The role of tlie laryngeal mask airway in children is supported by numerous papers (12 = 20), abstracts ( n = 33), and other reports ( i i = 88). but there are only a few large scale studies ( > I000 patients) assessing its safety and efficacy and none in which anaesthetic management was standardised. In addition, coiieeriis have been raised that placement may be more dillicult in children [4] and it has been suggested thxt the standard insertion technique recommended by Bruin may be suboptimal in infants and children [5, 61.Recently we conducted a trial assessing tlie rate of skill acquisition of trainee anaestlietists in 600 children [7]. We have continued to gather data about LMA usage by trainee anaestlietists pacdiatric anaesthetic practice and would like to present data from ii further 1400 LMA uses. The primary aim o f this further study was to provide information about insertion and complication rates using the standard recommended insertion technique. A secondary aim was to assess factors leading to an increased risk of problems with LMA usage in infants and children using a limited range of stundaidiscd anaesthetic techniques. ,\~i,lll O d \A prospective survey of 1400 consecutive pacdiati-ic anaesthetics given by trainee anxsthetists in which the LMA W;IS the planned form of airway management was iindcrtitkcn at tlie Maranon University Hospital. Data from ;I previous prospective study determining skill acquisition were excluded from the analysis [7]. Ethics committee approval W;IS not obtained sincc all aspects of management wcrc part o f routine practice.Iletailcd records were kept of all LMA uses by trainee anacsthetists tising ii predesigned data sheet. All observations were made by tlie supervising consultant involved in the case wlio was trained in the sttidy protocol and problem definitions. The supervising consultants only intervened if the oxygen saturation decreased below W%,. All trainees were individually instructed in LMA tisagc and the study protocol by one of tlie authors. wlio also ensured that the study protocol was adhered to by const;int education and supervision. The decision to LISC the LMA in each patient was made by [he supervising consultant. ;is W;IS the mode of its use. These decisions were based on tlie requirements of individual patients and the prcfcrred choice of the supervising consultant within thc confines o f tlie study protocol. The LMA was not used In patients ;it I-isk of a s pi ration o r for in t 1-21 -;I bdom i n a I. thoracic. in Li-io r head and neck 01-vascular surgery. or patients who were ASA grade 4 o r 5.Data obtained included age, sex, ASA griide. anaesthetic technique, type and duration of surgery. LMA size ;ind tlie number of attempts required for succcssftil placement. The cumulative experience of the trainee with tlic LMA in paediatric practice and predelincd problems occurring d iir i ng i lid uc ti on. main tena nee and recovery were ;I 1 so documented. Induction was delined H S the start 01' iqjcction of propofol until the beginning of surgery. M...

The PLMA is an effective airway device in children and isolates the glottis from the esophagus when correctly positioned. Despite the lack of a dorsal cuff, the performance of the size 2 was similar to the size 3 PLMA in the age groups tested.

We conclude that all four tests provide accurate and reliable information about oropharyngeal leak pressure in children.

We conclude that ease of insertion, fibreoptic position, and frequency of mucosal trauma are similar for the PLMA and cLMA in children, but oropharyngeal leak pressure is higher and gastric insufflation less common for the PLMA. Gastric tube insertion has a high success rate, provided the PLMA is correctly positioned.

We conclude that bougie-guided insertion of the ProSeal LMA has a higher first attempt success rate than the digital technique in children.