Laryngeal mask insertion in children: a rational approach.
BACKGROUND
Various techniques of laryngeal mask airway (LMATM) insertion have been described in adults but only limited clinical trials have been conducted in children despite a varying range in success rate by the recommended method.


METHODS
The study was conducted in 62 ASA 1 and 2 children who were randomly allocated for the evaluation of LMA insertion by the midline approach with the cuff completely deflated (group MD, control group, n = 31) or laterally with the cuff partially inflated (group LP, study group, n = 31). Propofol was used as the sole induction agent in all children. Ease of insertion, position of the LMA with fibreoptic laryngoscope and incidence of stomach insufflation were assessed.


RESULTS
Fewer attempts and a significant reduction in the time for insertion was noted in group LP (14.4 +/- 4.2 s) compared with group MD (23.1 +/- 2.1 s), P < 0.05. Despite a good seal around the cuff and satisfactory ventilation a significantly higher incidence of malposition of the LMA was recorded by intraluminal fibreoptic endoscopy in group MD (13% to nil), P < 0.05. Similarly gastric insufflation was significantly greater in group MD (42% compared with 10%). In children with grade 3 fibreoptic view significantly higher endtidal carbon dioxide values were recorded throughout the study period after LMA insertion until its removal. LMA was stained with blood in 13% children in group MD compared with 3% in group LP at the time of removal.


CONCLUSIONS
A partially inflated cuff inserted by the lateral route is a better method of insertion in children and grade 3 fibreoptic views can be associated with a significant build up of carbon dioxide in children breathing spontaneously.
Kundra
Pankaj
P
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. pankajkundra@satyam.net.in
Deepak
R
R
Ravishankar
M
M
D000776:Anesthesiology / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D017214:Laryngeal Masks; D007828:Laryngoscopy; D008297:Male; D015742:Propofol / Q000627:therapeutic use; D013997:Time Factors
D018686:Anesthetics, Intravenous; D002245:Carbon Dioxide; D015742:Propofol