THE LARYNGEAL MASK AIRWAY IN PEDIATRIC-PATIENTS - FACTORS AFFECTING EASE OF USE DURING INSERTION AND EMERGENCE

Use of the laryngeal mask airway (LMA) permits the maintenance of a pa tent airway with successful insertion rates of the LMA on the first at tempt varying between 67%-92% in children. The recommended insertion t echnique involves deflation of the mask using a syringe, and applicati on of a lubricant jelly. In a randomized study of 122 children, we com pared the time to complete LMA insertion, the number of attempts befor e successful placement, and the occurrence of laryngospasm and SpO2 < 90% during insertion using the standard deflated method and an alterna tive method of insertion with the LMA cuff partially inflated. Indepen dently, the children were randomly assigned to have K-Y sterile lubric ating jelly or 2% lidocaine topical solution applied to the back of th e mask. The occurrence of coughing, laryngospasm, and vomiting during emergence were recorded. Insertion of the LMA partially inflated requi red 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 < 0.0 5). In those who did not receive morphine, 2% lidocaine topical soluti on 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 i nflation of the cuff and in addition, 2% lidocaine topical solution wa s as beneficial as morphine in reducing coughing on emergence.