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Alternative methods for laryngeal mask airway size selection in paediatric patients

Mases, Anna; Gallart, Lluís

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European Journal of Anaesthesiology: September 2013 - Volume 30 - Issue 9 - p 575
doi: 10.1097/EJA.0b013e3283623da5


We read with great interest the paper by Zahoor et al.1 reporting on a novel method for the selection of the size of a laryngeal mask airway in paediatric patients. This new method consists of using the size of the external ear to choose the size of the laryngeal mask airway. We would like to comment on that study.

Zahoor et al. argue that in children, the size of the little finger is used to estimate the size of the orotracheal tube but that no analogous method has been described for choosing the appropriate size of the laryngeal mask airway. However, we have previously described a method to estimate the correct laryngeal mask airway number according to the size of the fingers.2 This method consists of extending the hand with the palm up and applying the ventral surface of the laryngeal mask airway against the palmar side of the second, third and fourth finger kept together. The laryngeal mask airway that best fits with the width of these three fingers would then be chosen.

This ‘finger’ method showed an ‘excellent agreement’ with the gold standard (weight-based) method; the estimated kappa coefficient was 0.81. In contrast, the ‘ear’ method described by Zahoor et al. showed a ‘moderate agreement’ only; the estimated kappa statistic was 0.5. Furthermore, in our study, we included patients less than 6 months of age, which is one of the limitations of the study by Zahoor et al.

In conclusion, two anatomical related methods to choose the adequate size of the laryngeal mask airway in children have been described. Both tools are easy to use at the bedside and they are good alternatives to the standard weight-related method.


Assistance with the letter: none declared.

Financial support and sponsorship: none declared.

Conflicts of interest: none declared.

Comment from the Editor: Dr Zahoor and colleagues did not wish to respond to that letter.


1. Zahoor A, Ahmad N, Sereche G, et al A novel method for laryngeal mask airway size selection in paediatric patients. Eur J Anaesthesiol 2012; 29:386–390.
2. Gallart L, Mases A, Martínez J, et al Simple method to determine the size of the laryngeal mask airway in children. Eur J Anaesthesiol 2003; 20:570–574.
© 2013 European Society of Anaesthesiology