Comparison of Weight-Based Versus External Ear-Size-Based Technique for Selection of Laryngeal Mask in Pediatric...

The Laryngeal Mask (LM) has grown in appreciation for use in the pediatric population. The manufacturer recommends that the size of the LM to be used in children should be based on actual body weight. This method may not be appropriate in emergencies, where the weight of the patient is unknown, resulting in the correlation between the weight and size of the LM being impossible. Weight-based recommendations may also not be suitable as the development of the child's oropharyngeal cavity is related to height and age rather than weight. To overcome these concerns, various alternatives to weight-based techniques have been tried. One of them is the external ear size for LM size selection. This study aimed to evaluate the two methods by assessing the proper placement and adequacy of ventilation.

A total of 137 children, aged between 6 months and 18 years, undergoing surgery, under general anesthesia with muscle relaxation and positive pressure ventilation, were included. After obtaining approval from the ethical review committee, written informed consent was obtained from all participants. The children were randomly assigned to one of two groups: the weight-based group (Group W) and the external ear-size-based group (Group E), after fulfilling the study's inclusion criteria. Both groups were compared for the accurate placement of the LM.

Demographic data were comparable in both groups. The leak was audible in 44.1% in Group W versus 11.6% in Group E. Leak fraction (> 15%) was significantly higher in Group W, 44.1% as compared to Group E, 11.6%. As a result, reinsertion with a one size larger LM was more in Group W. Mucosal injury and laryngospasm were also more pronounced in Group W.

External ear size-based selection of LM size is an effective and more accurate method than weight-based selection.