Pediatrics Medical News about Laryngeal Mask Airway

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Proseal Laryngeal Mask Airway In Infants And Toddlers With Upper Respiratory Tract Infections - Spontaneous vs Pressure Control Ventilation -
Middle East Journal of Anesthesiology, 10/20/09

Sinha A et al. – Pressure control ventilation with PEEP using PLMA is associated with lower incidence of adverse events in comparison to spontaneous respiration in infants and toddlers with upper respiratory tract infection undergoing infra umbilical surgeries under general anesthesia.

Exclusive Author Commentary
Aparna Sinha, 10/22/09

Upper respiratory tract infection is a frequently encountered condition which poses challenges to a pediatric anesthesiologist. An average child undergoes 5-6 episodes of URTI annually. We repeatedly encounter pediatric-specific surgical situations for which the choice to postpone either is not an option or would not serve the best interest of the child. In the setting of surgical missions which provide corrective or palliative procedures during a small window of time opportunity to the greatest number of patients as safely as possible, we are much less inclined to cancel an anesthetic. The inception of laryngeal mask airway has changed the conduct and outcome of anesthesia tremendously over last few decades particularly for such patients esp the infants and toddlers who are more prone to complications. We are faced with an ever increasing choice of supraglottic airway devices (SAD).Plenty of studies have been conducted to ascertain the usefulness and performance of LMA over TT and facemask (FM).The classic and Proseal LMAs (PLMA) are the most well established SADs in children, and large evidence base for efficacy and safety and form the benchmark by which other devices should be evaluated. In most cases they are a more practical choice than using a facemask, and in children with an upper respiratory tract infection they are associated with fewer complications than a tracheal tube. It is worthwhile to focus on benefits, the PLMA offers on choice of modality of ventilation, moreso in a child with upper respiratory tract infection. SADs particularly PLMA has made it possible to deliver PCV with PEEP without having to paralyze the patient, more so in infraumbilical surgeries, thereby obviating need for endotracheal intubation and minimizing adverse respiratory events in children particularly when URTI is present.

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