Airway protection by the laryngeal mask airway in children

The pediatric laryngeal mask airway (LMA) is a scale-down version of the adult form, and no direct postmortem specimen work has been performed so far. There are several anatomical differences between pediatric and adult airways, and hence, the scale-down version of the adult LMA is not necessarily water-tight in pediatric patients. We performed a prospective study to assess airway protection by the LMA in pediatric patients, using methylence blue (injected in the pharynx outside the LMA) and the fibreoptic bronchoscope to view the inside of the mask, to detect any leakage of the dye. Fifty Patients (40 boys and 10 girls) aged 1-10 years (mean 4.5 yr) were studied. All patients underwent surgery below the level of the umbilicus, under light general anesthesia combined with caudal epidural block. All patients were allowed to breath spontaneously over an Ayre's T-piece. Dye staining of the inside of the mask was detected in 5 patients (10%). The esophageal opening was visualized within the mask in 3 patients (6%). No serious complications occurred in any of our patients.