Objective: It is likely that laryngeal mask airway (LMA) is frequently misplaced because of the anatomical differences in children's airways. Our aim is to assess the feasibility of different ultrasonography (USG) techniques for the confirmation of the accurate placement of LMA in pediatric population. Method: After a local ethics committee approval and written informed consents were obtained, 50 children aged 1-12 years were consecutively included into this prospective, observational study. After the anesthetic induction, the position of LMA was evaluated by clinical tests and realtime upper airway USG in three planes (at the level of tongue base, the larynx and upper end of the esophagus). The symmetry of the cuff shadows at the tongue base and arytenoid cartilages was assessed by USG (arytenoid grade). The presence of cuff tip in the esophagus and the shape of the cuff (regular or distorted) was recorded. Fiberoptic bronchoscopy (FOB) was performed to confirm the position of LMA (FOB grade). The Spearman correlation coefficient and Fisher's exact tests were used to test the relationship between FOB and sonographic parameters. Results: The rate of accurate LMA placement through clinical tests was determined as 82% at the first attempt. The rate of recognizing the glottic opening was also found as 74% with FOB. The result showed a statistically significant association between the asymmetry of cuff shadow at the tongue base and FOB LMA grade (Fisher's exact test, p<0.001). The correlation was also statistically significant between FOB grade and USG arytenoid grade (r=0.672, p<0.001). Conclusion: USG can be used to identify the accurate placement and repositioning of LMA as a non-invasive, rapid and reliable method not requiring interruption of the ventilation. Further detailed studies are required to compare the different USG techniques for the confirmation of correct placement of LMA.
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