Laryngeal mask airways in anaesthetised infants: a paradigm shift?

With the introduction of the laryngeal mask airway (LMA) in 1983, 1 Brain AI The laryngeal mask—a new concept in airway management. Br J Anaesth. 1983; 55: 801-805 Crossref PubMed Scopus (775) Google Scholar the specialty of anaesthesiology took a great leap forward in patient safety. Since its implementation and throughout different designs, the LMA has been indispensable in anaesthesia practice as a substitute for tracheal intubation in selected cases and to rescue patients with life-threatening upper airway obstruction. These devices are frequently used to maintain ventilation in routine anaesthetic cases in which tracheal intubation is unnecessary. LMAs save time and improve workflow in the surgical suite and have eliminated countless numbers of patient injuries (eg, chipped or displaced teeth) and reduced temporary annoyances (eg, postoperative sore throat) associated with tracheal intubation. However, as LMA use expanded to children, the miniaturised adult design was clearly not suited for the pharyngeal space of small infants, and too often required manipulation for poor fit and transition to tracheal intubation because of persistent air leak and inadequate ventilation. 2 Mason DG Bingham RM The laryngeal mask airway in children. Anaesthesia. 1990; 45: 760-763 Crossref PubMed Scopus (191) Google Scholar , 3 Mizushima A Wardall GJ Simpson DL The laryngeal mask airway in infants. Anaesthesia. 1992; 47: 849-851 Crossref PubMed Scopus (103) Google Scholar , 4 Dubreuil M Laffon M Plaud B Penon C Ecoffey C Complications and fiberoptic assessment of size 1 laryngeal mask airway. Anesth Analg. 1993; 76: 527-529 Crossref PubMed Scopus (77) Google Scholar As a result, in many centres worldwide an accepted practice has been to avoid use of LMAs in small infants and to use tracheal intubation as the first-line approach for airway management during general anaesthesia. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trialIn infants undergoing minor elective procedures, LMAs were associated with clinically significantly fewer PRAE and lower occurrence of major PRAE (laryngospasm and bronchospasm) than endotracheal tubes. This difference should be a consideration in airway device selection. Full-Text PDF