Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway

Webster, A. C.; Morley-Forster, Pat; Dain, Steven; Ganapathy, S.; Ruby, R. R. F.; Au, A.; Cook, Mary Jo

doi:10.1007/bf03009607

Cited by 125 publications

(106 citation statements)

References 16 publications

(1 reference statement)

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“…Finally, the prone position and airway surgery were considered to be contraindications to the LMA because of difficulty in airway management in the event of complications during surgery. Although there are studies that show that the LMA can be effective in these conditions [28][29][30], data about safety are lacking.…”

Section: Discussionmentioning

confidence: 99%

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

Bernardini¹,

Natalini

2009

Anaesthesia

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SummaryWe compared the risk of pulmonary aspiration in patients whose lungs were mechanically ventilated through a laryngeal mask airway (35 630 procedures) or tracheal tube (30 082 procedures). Three cases of pulmonary aspiration occurred with the laryngeal mask airway and seven with the tracheal tube. There were no deaths related to pulmonary aspiration. The incidence and outcome of pulmonary aspiration detected in this study were similar to those previously reported. The adjusted odds ratio (OR) for pulmonary aspiration with the laryngeal mask airway was 1.06 (95% CI 0.20-5.62). Unplanned surgery (OR 30.5,) and male sex (OR 8.6, 95% CI 1.1-68) were associated with an increased risk of aspiration and age < 14 years with a reduced risk (OR 0.21, 95% CI 0.07-0.64). There were contraindications and exclusions to the use of the laryngeal mask airway but in this selected population the use of an laryngeal mask airway was not associated with an increased risk of pulmonary aspiration compared with a tracheal tube.

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Section: Discussionmentioning

confidence: 99%

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

Bernardini¹,

Natalini

2009

Anaesthesia

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“…2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.…”

mentioning

confidence: 99%

“…2 Il a été démontré que les craintes initiales concernant l'utilisation du LMA TM pour les interventions au niveau de la tête et du cou étaient largement sans fondement. Par exemple, il a été démontré que le LMA TM était sécuritaire et efficace lors de son utilisation en chirurgie ophtalmologique et pour des amygdalectomies chez les enfants 3,4 ; de telles situations nécessitent toutefois un chirurgien qui sache reconnaître que la trachée n'est pas intubée.…”

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Supraglottic airways in children: past lessons, future directions

Cox

Lardner

2009

Can J Anesth/J Can Anesth

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The first prototype of the laryngeal mask airway (LMA TM ) was used clinically in the summer of 1981 at Ashford, Kent, UK, by Dr. Archie Brain. Dr. Brain followed in the worthy footsteps of Clover, O'Dwyer, Shipway, Leech, and others in developing a supraglottic airway to facilitate the delivery of anesthetic gases via a reliable supraglottic airway. 1 The LMA TM was released in the UK in 1988 and in the USA in 1992. Since the original range of pediatric LMAs TM was soon found to be inadequate to address all children's sizes, half-sizes (1.5 and 2.5) were developed. As with adult practice, the LMA TM and other supraglottic airways have radically changed pediatric anesthesia practice and have become a key component of airway management in children, both in the operating room and in remote anesthesia locations. These devices have increasingly been advocated for emergency airway control in the field, in the emergency department, and in the delivery suite. So what have we learned about pediatric supraglottic airways over the past two decades and where does the future lie with respect to these devices?Much of the published research in this area relates to the LMA Classic TM . From the clinical anesthesiologist's perspective, the following questions relating to the LMA Classic TM are important: When should it be used (patient and procedure related factors), how should it be used, and when should an alternative device be used?Indications for the use of the LMA Classic TM are extensive, and it is often the airway of choice in routine general anesthesia for minor procedures in children. In a prospective study of 1,400 children who had LMA TM -based anesthesia conducted by supervised trainees, the device was found to be highly effective for a broad range of surgical procedures, and there was no instance where the LMA TM had to be replaced with an endotracheal tube (ETT). 2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.Pediatric anesthesia is increasingly being delivered in areas outside the operating room where the LMA TM has been proven to be particularly valuable. For instance, the LMA TM has been used for radiotherapy, 5 magnetic resonance imaging, 6 fibreoptic bronchoscopy, 7 and upper gastrointestinal endoscopy. 8 Its relative stability combined with the ease of respiratory monitoring and the relative lack of airway complications are distinct advantages in these remote locations.One clinical scenario of particular interest is the difficult pediatric airway. Here the LMA TM has proven to be invaluable both as a rescue airway device in the child with a difficult airway and as a conduit for fibreoptic bronchoscopy and endotracheal intubation. 7 Consequently, the LMA TM has a role in both anticipated and unanticipated difficu...

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“…The incidence of post-extubation complications was reduced but not eliminated by using the less invasive laryngeal mask airway [9].…”

Section: Discussionmentioning

confidence: 99%

Can i-gel Replace Endotracheal Tube during Elective Cesarean Section?

Amin¹,

Fathy²

2016

J Anesth Clin Res

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Anaesthesia for adenotonsillectomy: A comparison between tracheal intubation and the armoured laryngeal mask airway

Cited by 125 publications

References 16 publications

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

Supraglottic airways in children: past lessons, future directions

Can i-gel Replace Endotracheal Tube during Elective Cesarean Section?

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