SAFETY AND EFFICACY OF THE LARYNGEAL MASK AIRWAY - A PROSPECTIVE SURVEY OF 1400 CHILDREN

A survey of laryngeal mask airway usage in 1400 infants and children b y ten trainee anaesthetists was undertaken to provide information abou t insertion and complication rates using the standard insertion techni que and a limited range of standardised anaesthetic techniques. Placem ent was successful in 90% (1258/1400) at the first attempt, 8% (112/14 00) at the second attempt and 2% (29/1400) required an alternative tec hnique of insertion. One patient vomited during insertion and the proc edure was abandoned, but aspiration did not occur. The overall problem rate was 11.5% and there were significantly more problems during indu ction of anaesthesia (p < 0.02). Oxygen saturation decreased below 90% briefly on 23 occasions (1.7%). The incidence of problems was unrelat ed to the mode of ventilation, or whether isoflurane or total intraven ous anaesthesia with propofol was used for maintenance. Most problems came with use of the size 1 laryngeal mask (p < 0.001). The subspecial ty with the highest problem rate was ear, nose and throat surgery (p < 0.001). There was a significant decrease in problems with increasing experience (p < 0.001). There was no major morbidity associated with u se of the device. We conclude that the laryngeal mask provides a safe and effective form of airway management for infants and children in th e hands of supervised anaesthesia trainees both for spontaneous and co ntrolled ventilation using either isoflurane or total intravenous anae sthesia.