Pediatric Laryngeal Mask Airways
Laryngeal Mask Airways
Key Points
- Safe alternative to endotracheal intubation for appropriate cases
- Size selection critical for optimal seal and positioning
- Various types available for specific clinical scenarios
- Regular position verification and monitoring essential
Pediatric LMAs are supraglottic airway devices that provide a less invasive alternative to endotracheal intubation. They are designed to create a seal around the laryngeal inlet without entering the trachea.
Types of Pediatric LMAs
1. Classic LMA
- Original design, reusable
- Silicone construction
- Available in all pediatric sizes
- Cost-effective for multiple uses
- Characteristics:
- Simple design
- Well-established safety profile
- Easy to clean and sterilize
- Limited aspiration protection
2. ProSeal LMA
- Double cuff design
- Gastric drainage channel
- Higher seal pressures
- Better aspiration protection
- Features:
- Bite block incorporated
- Better seal for positive pressure ventilation
- Allows gastric tube placement
- More complex insertion technique
3. i-gel LMA
- Gel-like thermoplastic elastomer
- No inflatable cuff
- Easier insertion
- Built-in bite block
- Advantages:
- Less trauma during insertion
- No risk of over-inflation
- Gastric channel included
- Excellent anatomical fit
4. Supreme LMA
- Single-use device
- Curved rigid airway tube
- Gastric access port
- Enhanced safety features:
- Fixed curve prevents device rotation
- Improved seal pressure
- Integrated bite block
- Easy first-time placement
LMA Size Selection and Guidelines
Size Selection by Weight
- Size 1: Neonates/Infants up to 5 kg
- Size 1.5: Infants 5-10 kg
- Size 2: Children 10-20 kg
- Size 2.5: Children 20-30 kg
- Size 3: Children 30-50 kg
- Size 4: Children/Adults 50-70 kg
Maximum Cuff Volumes
- Size 1: 4 mL
- Size 1.5: 7 mL
- Size 2: 10 mL
- Size 2.5: 14 mL
- Size 3: 20 mL
- Size 4: 30 mL
Pressure Monitoring
- Recommended cuff pressure: 40-60 cmH2O
- Regular monitoring during procedure
- Adjust for altitude changes
- Consider temperature effects
Insertion Techniques and Management
Preparation
- Equipment checks:
- Device integrity
- Size verification
- Cuff deflation
- Lubrication
- Patient positioning:
- Sniffing position
- Neutral head alignment
- Adequate depth of anesthesia
Insertion Methods
- Standard technique:
- Midline approach
- Smooth advancement
- Resistance indicates position
- Rotational technique:
- Lateral insertion
- 90-degree rotation
- Useful in difficult cases
Position Verification
- Clinical indicators:
- Chest movement
- Breath sounds
- End-tidal CO2
- Adequate tidal volumes
- Troubleshooting:
- Leak assessment
- Position adjustment
- Size reassessment if needed
Clinical Applications and Considerations
Suitable Procedures
- Short elective surgeries
- Diagnostic procedures
- Ophthalmologic procedures
- Surface procedures
- Emergency airway management
Contraindications
- Absolute:
- Full stomach
- Severe airway pathology
- Upper airway obstruction
- Relative:
- Respiratory infection
- Poor lung compliance
- Prolonged surgery
Special Considerations
- Emergency situations
- Difficult airway management
- Training requirements
- Cost considerations
