Laryngeal mask airways (LMA) are commonly used in paediatric anaesthesia. A well-placed LMA should provide a direct view of the vocal cords facilitating bronchoscopy or fibreoptic intubation. The aim of this audit was to assess the bronchoscopie view of the glottis obtained through an LMA with regard to its size. We prospectively assessed the position of LMAs in relation to the glottic aperture in 350 children (zero to seven years) undergoing elective fibreoptic examination of the upper and/or lower airways. Following induction of anaesthesia and positioning of the LMA, a fibreoptic evaluation of the view of the glottis was performed (complete, partial or no visualisation). Chest movement on manual ventilation was judged as good in the majority of patients and adequate for the remainder. No overt signs of airway obstruction were noted in any patient. However, a complete view of the glottic aperture was present in only 50% of size 1 LMAs, 57.5% of size 1.5, 72.7% of size 2 and 77.8% of size 2.5. The epiglottis impinged on the LMA opening, partially obstructing the view of the glottis in 36.3% of size 1 LMAs, 31.5% of size 1.5, 21% of size 2 and 17.8% of size 2.5. In 13.7% of size 1 LMAs, 11% of size 1.5, 6.3% of size 2 and 4.4% of size 2.5, the epiglottis was completely downfolded, obstructing the view of the glottic aperture. The findings indicate that even if ventilation is judged as adequate, smaller paediatric LMAs are more commonly associated with suboptimal anatomical positioning with partial obstruction of the glottic aperture than larger LMAs, and therefore may require repositioning more often.

patient's medical record. A total of 216 circumcisions were performed on patients aged from 5 months to 15 years. A total of 115 patients received CEA, 46 DPNB-LM and 55 DPNB-LM. Patients in the DPNB-LM group required rescue morphine administration in the Recovery unit more frequently (30.4%) than either the DPNB-US (3.5%) or CEA groups (3.6%). Similarly, the DPNB-LM group required a larger total dose of morphine, and had longer recovery ward stays than CEA or DPNB-US groups. Time to first analgesia was greatest for the CEA group whilst there was no significant difference between time to first analgesia for DPNB-LM and DPNB-US. About 63% of patients in the DPNB-LM group, 1.7% of CEA and 5.5% of the DPNB-US required intraoperative opiates (P<0.0001). There was no difference in time to hospital discharge. Reference 1 Sandeman DJ, Dilley AV. Ultrasound guided dorsal penile nerve block in children. Anaesth Int Care 2007; 35(2): 266-269.