Use of laryngeal mask airway in flexible bronchoscopy in infants and children

Naguib, M.; Streetman, Daniel S.; Clifton, Shelley; Nasr, Samya Z.

doi:10.1002/ppul.20139

Cited by 49 publications

(35 citation statements)

References 23 publications

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“…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.…”

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confidence: 99%

“…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 difficult airways, and it now features in pediatric difficult intubation algorithms. 9 Even if tracheal intubation is difficult in a child, it must be remembered that the airway is often easy to manage with an LMA TM .…”

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confidence: 99%

“…Dans une telle situation, le LMA TM s'est avéré un outil précieux, tant comme instrument de sauvetage chez un enfant présentant des voies aériennes difficiles que comme conduit pour réaliser une bronchoscopie par fibres optiques ou une intubation endotrachéale. 7 Par conséquent, le LMA TM joue un rôle important dans l'accès difficile aux voies aériennes, anticipé ou non; il figure désormais parmi les algorithmes pour l'intubation difficile chez les enfants. 9 Même si l'intubation trachéale est difficile chez un enfant, il faut garder à l'esprit que les voies aériennes sont souvent faciles à prendre en charge avec un LMA TM .…”

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Supraglottic airways in children: past lessons, future directions

Cox

Lardner

2009

Can J Anesth/J Can Anesth

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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...

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Supraglottic airways in children: past lessons, future directions

Cox

Lardner

2009

Can J Anesth/J Can Anesth

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“…Nussbaum et al [9] studied FB via the LMA in a group of children and concluded that the procedure had been well-tolerated in them and that no complication emerged. Naguib et al [2] demonstrated in 1947 procedures that FB through the LMA rendered the lowest rate of overall procedure-related complications when compared to other routes (nasal or endotracheal entubation). The LMA may complicate the assessment of the upper airway abnormalities such as laryngomalacia as a disadvantage.…”

Section: Discussionmentioning

confidence: 99%

“…No certain contraindications for bronchoscopy were noted [1]. The laryngeal mask airway (LMA) has been used since 1983, and the use of bronchoscopy via the LMA of infants and children has increased with the availbility of smaller sizes of the LMA [2]. We performed FB with a 3.7 mm bronchoscope via the LMA in a 75-day-old 1910 g premature baby with atelectasis.…”

Section: Introductionmentioning

confidence: 99%

Flexible Fiberoptic Bronchoscopy Through the Laryngeal Mask Airway in a Small Premature Infant

Gedik¹,

Çakır²,

Topuz³

2015

Turk Thorac J

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Flexible bronchoscopy (FB) can be used safely for wider indications in children. Ultra-thin bronchoscopes are used for premature or newborn infants and are of limited diagnostic value. Bronchoscopes with a suction channel, may lead to problems when the nasal passage is narrow, particularly in patients under 2.5 kg. In addition, it may cause bronchospasm and hypoxia in small infants during the procedure because of an almost complete obstruction of the airway. A laryngeal mask airway (LMA) may prevent both bronchospasm and hypoxia because it does not need a nasal route. In addition, the LMA allows positive pressure ventilation during the procedure. We performed FB with a 3.7 mm bronchoscope through the LMA in a 75-day-old and 1910 g premature baby with atelectasis. This is the first and successful FB experience in such a small premature infant reported in the literature using a 3.7 mm bronchoscope through the LMA. INTRODUCTIONFlexible endoscopy of pediatric airways was first reported in 1978. Since then, the technique has continued to develop, and the number of flexible bronchoscopy (FB) procedures in pediatric patients has increased with the availability of smaller devices. FB in children of the age group of 0-18 years can be used safely for wider indications in children of different weights and ages. Pediatric airway bronchoscopy may involve the inspection of the nose, pharynx, larynx, trachea, and bronchi. Diagnostic indications include the evaluation of stridor, an unexplained or persistant wheeze or cough, possible malformations, recurrent atelectasis or infiltrations, hemoptysis, and collection of specimens. No certain contraindications for bronchoscopy were noted [1]. The laryngeal mask airway (LMA) has been used since 1983, and the use of bronchoscopy via the LMA of infants and children has increased with the availbility of smaller sizes of the LMA [2]. We performed FB with a 3.7 mm bronchoscope via the LMA in a 75-day-old 1910 g premature baby with atelectasis. This is the first and successful FB experience in such a small premature infant reported in the literature using a 3.7 mm bronchoscope through the LMA.

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