LARYNGEAL MASK AIRWAY IN PEDIATRIC PRACTICE - A PROSPECTIVE-STUDY OF SKILL ACQUISITION BY ANESTHESIA RESIDENTS

Background: A prospective study was conducted to determine the rate of skill acquisition with the laryngeal mask airway in pediatric anesthe siology practice, The aim of the study was to provide information abou t the amount of supervised training required before satisfactory level s of skill were achieved. Methods: Eight anesthesia residents in their third year of training with no prior experience using the laryngeal m ask airway were observed using the device in 75 Pediatric patients eac h (600 patients in total), Residents were given standardized guideline s for laryngeal mask airway usage in accordance with the manufacturer' s recommendations and followed a predetermined protocol for anesthetic management. Induction was achieved with propofol followed by either a propofol infusion or isoflurane and either controlled or spontaneous ventilation as clinically indicated. Predefined major and minor proble ms were documented during the induction, maintenance, and recovery pha ses of anesthesia by a randomly selected supervising consultant traine d in the study protocol and problem definitions. Results: The total nu mber of problems was 189 occurring in 121 children, Fifty-five childre n had one problem, sixty-four children had two problems, and two child ren had three problems, Of the problems, 77 were major and 112 were mi nor. The problem rate per patient for overall, major, and minor proble ms was 31.5%, 12.8%, and 18.7%, respectively. The problem rate compari ng the first to last epochs of 15 uses decreased from 62% to 2% for ov erall problems, 23% to 2% for major problems, and 39 to 1% for minor p roblems. The residents with the most problems in the final epoch had p roblem rates of less than 10% after 60 uses. There was a significant d ecrease in the overall problem rate for induction, maintenance, and re covery (P < 0.05). The major problem rate decreased significantly for induction and maintenance (p < 0.05), but not for recovery. The minor problem rate decreased significantly for induction and recovery (P < 0 .05). Conclusions: This study confirms that there is a rapid improveme nt in laryngeal mask airway skills when the standard recommended techn ique is employed and that a low problem rate can be achieved within 75 uses, Pediatric anesthesiologists with problem rates greater than 10% should determine if they are using the device suboptimally.