Supraglottic airway devices in children

Abstract

Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children.

Comparison of sevoflurane concentration for insertion of proseal laryngeal mask airway and tracheal intubation in children (correlation with BIS)

“…Advantages of LMA over TI in paediatric patients have been studied previously. 1,2,7 Proseal LMA is superior to classic LMA in terms of higher seal pressure with safety of controlled ventilation in children. Paediatric PLMA with revised cuff profile and two tube results into more secure anchoring of the device in place.…”

“…These features make the PLMA ideal for use in children. 2 Thus safety and efficacy in paediatric patients have been increased. The PLMA has yet to be outperformed by any other SAD, making it premier SAD in children.…”

“…proseal LMA with higher seal pressure, has become the benchmark device. 2 Previous studies have shown that less sevoflurane is required for LMA insertion than laryngoscopy and tracheal intubation. 1,3,4 More recently BIS monitor is used as clinical marker of hypnosis and various workers have used BIS index to study the sevoflurane concentration.…”

Comparison of I-Gel and classic Laryngeal Mask Airway in paediatric population: a parallel group study

“…I-gel is a newer second generation supraglottic airway device with promising results. 1 The cLMA (classic laryngeal mask airway) is the earliest of supraglottic device discovered in 1983 by Archie Bains. It is recommended as a conduit in difficult airway guidelines and also used routinely for elective surgery and cardiopulmonary resuscitation.…”

A Comparative Study on Intraocular Pressure Changes on Insertion of Endotracheal Tube, Ambu Auragain and I-Gel in Paediatric Patients in Non-Ocular Surgeries

“…In cases of elective and difficult airway management, SADs are increasingly preferred due to their confirmed efficacy and safety [6] and nowadays they are used for maintenance of airway in paediatric patients too with lesser complications and failure rates compared to conventional laryngoscopy and intubation. [7,8] Among the supraglottic devices, various changes have been enforced to improve the perilaryngeal seal and reduce risk of aspiration. Also, sympathetic stimulation has been found lesser in second generation SADs.…”