ALTERNATE METHOD FOR DETERMINING THE SIZE OF CLASSIC LARYNGEAL MASK AIRWAY (CLMA) IN CHILDREN. A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
cLMA, supraglottic airway, pediatric anesthesia, auricle size, weight-based method, airway management.
Abstract
Introduction: The classic laryngeal mask airway (cLMA) is a widely used supraglottic airway device in pediatric anesthesia. Accurate size selection is crucial to ensure effective ventilation and reduce complications. Traditionally, cLMA size is determined using weight-based guidelines. However, in emergency or low-resource settings, estimating weight may be challenging, prompting the need for alternative sizing methods.
Objective: To determine an agreement between weight-based and Auricle-size methods of selecting the correct size of cLMA in children undergoing genitourinary surgery.
Materials and Method: The study was a prospective observational study of 100 children ranging in age from 1 to 15 years at SIUT Karachi, Department of Anesthesiology, between June and November 2024. The size of cLMA based on auricle size and based on weight was noted. The Kappa statistics were used to measure whether the methods agreed or not.
Results: There was a moderately high agreement (Kappa = 0.616, p = 0.0005). Subgroup analyses increased the consistency of findings in the age, weight, and gender.
Conclusion: Auricle-size-based estimation is a reliable and practical alternative to weight-based cLMA size selection in pediatric patients.
References
2. Esen A, Bakan M, Topuz U, Dursun ZE, Karaaslan K. A new maneuver for classical laryngeal mask airway insertion: Prospective randomized study: A new maneuver for cLMA insertion. Journal of Surgery and Medicine. 2022 Aug 31;6(8):713-7.
3. Karaaslan E, Akbas S, Ozkan AS, Colak C, Begec Z. A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial. BMC anesthesiology. 2021 Dec;21:1-9.
4. Rather SA, Andrabi SF, Gupta A, Koley S, Koul P. A Study on the Comparative Effects of the Efficacy of I-Gel and Laryngeal Mask Airway Classic (C-LMA) and the Safety Profile of the Patients undergoing General Anesthesia for Elective Lower Abdominal and Lower Limb Surgeries.
5. Atar F, Keskin G, Akaslan F, Donmez A. The Role of Ultrasonography in Confirming the Position of the Laryngeal Mask Airway in Adult Patients. Journal of Anesthesia/Anestezi Dergisi (JARSS). 2023 Apr 1;31(2).
6. Padmarajan A. Acute neonatal airway management-The role of laryngeal mask airway. Indian Journal of Child Health. 2021 Oct 26;8(10):343-8.
7. Gunwal P, Bathla S, Kumari A, Bajaj JK. Comparison of Dexmedetomidine with Midazolam as an adjuvant with Propofol for insertion of ProSeal laryngeal mask airway in Children. Turkish Journal of Anaesthesiology and Reanimation. 2023 Apr 1;51(2):128.
8. Zhang K, Zhou M, Zou Z, Zhu C, Jiang R. Supraglottic airway devices: a powerful strategy in airway management. American Journal of Cancer Research. 2024 Jan 15;14(1):16.
9. Martínez TP, Brogly N, Guasch E, Díez J, Gilsanz F. Efficacy and Safety of Three Inflation Methods of the Laryngeal Mask Airway Ambu Auraonce: a Randomized Controlled Study.
10. Shrestha A, Amatya BR, Gautam AR, Panta S. Effects of Sevoflurane and Halothane on Haemodynamics During Induction of General Anaesthesia using Laryngeal Mask Airway in Children. Medical Journal of Shree Birendra Hospital. 2024;23(2):7-12.
11. Kannojiya DP, Gautam S, Srivastava VK, Singh GP, g Maurya R, Malik A, Agarwal J, Kohli M. A comparative study of the ProSeal laryngeal mask airway versus endotracheal tube in neonates with anorectal malformations. Cureus. 2021 Jul 31;13(7):e16798.
12. Park S, Lee JE, Choi GS, Kim JM, Ko JS, Choi DH, Kim GS. Second-generation laryngeal mask airway as an alternative to endotracheal tube in prolonged laparoscopic abdominal surgery: a comparative analysis of intraoperative gas exchanges. Singapore medical journal. 2023 Nov 1;64(11):651-6.
13. Huang Y, Liao H, Li L, Xu J, Jiang P, Guo Y, Liu K. Minimal alveolar concentration of sevoflurane in combination with remimazolam in adults during laryngeal mask insertion: an up-down sequential allocation study. BMC anesthesiology. 2024 Mar 8;24(1):94.
14. Cataldo R, Zdravkovic I, Petrovic Z, Corso RM, Pascarella G, Sorbello M. Blind intubation through laryngeal mask airway in a cannot intubate-difficult to ventilate patient with massive hematemesis. Saudi Journal of Anaesthesia. 2021 Apr 1;15(2):199-203.
15. El-Shaarawy AM, Moselhy MA, Nour El-Din DM. Comparison Between Blind And Ultrasound Guided Laryngeal Mask Airway Insertion In Adult Patients Undergoing Elective Surgery: A Randomized Control Study. Egyptian Journal of Medical Research. 2022 Jul 1;3(3):182-95.
16. Gupta A, Gupta A, Jitendra M, Gupta S. Randomised Comparative Study of Nalbuphine Propofol Versus Fentanyl-Propofol for Proseal Laryngeal Mask Airway Insertion. JK Science: Journal of Medical Education & Research. 2022 Jul 10;24(3):199-204.
17. Liao H, Chen L, Sheng C. The effects of on hemodynamics, oxygen saturation, peak airway pressure and adverse events during anesthesia for thyroid surgery: tracheal intubation Vs. ProSeal laryngeal mask airway. American journal of translational research. 2021 Apr 15;13(4):2738.
18. Baker PA. Assessment and management of the predicted difficult airway in babies and children. Anaesthesia & Intensive Care Medicine. 2021 Nov 1;22(11):707-17.
19. Mitra S, DebRoy D, Mitra J, Goswami J. Gnana Laryngeal Airway Device–A Case Series of Our Experience at a Tertiary Care Cancer Hospital. Airway. 2022 Jan 1;5(1):57-60.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Zaid Bin Nasir
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan
Vijai Kumar
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan
Sagar Khurana
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan
Syed Saqib Ali
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan
Zamir Ahmad
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan
Mansoor Chandio
Department of anaesthesia, Sindh Institute of Urology and Transplantation Karachi, Pakistan