Laryngeal mask airway for ventilation during diagnostic and interventional fibreoptic bronchoscopy in children.
BACKGROUND
The use of the flexible fibreoptic bronchoscope in infants and children has expanded to include both interventional and diagnostic bronchoscopy. The present report utilizes the laryngeal mask airway (LMATM) for ventilation and anaesthesia administration in children during fibreoptic bronchoscopy using an adult bronchoscope.


METHODS
The technique was used in 10 children; their age ranged between 1.2 and 5 years. Six of these children had a history of foreign body aspiration and underwent interventional bronchoscopy, while four children underwent diagnostic bronchoscopy. Anaesthesia was induced by facemask using sevoflurane 6-8% followed by the insertion of a LMA size 2 or 2.5. A swivel adapter connected the proximal end of the LMA to the T-piece anaesthesia system. Anaesthesia was then maintained with spontaneous breathing of sevoflurane 2-4% in oxygen, delivered via the LMA. A flexible adult fibreoptic bronchoscope (outer diameter 4.9 mm) was inserted via the swivel adapter.


RESULTS
The procedure could be accomplished successfully in the 10 patients. However, one child developed laryngospasm that was easily relieved by deepening the level of anaesthesia. In a second child hypoxia and hypercarbia occurred and were relieved by intermittent withdrawal of the fibreoptic bronchoscope.


CONCLUSIONS
Laryngeal mask airway is a safe and effective adjunct to fibreoptic bronchoscopy under general anaesthesia in children. Its larger internal diameter compared with a tracheal tube permits the use of relatively large fibreoptic bronchoscope without a significant increase in airway resistance.
Yazbeck-Karam
Vanda G
VG
Clinique Dr Rizk, American University of Beirut Medical Center, Beirut, Lebanon.
Aouad
Marie T
MT
Baraka
Anis S
AS
D000402:Airway Obstruction / Q000601:surgery / Q000628:therapy*; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D002675:Child, Preschool; D005336:Fiber Optic Technology; D005547:Foreign Bodies / Q000601:surgery; D006801:Humans; D007223:Infant; D001239:Inhalation / Q000502:physiology; D017214:Laryngeal Masks; D008171:Lung Diseases / Q000175:diagnosis*; D008738:Methyl Ethers / Q000627:therapeutic use; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane