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The laryngeal mask airway in infants

A Mizushima1, G J Wardall, D L Simpson

  • 1Department of Anaesthetics, Royal Hospital for Sick Children, Edinburgh, Scotland.

Anaesthesia
|October 1, 1992
PubMed

Insights

Clinical assessment of laryngeal mask airway (LMA) placement in infants is unreliable. Even when an airway appears patent, fiberoptic evaluation reveals many LMA devices are poorly positioned, risking obstruction.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Medical Devices

Background:

  • The laryngeal mask airway (LMA) is a common supraglottic airway device used in pediatric anesthesia.
  • Ensuring correct LMA positioning is crucial for effective ventilation and preventing complications.
  • Infants present unique challenges for airway device placement due to anatomical differences.

Purpose of the Study:

  • To evaluate the accuracy of clinical assessment in determining correct laryngeal mask airway (LMA) positioning in infants.
  • To investigate the incidence of delayed airway obstruction despite initial clinical airway patency.

Main Methods:

  • A prospective study involving 50 infants undergoing airway management with a size 1 LMA.
  • Clinical assessment of airway patency was performed initially.
  • Fiberoptic laryngoscopy was used to objectively assess the precise positioning of the LMA.
  • Airway patency was monitored for delayed obstruction.

Main Results:

  • A clinically patent airway was achieved in 47 out of 50 infants (94%) on the first attempt.
  • Fiberoptic assessment revealed that only 22 infants (44%) had ideally positioned LMAs.
  • Delayed airway obstruction occurred in 12 infants (24%) despite initial clinical success.

Conclusions:

  • Clinical assessment of airway patency is insufficient to confirm ideal LMA positioning in infants.
  • There is a significant discrepancy between clinically assessed and fiberoptically confirmed LMA placement in this pediatric population.
  • Continuous monitoring is essential due to the tendency for LMA position to deteriorate, increasing the risk of airway obstruction in infants.

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