The laryngeal mask airway for pediatric adenotonsillectomy: Predictors of failure and complications

Failure of the Laryngeal Mask Airway Unique™ and Classic™ in the Pediatric Surgical Patient

“…Recent pediatric laryngeal mask studies report adverse event frequency ranging from 0 to 10%. 8,[13][14][15][16][17] These data are limited by a focus on specific surgical procedures or by small sample size resulting in simplistic univariate or underpowered multivariate analyses. In addition, although data on adverse events are presented, laryngeal mask failure requiring endotracheal intubation is sparsely reported.…”

“…8 Collectively, the only risk factors for pediatric laryngeal mask failure previously identified in the peer-reviewed literature are provider experience, patient age, and type of surgery. 16,17 However, these risk factors are not based on adequately powered multivariate analyses in a broad and representative pediatric surgical population.…”

“…Variables evaluated for each patient (tables 1-3) were selected on the basis of a detailed literature review that identified preoperative and intraoperative factors associated with adverse respiratory events. As suggested by prior literature, anthropometric and patient history factors included sex, 12,17 age, 8,17-21 BMI, 12,19,22 smoke exposure, 12,23,24 asthma, 25,26 Failed Laryngeal Mask Airway in Pediatrics recent upper respiratory infection (URI), 7,8,20,25,27,28 gastroesophageal reflux disease, [29][30][31] obstructive sleep apnea, 19,32 congenital or acquired airway abnormalities, 27,[33][34][35][36][37][38][39][40] and history of difficult airway. 41,42 Surgical-related factors included procedure type (classified by Current Procedural Terminology code), 3,[19][20][21]43,44 surgical duration, [45][46][47] patient positioning, 48 and surgical table rotation.…”

The use of bougie‐guided insertion of a laryngeal mask airway device in neonatal piglets after unexpected complications

“…However, failure of LM placement or complications (hypoxia, hypercapnia, respiratory obstruction) are reported in children (Ramachandran and others 2012) in whom much more experience has been obtained. Anatomical modifications of the larynx in children scheduled for adenotonsillectomy increases the risk for complications (Lalwani and others 2013). In human medicine the Mallampati and the Cormack–Lehane classification are used to evaluate the view of the glottis at laryngoscopy: the higher the scoring, the poorer the visualisation of the laryngeal structures (Cormack and Lehane 1984, Mallampati and others 1985).…”

The Flexible Laryngeal Mask Airway in Pediatric Patients Undergoing Adenotonsillectomy

“…Endotracheal intubation is the standard means to secure the airway in adenotonsillectomy [1]. In recent years, the flexible laryngeal mask airway (FLMA) has been used with increased frequency as an alternative [2].…”