Congenital Cardiac surgery with cardiopulmonary bypass using supraglottic airway in pediatric patient: A new horizon

Congenital heart defects like atrial septal defects have proven to be a leading cause of mortality and chronic diseases in the pediatric age group and are often regarded as benign heart lesions. These defects can be small, medium or large and have hemodynamic and electrophysiological consequences. Closure of these defects with cardiac surgery utilizing cardiopulmonary bypass (CPB) remains the standard treatment and is associated with less morbidity and mortality with advancing medical sciences. Laryngoscopy and endotracheal intubation produce reflex sympathetic stimulation and are associated with raised levels of plasma catecholamines, hypertension, tachycardia, myocardial ischemia, depression of myocardial contractility, ventricular arrhythmias, and intracranial hypertension.

Laryngeal mask airways have had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. Newer supraglottic airway devices have evolved over time and apart from providing a secure airway they ensure hemodynamic stability, which is an essential requirement for patients undergoing cardiac surgery. I-gel (second-generation supraglottic airway device), is a single-use device which has been designed to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal and peri laryngeal structures while avoiding compression trauma. It facilitates insertion, minimizes tissue compression, maintains the stability of position after placement and separates the gastrointestinal and respiratory tracts.  I-gel is very easy to insert and demands no learning curve for acquiring a high success insertion rate.

Nowadays cardiac surgery has faced a growing interest for fast extubation and early discharge from the intensive care unit (ICU) after the operation. While large doses of fentanyl have been used to assure hemodynamic stability during cardiac surgery, they invariably tend to prolong mechanical ventilation in the ICU. The use of a supraglottic airway along with neuraxial analgesia allows smoother extubation with lower doses of opioid utilisation and better hemodynamic control.

I-gel appears to be safe for paediatric management but no literature exists on its use while conducting a major open-heart surgery under CPB in the pediatric age group. The objective of this  study is to evaluate the feasibility of I-Gel  for induction and maintenance of anaesthesia in children undergoing surgery for acyanotic congenital heart disease with cardiopulmonary bypass.