglottic Airway
Abstract   Open access

Usefulness Of Respiratory Sound Within Respiratory Circuit Monitoring For Detecting Laryngeal Narrowing In Anesthetized Children Managed With Supraglottic Airway

Shinichiro Kato, Katsuhiko Ishibashi, Yuji Kitamura and Shiroh Isono
Euroanaesthesia 2018
2017
DOI: 10.26226/morressier.5aeb0acb07b0d6001a79aaa3
url
https://doi.org/10.26226/morressier.5aeb0acb07b0d6001a79aaa3View
Published (Version of record) Open Access

Abstract

Background and Goal of Study:Use of supraglottic airway devices (SAD) for securing patent airway becomes a common technique even for small children undergoing minor surgeries under general anesthesia. However, it is well documented that serious respiratory complications often occur particularly at anesthesia emergence. Accordingly, early detection of the disordered breathing would improve safety and quality of anesthesia management. In this context, respiratory sound monitoring (RSM) with using a stethoscope on the cheat wall has been used in pediatric anesthesia field. However, potential usefulness of the RSM at different sites have not been explored. As a secondly aim of a clinical study in which primarily examines effects of sugammadex on laryngeal airway patency (abstract is separately submitted to this ESA meeting), we are assessing usefulness of RSM at various sites for detecting the laryngeal narrowing. Here we report our preliminary results of analyses of respiratory sounds at various sites for differentiating laryngeal narrowing.Materials and Methods:With Institutional Ethics Review Board approval and clinical registration (UMIN000025058), we so far completed a clinical study in 19 small children undergoing elective minor surgeries under general anesthesia while the airway was secured by a SGA. Endoscopic images of the vocal cords were continuously monitored to detect laryngeal narrowing. In addition to measurements of respiratory flow and airway pressure, microphones were placed for measuring respiratory sounds at three different locations: on the chest wall and neck, and within the airway circuit. Frequency analyses were performed for the respiratory sounds to assess the performance of the respiratory sound analyses to detect laryngeal narrowing and to find out the best location for the purpose. Results and Discussion:Seven out of 19 children developed laryngeal narrowing during spontaneous breathing at emergence of anesthesia. Microphone on the chest wall did not clearly and accurately detect the laryngeal narrowing. In contrast, as presented in the attached table, significantly higher power spectrum was detected by a microphone placed within the respiratory circuit in children with laryngeal narrowing. Conclusion:Although not conclusive at present, respiratory sound monitoring by a microphone placed within a respiratory circuit can be used as a sensitive monitor of the laryngeal airway patency in children with SAD.

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