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Optimal flexible laryngeal mask airway size in children weighing 10 to 20 kg

K Z Chen1, T J Liu1, W X Li1

  • 1Anesthesiologist, Department of Anesthesiology, Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.

Anaesthesia and Intensive Care
|September 9, 2016
PubMed

Insights

Choosing the correct flexible laryngeal mask airway (FLMA) size is crucial for pediatric patients. While both size 2 and 2.5 FLMA showed similar oropharyngeal leak pressure (OLP) in smaller children, size 2.5 is preferable for children weighing 16-20 kg to ensure adequate ventilation.

Area of Science:

  • Anesthesiology
  • Pediatric Airway Management
  • Medical Device Evaluation

Background:

  • Securing a pediatric airway during surgery requires careful device selection.
  • Flexible laryngeal mask airways (FLMA) are commonly used, but optimal sizing for effective ventilation is critical.
  • Oropharyngeal leak pressure (OLP) is a key indicator of airway seal efficacy.

Purpose of the Study:

  • To evaluate the impact of flexible laryngeal mask airway (FLMA) size on oropharyngeal leak pressure (OLP) in pediatric patients.
  • To compare OLP and ventilation adequacy between size 2 and size 2.5 FLMA in children undergoing elective ophthalmic surgery.
  • To identify optimal FLMA sizing based on patient weight for effective airway management.

Main Methods:

  • Prospective, randomized study involving 120 children undergoing elective ophthalmic surgery.
  • Children were randomized to receive either a size 2 or size 2.5 FLMA at a recommended intracuff pressure of 40 cmH2O.
  • Primary outcome was OLP; secondary outcomes included ventilation sufficiency, insertion success, and adverse events.

Main Results:

  • Median OLP was comparable between size 2 and 2.5 FLMA (18 cmH2O) in the overall cohort.
  • The size 2 FLMA group exhibited a higher incidence of low OLP (<10 cmH2O) and insufficient ventilation (13.3% vs. 0%, P=0.006).
  • In children weighing 16-20 kg, the size 2.5 FLMA demonstrated significantly lower rates of low OLP and insufficient ventilation (27% vs. 0%, P=0.0046).

Conclusions:

  • FLMA size 2 and 2.5 provide similar OLP in children weighing 10-15.9 kg at 40 cmH2O intracuff pressure.
  • For pediatric patients weighing 16-20 kg, a size 2.5 FLMA is recommended to reduce the incidence of low OLP and ensure adequate ventilation.
  • Appropriate FLMA sizing based on weight is essential for optimizing pediatric airway management and ventilation.

Keywords:
airway, anaesthesia, laryngeal mask airway, paediatric

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