Laryngeal mask insertion in children: a rational approach

Kundra, Pankaj; Ravindran, Deepak; Ravishankar, M

doi:10.1046/j.1460-9592.2003.01134.x

Cited by 36 publications

(42 citation statements)

References 12 publications

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“…The current investigation has addressed this by using the lateral insertion technique [10], which has a higher reported success rate in children [9,10] than the Brain's technique. Despite making this change, the rate of successful LMA insertion remains similar to that we previously reported, and comparable to success rates reported for adult cardiac arrest [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…This consisted of a 1-h session, during which nurses used manikins to refresh their skills with bag ⁄ mask ventilation, followed by training in LMA insertion using the lateral approach [10]. The nurses were trained at intervals during the study period, in groups of no more than five.…”

Section: Methodsmentioning

confidence: 99%

“…Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to be representative of first responders.…”

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confidence: 99%

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confidence: 99%

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A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Blevin¹,

McDouall²,

Rechner³

et al. 2009

Anaesthesia

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In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39-65 [8-149])) s than the facemask ⁄ airway (35 (25-53 [14-120]) s; p < 0.0001). In 10 cases (10%) the lungs were ventilated using the laryngeal mask airway but not using the facemask ⁄ oropharyngeal airway. We conclude that ventilation is achieved rapidly using a facemask and oropharyngeal airway, and that the laryngeal mask airway may represent a useful second line option for first responders. The laryngeal mask airway (LMA) has been advocated as a device for airway management during the resuscitation of adults following cardiopulmonary arrest [1] but its role in the resuscitation of children is less clear. Tracheal intubation, the gold standard for securing the airway, is a difficult skill to acquire and maintain and can lead to further complications if an unsuccessful intubation is not recognised [2,3]. In contrast, insertion of the LMA can be learnt quickly and easily by inexperienced personnel [2, 4-6]; however, the LMA is not currently recommended for first line airway management in children requiring resuscitation [7].In an attempt to establish the utility of the LMA during resuscitation of children by first responders untrained in tracheal intubation, we have previously studied paediatric critical care nurses [8]. Their ability to ventilate the lungs of an apnoeic, anaesthetised child using an LMA was compared with that using a facemask and oropharyngeal airway. We found no difference in the efficacy of ventilation between the two methods; however, ventilation with the LMA took significantly longer to achieve. Two main limitations of that study are first, the practitioners were relatively experienced with facemask ventilation and as such may not be representative of first responders to cardiopulmonary arrests in children. Second, the method of LMA insertion that was taught was the method advocated by Brain in adults and this may not be optimal, studies having shown that the lateral insertion technique has a higher success rate in children [9][10][11].In view of these limitations we have repeated our randomised crossover trial, comparing the LMA with the facemask and oropharyngeal airway for manual ventilation of the lungs of apnoeic anaesthetised children. We studied ward based paediatric nurses as our cohort of practitioners as we felt their skills were more likely to...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Blevin¹,

McDouall²,

Rechner³

et al. 2009

Anaesthesia

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“…The LMA direct and rotational technique with a partially inflated cuff was demonstrated 8 9. All participants were informed of the purpose of the study and the goals of the resuscitation simulations, including the timely and correct positioning of the SADs.…”

Section: Methodsmentioning

confidence: 99%

A comparison of three supraglottic airway devices used by healthcare professionals during paediatric resuscitation simulation

et al. 2012

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Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement

Malik

Arora

Kakkar

et al. 2023

J of Ultrasound Medicine

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Objectives 1) To compare ultrasound (US) examination and fiberoptic laryngoscopy (FOL) for confirmation of laryngeal mask airway (LMA) placement. 2) To evaluate the necessity for reinsertion of LMA based on FOL. Methods This prospective observational study included 100 adult patients of American Society of Anesthesiologists (ASA) Grade I and II, undergoing elective surgery under General Anesthesia requiring Proseal LMA™ placement as an airway device. LMA placement was first confirmed by clinical tests. Clinically acceptable patients were further assessed by US and categorized as acceptable (US‐A) or unacceptable (US‐U) and again by FOL as (FOL‐A and FOL‐U). Categorical variables presented in number, percentage (%), and continuous variables presented as mean ± SD and median. Inter‐rater kappa agreement was used to find out the strength of agreement of acceptability between FOL and US. Results The LMA placement was clinically acceptable in 82% of patients on first attempt. FOL had 63% (FOL‐A) acceptable LMA placement as compared with US examination which had 56% (US‐A). In 85% of patients, US and FOL findings were in good agreement with each other for LMA placement (κ = 0.690 and P < .05). In all patients of FOL of unacceptable (FOL‐U) category (37%), LMA was replaced with endotracheal tube. Conclusion US provides a safe, non‐invasive, and real‐time dynamic assessment with 85% diagnostic accuracy for confirmation of LMA placement as compared with FOL.

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Laryngeal mask insertion in children: a rational approach

Abstract: A partially inflated cuff inserted by the lateral route is a better method of insertion in children and grade 3 fibreoptic views can be associated with a significant build up of carbon dioxide in children breathing spontaneously.

Cited by 36 publications

References 12 publications

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

A comparison of three supraglottic airway devices used by healthcare professionals during paediatric resuscitation simulation

Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement

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