Radiologic Localization of the Laryngeal Mask Airway in Children

Goudsouzian, Nishan G.; Denman, William T.; Cleveland, Robert H.; Shorten, George

doi:10.1097/00000542-199212000-00007

Cited by 101 publications

(70 citation statements)

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“…7 In children especially, down folding of the epiglottis, obscuring, but not obstructing the glottis, is a common finding on a fibrescope view through the LMA. 8,9 The size 2 PLMA differs from the adult PLMA not only in size but in design. It has an esophageal drain tube, an integrated bite block and a detachable metal introducer, but lacks the dorsal cuff extension which is thought to be important in maintaining pharyngeal seal during IPPV.…”

Section: Méthodementioning

confidence: 99%

Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade

Lardner

Cox

Ewen

et al. 2008

Can J Anesth/J Can Anesth

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CAN J ANESTH 55: 1 www.cja-jca.org Januar y, 2008Purpose: To determine whether a functional difference exists between the size 2 laryngeal mask airway (LMA)-Classic™ (CLMA) and LMA-Proseal™ (PLMA) in anesthetized children who have received neuromuscular blockade. Airway leak during intermittent positive pressure ventilation (IPPV) and adequacy of fibreoptic laryngeal view were the primary study outcomes. Methods:A randomized, controlled, single-blinded study of 51 ASA I or II children weighing 10-20 kg was undertaken. The anesthetic technique was standardized. Following insertion of the LMA and cuff inflation to 60 cm H 2 O, we measured oropharyngeal leak pressure and gastric insufflation and leak fraction during IPPV, and evaluated the adequacy of fibreoptic view.Results: Oropharyngeal leak pressure measured by neck auscultation was higher for the PLMA compared to the CLMA (23.7 vs 16.5 cm H 2 O, P = 0.009) but, when measured by the inspiratory hold maneuver was not significantly different (24.8 vs 20.3 cm H 2 O, respectively, P = 0.217). Leak fraction values were similar for the CLMA and the PLMA (21.2%. vs 13.3%, respectively, P = 0.473). A satisfactory view of the larynx was obtained more frequently in the PLMA group (21/25 vs 10/25, P = 0.003). Gastric insufflation during leak determination was more common with the CLMA (12/26 vs 2/25 CLMA vs PLMA, respectively, P = 0.006). Conclusion:In children undergoing IPPV with neuromuscular blockade, the size 2 PLMA is associated with a higher leak pressure by auscultation and less gastric insufflation compared to the CLMA. Leak pressures assessed by manometric stability are similar with these two devices. The improved fibreoptic view of the larynx through the PLMA may be advantageous for bronchoscopy. CLMA (23,7 vs 16,5 cm H 2 O, P = 0,009) ; toutefois, lorsque celle-ci a été mesurée par manoeuvre de retenue respiratoire, il n'y a pas eu de différence significative (24,8 vs 20,3 cm H 2 O, respectivement, P = 0,217). Les valeurs de fraction de fuite étaient semblables avec le CLMA et le PLMA (21,2 % vs 13,3 %, respectivement, P = 0,473). Une vision satisfaisante du larynx a été plus fréquemment obtenue dans le groupe PLMA (21/25 vs 10/25, P = 0,003). L'insufflation gastrique pendant la détermination de la fuite a été plus fréquemment observée dans le groupe CLMA (12/26 vs 2/25 CLMA vs PLMA, respectivement, P = 0,006).

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Section: Méthodementioning

confidence: 99%

Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade

Lardner

Cox

Ewen

et al. 2008

Can J Anesth/J Can Anesth

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“…There is speculation from the present investigation that potentially could result in the correlation of these novel ENLs and individual patient demographic factors. Laryngeal morphology is complex with many variables which should be taken into consideration in order to accurately predict such laryngeal structure and airway size, as well as appropriate sizing of EADs [15][16][17], and further studies are currently under investigation, with some given preliminary results [18][19].…”

Section: Discussionmentioning

confidence: 99%

External neck landmark identification and measurement correlation in a normal weight cohort

Cattano¹,

Wojtczak²,

Callender³

et al. 2014

J Anesthesiol Clin Sci

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Background: Airway management, including proper airway devices sizing, is dependent on airway features, which ultimately should correlate with body features: unfortunately such correlation has been inconsistent. The aim of this study was to determine the correlation of normal values of several external neck landmark (airway features) measurements with with age, gender, height and weight (body features) for normal weight adult subjects to establish a consistent correlation. Methods: After IRB approval, 200 subjects (100 male and 100 female) were enrolled. External neck landmarks were measured using a measuring tape. Measurements were also assessed by digital caliper to compare marginal errors. Only non-obese (BMI≤30 kg/m²) adults presenting for preoperative anesthesia assessment were screened.

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“…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].…”

Section: ó 2008 the Authorsmentioning

confidence: 99%

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

et al. 2008

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SummaryWe prospectively assessed common clinical endpoints for their usefulness in avoiding hyperinflation of the cuffs of laryngeal mask airways (slight outward movement) and tracheal tubes (disappearance of an audible leak around the cuff during manual ventilation < 20 cmH 2 O) in 640 children. Cuff pressures were measured at induction and immediately before emergence from anaesthesia. With the laryngeal mask airway (sizes 1-4), the median cuff pressures ranged from 90 to > 120 cmH 2 O at induction and 105 to > 120 cmH 2 O before emergence. With tracheal tubes (sizes 3-7 mm), median cuff pressures were 40-60 cmH 2 O at induction and 45-70 cmH 2 O at emergence. With the use of nitrous oxide a consistent rise in cuff pressure was observed between the first and second readings whereas cuff pressures remained constant when nitrous oxide was not used. The use of clinical endpoints alone was associated with significant hyperinflation of cuffs with both devices in almost all patients, with an exacerbation when nitrous oxide was used. In order to avoid unnecessary cuff hyperinflation in laryngeal mask airways and tracheal tubes, the routine use of cuff manometers is mandatory in children.

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Radiologic Localization of the Laryngeal Mask Airway in Children

Cited by 101 publications

References 0 publications

Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade

Comparison of laryngeal mask airway (LMA)-Proseal™ and the LMA-Classic™ in ventilated children receiving neuromuscular blockade

External neck landmark identification and measurement correlation in a normal weight cohort

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

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