Home About SPA Join SPA Education Newsletter Jobs & Fellowships Volunteer Service Abroad Links of Interest

SPA Newsletter

.

Laryngeal mask insertion in children: a rational approach

Summary. The authors compared two methods of LMA insertion in children 4 months-12 years: the classic midline approach with a deflated cuff originally described by Brain (MD) and a 45ø lateral approach with a partially inflated cuff using 1/2 the recommended inflation volume (LP). The number of insertion attempts, time to insertion, and complications on insertion were noted by an observer not involved in the study. After placement, a blinded observer assessed the ability to ventilate with a Jackson Reese circuit, degree of air leak at 20 cm H20, LMA positioning by fiberoptic endoscopy, and gastric insufflation by auscultation. Finally, the LMA was inspected for blood after removal.

Sixty-five percent of patients had insertion of a #2 LMA. All patients were easy to ventilate and 97% had a good seal. Insertion using the LP technique took less time (14 vs 23 sec). The LMA was malpositioned in 13% of MD patients vs 0 LP patients and these patients had significant increases of ETCO2 as their cases progressed compared with the other patients. The stomach was insufflated in 42% of MD patients vs 10% of LP patients. Blood was noted on the LMA in 13% MD vs 3% of LP patients. The authors attribute the superior results with the LP technique to two factors: 1. pushing the tongue to the side helps with managing the relative macroglossia of childhood, and 2. partial inflation of the cuff helps the LMA negotiate the posterior oropharyngeal curve.

Comment. Although this study is small, it was well designed, written and referenced. The authors caution against using a 90ø rotation insertion method as this may damage the anterior pillars or hypertrophied tonsils. Notably, the age limit likely excluded the use of the #1 LMA which has been shown in other studies to have a higher complication rate. The results are convincing that the lateral approach with partial filling of the cuff is the best way to go!

Table of Contents

• President's Message
• Editor's Corner
• Joint Meeting of SPA and JSPA
• Out and About the ASA
  • Pediatric Clinical Forum at ASA
  • Pediatric Panel: Pediatric Pain Management
  • Controversies in Malignant Hyperthermia, Cases from the MH Hotline
  • American Academy of Pediatrics Secion on Anesthesiology Breakfast Panel
  • Tuesday Morning general Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia
• American Academy of Pediatrics Section on Anesthesia and Pain Medicine Update
• Fellows Corner
  • Non-ACGME Approved Fellowship Training Programs for Pediatric Anesthesia
• WEB ONLY
  • SPA Governmental Affairs Committee Report
  • Literature Review: Hyperkalemia and Pyloric Stenosis
  • Literature Review: Early Exposure to Common Anesthetic Agents Causes Widespread Neurodegeneration in the Developing Rat Brain and Persistent Learning Deficits
  • Laryngeal mask insertion in children: a rational approach
  • Remifentanil Infusion for Cleft Palate Surgery in Young Infants
  • Tuesday Morning General Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia

  ---

  Newsletter Archive