The laryngeal mask airway in pediatric patients: factors affecting ease of use during insertion and emergence.

Abstract

Use of the laryngeal mask airway (LMA) permits the maintenance of a patent airway with successful insertion rates of the LMA on the first attempt varying between 67%-92% in children. The recommended insertion technique involves deflation of the mask using a syringe, and application of a lubricant jelly. In a randomized study of 122 children, we compared the time to complete LMA insertion, the number of attempts before successful placement, and the occurrence of laryngospasm and Spo2 < 90% during insertion using the standard deflated method and an alternative method of insertion with the LMA cuff partially inflated. Independently, the children were randomly assigned to have K-Y sterile lubricating jelly or 2% lidocaine topical solution applied to the back of the mask. The occurrence of coughing, laryngospasm, and vomiting during emergence were recorded. Insertion of the LMA partially inflated required significantly less time (16 vs 23 s, P < 0.05), and was associated with a higher success rate on first attempts (85.5% vs 96.7%, P < 0.05). In those who did not receive morphine, 2% lidocaine topical solution decreased the incidence of coughing on emergence (10.3% vs 36.4%). The ease of insertion of the LMA in children was improved by partial inflation of the cuff and in addition, 2% lidocaine topical solution was as beneficial as morphine in reducing coughing on emergence.