Positive Pressure Ventilation with the Laryngeal Mask Airway in Children

Abstract

We studied the safety of positive pressure ventilation (PPV) when using the size 2 laryngeal mask airway (LMA) in 46 ASA physical status I or II children (aged 38 +/- 21 mo) undergoing elective surgery. The LMA cuff was inflated in incremental steps to achieve a cuff leak pressure > or = 15 cm H2O. Abdominal circumference was measured before and after PPV in study patients, as well as in a control group managed with tracheal intubation. Cuff leak pressure was 17 +/- 4 cm H2O (range 12-34 cm H2O). Forty-five patients successfully underwent PPV. Gas leak around the LMA cuff prevented PPV in one infant. The only respiratory variable that changed significantly was end-tidal CO2, which decreased from 40 +/- 6 to 34 +/- 5 mm Hg. Abdominal circumference increased in 28 patients but was not associated with any complications. Change in abdominal circumference in the study group was not significantly different from that observed in the control group. However, abdominal circumference increased 8 cm in one study patient, prompting insertion of an orogastric tube. The size 2 LMA provides an effective airway for PPV. Mild gastric distention often occurs. The risk of clinically significant gastric distention appears to be small, but it warrants close monitoring. We conclude that with certain precautions described in the text, the size 2 LMA provides a relatively safe airway for PPV in children.

Insertion characteristics, sealing pressure and fiberoptic positioning of CobraPLA in children

“…Our results confirm an overall median airway sealing pressure of 20 cmH 2 O in paralyzed children, although there was a large interindividual variability (14 to more than 30 cmH 2 O). Positive pressure ventilation (PPV) using the LMA in children has been described as a safe technique (13)(14)(15)(16), but there is a continuing controversy regarding gastric air insufflation during PPV using a supraglottic device in this patient population (11,17,18). However, assisted or controlled ventilation with a supraglottic device is frequently necessary during anesthesia to treat excessive respiratory depression or to deepen the level of anesthesia.…”

Comparison of the CobraPLATM (Cobra Perilaryngeal Airway) and the Laryngeal Mask Airway UniqueTM in children under pressure controlled ventilation

“…Several studies have shown that the LMAC can be used to manage the airways of pediatric patients during general anesthesia with safety and efficacy (5,6). However, this re-usable device has some limitations, especially with concern to its low pressure seal that might be inadequate for positive pressure ventilation (7). A leak in some cases may cause gastric distention with a risk of regurgitation (7).…”

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

“…In a subsequent attempt to verify the importance of this finding, Joshi et al (16) inserted, 15 cmH 2 O, the value considered critical to prevent gastric insufflation (22). Abdominal expansion may also in adult patients, pH probes at the hypopharyngeal level, since they postulated that the occur during ventilation with intermittent positive pressure through the LMA, but the risk of important clinical significance of the gastric regurgitation was stronger at the hypopharyngeal level than in any gastric insufflation seems to be rare (23) and we found only one case with this complication in our other section of the oesophagus, but did not detect any episodes of reflux at this level. We could not tell study.…”