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Comparison of different techniques of laryngeal mask placement in children

Ghai, Babita; Wig, Jyotsna

Current Opinion in Anaesthesiology: June 2009 - Volume 22 - Issue 3 - p 400–404
doi: 10.1097/ACO.0b013e3283294d06
Pediatric anesthesia: Edited by Bernard J. Dalens

Purpose of review: The insertion of laryngeal mask airway is not always easy in children, and many techniques are described to improve success rate of placement. It is very important to determine the optimal insertion technique as unsuccessful prolonged insertion and multiple attempts are associated with adverse respiratory events and trauma in children. This article will review different techniques studied recently for the placement of classical laryngeal mask airway in children as well as recent findings of cuff pressure and depth of anesthesia for laryngeal mask airway placement. Laryngeal mask airway in children has undergone many modifications such as ProSeal laryngeal mask airway to improve its functioning. This article will also review different insertion techniques for ProSeal laryngeal mask airway.

Recent findings: Rotational technique with partially inflated cuff is reported to have the highest success rate of insertion and lowest incidence of complications for classical laryngeal mask airway in children. Clinical endpoints for cuff inflation are associated with significant hyperinflation and increased leakage around the laryngeal mask airway cuff. The inferences regarding the dosage of intravenous anesthetic agents and end-tidal concentration of volatile anesthetics in children to achieve adequate depth for laryngeal mask airway placement are very difficult to draw. ProSeal laryngeal mask airway is associated with a very high first attempt success and overall success of insertion in children.

Summary: Rotational technique may be considered as the first technique of choice for classical laryngeal mask airway insertion in children. The routine use of cuff pressure monitoring is mandatory during the use of laryngeal mask airway in children. Modification of laryngeal mask airway in children, that is ProSeal laryngeal mask airway, is promising and improves the success rate of insertion.

Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India

Correspondence to Dr Babita Ghai, MD, DNB, MAMS, Associate Professor, Department of Anaesthesia and Intensive Care, PGIMER, Sector-12, Chandigarh 160 012, India Fax: +91 172 2744401; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.