Comparison of positive pressure ventilation strategies in young children undergoing laparoscopic inguinal hernia repair with laryngeal mask airway: a prospective randomized study

A laryngeal mask is a viable alternative to tracheal intubation for airway control in pediatric day surgery. Therefore, the methodology for respiratory management using a laryngeal mask in mechanically ventilated patients is of particular significance. Here, we compare pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), and pressure-controlled ventilation with volume guaranteed (PCV-VG) in terms of respiratory mechanics in children who underwent laparoscopic inguinal hernia repair at various time intervals. This prospective, randomized, comparative study was conducted on 90 children aged 1–5 years who underwent elective laparoscopic inguinal hernia repair and had an American Society of Anesthesiologists (ASA) physical status of I or II. They were assigned to the PCV, VCV, or PCV-VG groups (30 patients per group). The primary outcome measure was peak inspiratory pressure (PIP). Secondary outcome measures were other parameters of respiratory dynamics, hemodynamic parameters and adverse respiratory events in the postoperative period. The PIP was significantly lower in the PCV and PCV-VG groups compared to the VCV group at all measured time points. For example, at T1, PIP was lower in the PCV group (11.2 ± 0.8 cmH2O) and the PCV-VG group (11.7 ± 0.9 cmH2O) compared to the VCV group (13.7 ± 2.1 cmH2O) (p < 0.001). Similarly, also at T3, it was lower in the PCV (15.5 ± 1.5 cmH2O) and the PCV-VG group (15.8 ± 1.3 cmH2O) compared to the VCV group (17.6 ± 2.4 cmH2O) (p < 0.001). Additionally, plateau pressure (Pplat) and respiratory airway resistance (Raw) were significantly lower, while dynamic compliance (Cdyn) was significantly higher in the PCV and PCV-VG groups compared to the VCV group at all time points. At T2, Pplat was notably lower in the PCV group (10.6 ± 0.8 cmH2O) and the PCV-VG group (13.5 ± 1.4 cmH2O) compared to the VCV group (15.3 ± 2.5 cmH2O) (p < 0.001). Cdyn was significantly higher in the PCV group and the PCV-VG group (e.g., at T2, PCV: 19.9 ± 2.7 mL/cmH2O; PCV-VG: 20.8 ± 3.5 mL/cmH2O) compared to the VCV group (15.3 ± 2.6 mL/cmH2O; p < 0.001). No significant differences were observed among the groups regarding expired tidal volume (VTe), end-tidal CO2 (EtCO2), dead space ratio (Vd/Vt), hemodynamics, or postoperative respiratory adverse effects. In pediatric patients undergoing laparoscopic surgeries, PCV and PCV-VG are superior to VCV as evidenced by lower PIP and higher dynamic compliance (Cdyn). This trial was registered prospectively on ClinicalTrials.gov (NCT06612125) on September 25, 2024.