Supraglottic airways in children: past lessons, future directions

Abstract

The first prototype of the laryngeal mask airway (LMA TM ) was used clinically in the summer of 1981 at Ashford, Kent, UK, by Dr. Archie Brain. Dr. Brain followed in the worthy footsteps of Clover, O'Dwyer, Shipway, Leech, and others in developing a supraglottic airway to facilitate the delivery of anesthetic gases via a reliable supraglottic airway. 1 The LMA TM was released in the UK in 1988 and in the USA in 1992. Since the original range of pediatric LMAs TM was soon found to be inadequate to address all children's sizes, half-sizes (1.5 and 2.5) were developed. As with adult practice, the LMA TM and other supraglottic airways have radically changed pediatric anesthesia practice and have become a key component of airway management in children, both in the operating room and in remote anesthesia locations. These devices have increasingly been advocated for emergency airway control in the field, in the emergency department, and in the delivery suite. So what have we learned about pediatric supraglottic airways over the past two decades and where does the future lie with respect to these devices?Much of the published research in this area relates to the LMA Classic TM . From the clinical anesthesiologist's perspective, the following questions relating to the LMA Classic TM are important: When should it be used (patient and procedure related factors), how should it be used, and when should an alternative device be used?Indications for the use of the LMA Classic TM are extensive, and it is often the airway of choice in routine general anesthesia for minor procedures in children. In a prospective study of 1,400 children who had LMA TM -based anesthesia conducted by supervised trainees, the device was found to be highly effective for a broad range of surgical procedures, and there was no instance where the LMA TM had to be replaced with an endotracheal tube (ETT). 2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.Pediatric anesthesia is increasingly being delivered in areas outside the operating room where the LMA TM has been proven to be particularly valuable. For instance, the LMA TM has been used for radiotherapy, 5 magnetic resonance imaging, 6 fibreoptic bronchoscopy, 7 and upper gastrointestinal endoscopy. 8 Its relative stability combined with the ease of respiratory monitoring and the relative lack of airway complications are distinct advantages in these remote locations.One clinical scenario of particular interest is the difficult pediatric airway. Here the LMA TM has proven to be invaluable both as a rescue airway device in the child with a difficult airway and as a conduit for fibreoptic bronchoscopy and endotracheal intubation. 7 Consequently, the LMA TM has a role in both anticipated and unanticipated difficu...

ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures

“…[1] There are limitations of Classic LMA (air leak, gastric distension and aspiration). In ProSeal LMA, there is presence of drain tube, integral bite block[1] and different cuff design, increased depth of the bowl to improve the seal with the larynx,[4] from CLMA.…”

“…Hence, the 100% first attempt success in their study where difficult airways were excluded was an occurrence on expected lines. The different morphology of PLMA from the CLMA and after deflation the semirigid distal end of drain tube[1] of PLMA may contribute to difficult insertion.…”

“…[1] An endotracheal tube (ET) is always considered to be the gold standard[23] device to maintain an airway because of its inherent ability to provide positive pressure ventilation (PPV) and to prevent occurrences of gastric inflation and pulmonary aspiration. [3] Haemodynamic responses, situations of failed intubation and damage to the oropharyngeal structures[3] during intubation are also a serious concern.…”

Successful Tracheal Intubation through an Intubating Laryngeal Airway in Pediatric Patients with Airway Hemorrhage

“…A supraglottic airway device can be used as a rescue airway for oxygenation and ventilation when traditional bag mask ventilation or tracheal intubation is difficult to perform (4,18). In pediatric patients, the most widely used and researched supraglottic airway for airway rescue is the cLMA (19,20). The proseal LMA (pLMA) is another supraglottic airway device used for airway rescue.…”

Comparing the Laryngeal Mask Airway, Cobra Perilaryngeal Airway and Face Mask in Children Airway Management

“…Her ikisi arasında farklılık olmadığı, ancak derin ekstü-basyon sonrası hipoksi ve öksürüğün daha az olduğu bildirilmiştir (16). Ekstübasyon sonrası yutma güçlüğü, öksürük, ses kısıklığı, laringospazm ve mukoza travmasına bağlı hiperemi, kanama gibi komplikasyonlar gözlenebilir (9,18).…”