comparing two different techniques for laryngeal mask airway size selection

Completed

• Conditions: ASA physical status 1 and 2

• Registration Number: CTRI/2018/01/011135
• Lead Sponsor: NA

Brief Summary

The  Laryngeal mask airway has emerged as a formidable choice over endotracheal in scenarios where endotracheal intubation is not mandatory.1 Compared with the face mask, the LMA allows for a more “hands-free approach†to airway management.2 The laryngeal mask airway is intended to be placed over the laryngeal inlet, is considered to be an intermediate between endotracheal tube and oropharyngeal airway in terms of invasiveness and offers some of the advantages of endotracheal intubation while surpassing the disadvantages like stimulation of the laryngopharyngeal reflex.2 An endotracheal tube (ET) is always considered to be the gold standard in airway management3, 4,is a device to maintain a patent airway because of ability to provide positive pressure ventilation (PPV) through it and to prevent of gastric inflation and pulmonary aspiration.4 Adverse haemodynamic responses, situations of failed intubation and injury to the oropharyngeal structures4 during intubation are also a serious concern.

The ProSeal LMA (PLMA) was introduced by Dr Archie Brain in 2000.5 ProSeal LMA has a channel for gastric drainage, placed by the side of the main airway tube. A gastric tube can be passed through the drainage channel and can detect malposition6 of PLMA. The paediatric PLMA lacks dorsal cuff 6 and is available in sizes 1, 1.5, 2 and 2.5.

In clinical practice, most commonly used method for size estimation is weight based calculation, which may not be suitable in many patients because of wide range for each category of weight. Many anaesthesiologists choose an orotracheal tube approximately equal to the size of the little finger of the child. Although this estimation may be imprecise and unreliable, it provides an approximation of the size of tube required. No analogous methods exist for rough estimation of the required laryngeal mask airway size.7

               The aim of current study is to determine whether combined width of patient’s index, middle and ring fingers could be used as a proxy for appropriate size of laryngeal mask airway to be used in children as an alternative in those situations where patient’s weight is unknown. 8,9 This technique should be easy to perform, easy to remember and accurate in determining the size of the laryngeal mask airway and applicable at patient’s bedside. The new method proposed relates to the anatomic features of patient and fulfils all these requirements. To validate this procedure, the size of the laryngeal mask airway determined with this method will be compared with size according to patient’s weight.

Final Summary: Toconclude, weight based method and novel method for the selection of ProSeallaryngeal mask airway in pediatric patients are in moderate level of agreement.Ease of insertion, number of attempts, visualization of glottis with fiberopticbronchoscope and ease of gastric tube insertion are comparable in both groups.Novel method can be used as a good alternative to standard weight based methodfor the selection of ProSeal laryngeal mask airway when weight is unknown.

Detailed Description

Not available

Study Timeline

• Study Start: 2015-10-14
• Study Completion: 2017-07-15
• Last Update Posted: 2018-03-01

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 102

Inclusion Criteria

• All paediatric patients undergoing elective surgical procedures of short duration (< 1-2 hour) like circumcision, open herniotomies, anal dilatation, urethral dilatation, open hernia repair etc., requiring general anaesthesia.
• (a)Age: 6 months to 10 years (b)Weighing between 5-30 kg (c)American Society of Anesthesiologists Physical Status I and II (d)Parents of children willing to comply with informed written consent.

Exclusion Criteria

• 1.Patients not belonging to above mentioned age and ASA status.
• 2.Patient’s / parental refusal to participate.
• 3.Ex-preterm infants.
• 4.Emergency surgeries and patients with history of hiatus hernia.
• 5.Patients with history of obstructive sleep apnoea, asthma, congenital heart disease, obesity, mental retardation.
• 6.Recent history of respiratory tract infection.
• 7.Children requiring rapid sequence induction.
• 9.Children with cleft palate of any degree.
• 10.Anticipated difficult airway.
• 11.Complete upper airway obstruction.
• 12.Suspected or known abnormalities of the airway.
• 13.Morbid obesity.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Placement of ProSeal LMA	During induction of anaesthesia

Trial Locations

Locations (1)

Kasturba Hospital, Manipal; 🇮🇳 Udupi, KARNATAKA, India

Kasturba Hospital, Manipal

🇮🇳Udupi, KARNATAKA, India

Dr Sahana H

Principal investigator

9663863186

sahanavasista@gmail.com