title: Ease of insertion of the laryngeal mask airway in pediatric surgical patients: Predictors of failure and outcome.
abstract: BACKGROUND
  Laryngeal mask airway (LMA) is an useful alternative to endotracheal tube for airway management. The risk of life-threatening adverse respiratory events during its use is rare, but we need to know about the risk-adjusted prediction of its insertion failure requiring rescue tracheal intubation and its impact on patient outcome.
  
  
  METHODS
  Five hundred patients; 6 months to 12-year-old, American Society of Anesthesiologists I and II scheduled to undergo elective surgical procedures that require general anesthesia were included in this study. LMA was inserted after induction of anesthesia. The insertion conditions, intra, and postoperative events were recorded. Our primary outcome variable was trial success from the first time.
  
  
  RESULTS
  We recorded 426 cases (85.2%) of first trial success with clear airway compared to 46 case (9.2%) of second trial success (P ≤ 0.001). Predictors of failure of first attempt of LMA insertion include abnormal airway anatomy (91%), body weight <16 kg and age below 5 years (44%), the use of LMA size of 1 and 1.5 (3.8%), the intraoperative lateral position (3.8%).
  
  
  CONCLUSIONS
  The data obtained from this study support the use of the LMA as a reliable pediatric supraglottic airway device, demonstrating relatively low failure rates. Predictors of LMA failure in the pediatric surgical population should be independently considered.
  
  
  BACKGROUND
  The study is registered in the Australian and New Zealand clinical trial registry with the allocated trial number: ACTRN12614000994684. Web address of trial: http://www.ANZCTR.org.au/A CTRN12614000994684.aspx.
authors.affiliation: Department of Anesthesia, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
authors.forename: S M
authors.initials: SM
authors.lastname: Asida
authors.affiliation: Department of Public Health, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
authors.forename: S S
authors.initials: SS
authors.lastname: Ahmed
keywords: Failed insertion; laryngeal mask airway; pediatric laryngeal mask airway