title: Clinical assessment of the laryngeal tube in pediatric anesthesia.
abstract: BACKGROUND
  The aim of this study was to evaluate a new device for airway management in children: the laryngeal tube (LT).
  
  
  METHODS
  The LT is available in sizes S0-S3 for pediatric anesthesia. This prospective open study included 70 children ASA 1. The local Ethics Committee approval and parental consent were collected. The primary criterion was the success rate for insertion and ventilation. Secondary criteria were additional maneuvers and incidents elicited from LT use.
  
  
  RESULTS
  Seventy children were included: S0 = 5, S1 = 8, S2 = 36, and S3 = 21. Insertion was successful: at the first attempt in 78.6%, second in 17.1%, and third or more in 4.3%. In 12% of cases it was not possible to successfully insert the LT and proceed to adequate ventilation. Failures were explained by: inability to obtain satisfying ventilation (n = 4), hypoxemia (n = 1), gastric insufflation (n = 6), cough (n = 1), and laryngospasm or stridor (n = 2), some with the same child. Minimal additional maneuvers for adequate ventilation were necessary in 35% of cases (all groups), but <20% when considering only sizes 2 and 3. Moreover, after five cases, the anesthesiologists became more proficient at inserting the LT (respectively 73.3% failure before five cases vs 13% afterwards). Gastric insufflation occurred in eight cases (11.4%). Controlled ventilation was used in 30 children and peak inspiratory pressure was 19.2 +/- 4 cmH(2)O.
  
  
  CONCLUSIONS
  The LT is not recommended for children <10 kg. Over 10 kg, it provides a clear airway in most children, with a low rate of minimal additional maneuvers for sizes 2 and 3. The failure rate also decreases with the operator's training.
authors.affiliation: Department of Anaesthesiology 3, Hôpital Saint André, Centre Hospitalier et Universitaire de Bordeaux, Bordeaux Cedex, France. philippe.richebe@chu-bordeaux.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Richebé
authors.forename: François
authors.initials: F
authors.lastname: Semjen
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Cros
authors.forename: Pierre
authors.initials: P
authors.lastname: Maurette
mesh_terms: D000293:Adolescent; D000769:Anesthesia, Inhalation; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D007830:Larynx; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome