Complications and Fiberoptic Assessment of Size 1 Laryngeal Mask Airway

Abstract

In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. The following complications were recorded: cough, laryngospasm, bronchospasm, apnea, and airway obstruction. In 14 patients in the size 1 LMA group and 26 patients in the size 2 LMA group, pharyngolaryngeal structures were checked with fiberoptic examination. The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.

Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation?

“…Many morbidities arise from reduced mucosal blood flow because of the raised intracuff pressure and high filling volumes [3,4]. Although the laryngeal mask airway sealing pressure is higher in smaller sized devices [15][16][17][18], a correlation between sealing pressure and position of the cuff has not been established [19]. Moreover, adequacy of ventilation does not necessarily correlate with ideal positioning based both on fibreoptic and radiological assessment [3,4,14].…”

The Role of Supraglottic Airways in Pediatric Emergency Medicine

“…Epiglottic downfolding is often seen with fiberoptic views of the larynx after SGA placement and can result in anatomic obstruction to the larynx, but this rarely causes functional obstruction (inadequate ventilation). 14,15 The mask portion of the air-Q contains an elevated keyhole-shaped ventilating orifice designed to prevent epiglottic downfolding; however, this downfolding may still occur in placement of air-Qs in smaller children. 16 The air-Q was also designed to facilitate tracheal intubation.…”

Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review

“…53,54 The use of airway exchange catheters and guidewires requires a series of additional steps that may be impractical in smaller children who physiologically show lower cardiopulmonary reserve than older children and adults. 55 In addition, the AIC is not available for pediatric patients.…”