The Laryngeal Mask Airway in Pediatric Anesthesia
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 7, Issue 2
Abstract
Since the reports that the laryngeal airway mask (LMA) could be used safely and effectively in pediatric anaesthesia in 1990s [1,2], LMA are currently recommended for use in a variety of challenging scenarios, such as in the difficult airway, remote locations, ventilation during resuscitation, long-duration surgeries, in children with recent upper respiratory infection, even in laparoscopic surgery and prone position procedures. In the past years, there are many randomized trials carried out in pediatric group among various clinical scenarios. This mini-review aims to present the current literatures on the usage of the laryngeal airway mask in children. The successful use of the laryngeal mask airway in children depends partly on the correct selection of size [3]. The appropriate size of the laryngeal mask airway in children is usually determined by the pediatric’s body weight. In addition, there are several alternative methods to predict the size of the laryngeal mask airway. Gallart L et al. [4] proposed a new method that the size of the laryngeal mask airway was determined by the combined widths of the patient’s index, middle and ring fingers. They compared the results with the standard method recommended by the manufacturer’s weight-related guidelines and found an “excellent agreement” between both methods. The literature proposed that this new approach is of valid and practical use in children. Zahoor A et al. [5] chose the size of the laryngeal mask airway in children according to the size of the external ear that was associated with a success rate of 93%. That simple method might allow a rapid choice of the correct size of laryngeal mask airway and eliminate the need to remember different tables or formulae. However, in over- or underweight children, Kim HJ et al. [6] found that laryngeal mask airway size according to the manufacturer’s weight-based recommendation is to be preferred in overweight children, but laryngeal mask airway size by an ideal weight estimated from the pediatric patient’s age is a better choice in underweight children. A relatively large tongue, a higher and more anterior larynx with a relatively large floppy epiglottis and frequent presence of tonsillar hypertrophy may make correct placement of LMA more difficult in pediatric patients. Hence, the insertion of the LMA by the standard technique is not always easy. Alternative techniques such as rotational, cuff partially inflated and lateral approaches have been used to improve the ease and success of LMA [7] insertion in children. Ghai B et al. [8] compared the success and ease of insertion of three techniques of laryngeal mask airway: the standard Brain technique, a lateral technique with cuff partially inflated and a rotational technique with cuff partially inflated. A rotational technique with partially inflated cuff is associated with the highest success rate of insertion and lowest incidence of complications and could be the technique of first choice for LMA insertion in pediatric patients.
Authors and Affiliations
Wen Xian Li, Shuang shuang LI
Keywords
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- EP ID EP585870
- DOI 10.26717/BJSTR.2018.07.001480
- Views 139
- Downloads 0
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