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The laryngeal mask airway in infants and children

Chongdoo Park, MD^*, Jae-Hyon Bahk, MD, Won-Sik Ahn, MD, Sang-Hwan Do, MD and Kook-Hyun Lee, MD

^* From the Department of Anesthesiology, National Cancer Center, Koyang, Kyunggi-Do, Korea and the
Department of Anesthesiology and Clincal Research Institute, Seoul National University Hospital, Seoul, Korea.

Address correspondence to: Dr. Jae-Hyon Bahk, Department of Anesthesiology, Seoul National University College of Medicine, #28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea. Phone: 82-2-760-2818; Fax: 82-2-747-5639; E-mail: bahkjh{at}plaza.snu.ac.kr

Purpose: To compare the effectiveness of various laryngeal mask airway (LMA) sizes and their performance during positive pressure ventilation (PPV) in paralyzed pediatric patients.

Methods: Pediatric patients (n=158), < 30 kg, ASA 1 or 2 were studied. After paralysis, an LMA of the recommended size was inserted and connected to a volume ventilator. Fibreoptic bronchoscopy (FOB) was performed and graded: 1, larynx only seen; 2, larynx and epiglottis posterior surface seen; 3, larynx, and epiglottis tip or anterior surface seen—visual obstruction of epiglottis to larynx: < 50%; 4, epiglottis down-folded, and its anterior surface seen—visual obstruction of epiglottis to larynx: > 50%; 5, epiglottis down-folded and larynx not seen directly. Inspiratory and expiratory tidal volumes (V_T), and airway pressure were measured by a pneumo-tachometer, and the fraction of leakage (F_L) was calculated. In 79 cases, LMA was used for airway maintenance throughout surgery.

Results: Successful LMA placement was achieved in 98% of cases: three failures were due to gastric insufflation. For LMA # 1, 1.5, 2, and 2.5, FOB grades [median (range)] were 3(1-5), 3(1-5), 1(1-5) and 1(1-3) respectively. In smaller LMAs, the cuff more frequently enclosed the epiglottis (P < .001). F_L of LMA # 1 was higher than those of LMA # 1.5 and LMA # 2.5 (P < .05), and F_L of LMA # 2 was higher than that of LMA # 2.5 (P < .05). In the 79 patients, the number of patients experiencing complications decreased as LMA size increased (P < .05).

Conclusion: Use of the LMA in smaller children results in more airway obstruction, higher ventilatory pressures, larger inspiratory leak, and more complications than in older children.

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