BACKGROUND: Laryngeal mask UNIQUE® (LMAU) is supraglottic airway device with good clinical performance and low failure rate. Little is known about the ideal position of the LMAU on the magnetic resonance imaging (MRI) and whether radiological malposition can be associated with clinical performance (audible leak) in children. The primary aim of the study was to evaluate incidence of the radiologic malposition of the LMAU according to size. The secondary outcome was the clinical performance and associated complications (1st attempt success rate, audible leak) in LMAUs in correct position vs. radiologically misplaced LMAUs. METHODS: In prospective observational study, all paediatric patients undergoing MRI of the brain under general anaesthesia with the LMAU were included (1.9.2016-16.5.2017). The radiologically correct position: LMAU in hypopharynx, proximal cuff opposite to the C1 or C2 and distance A (proximal cuff end and aditus laryngis) ≤ distance B (distal cuff end and aditus laryngis). Malposition A: LMAU outside the hypopharynx. Malposition B: proximal cuff outside C1-C2. Malposition C: distance A ≥ distance B. We measured distances on the MRI image. Malposition incidence between LMAU sizes and first attempt success rate in trainees and consultant groups was compared using Fisher exact test, difference in incidence of malpositions using McNemar test and difference in leakage according to radiological position using two-sample binomial test. RESULTS: Overall 202 paediatric patients were included. The incidence of radiologically defined malposition was 26.2% (n = 53). Laryngeal mask was successfully inserted on the 1st attempt in 91.1% (n = 184) cases. Audible leak was detected in 3.5% (n = 7) patients. The radiologically defined malposition was present in 42.9% (n = 3) cases with audible leak. The rate of associated complications was 1.5% (n = 3): laryngospasm, desaturation, cough. In 4.0% (n = 8) the LMAU was soiled from blood. Higher incidence of radiological malposition was in LMAU 1.0, 1.5 and LMAU 3, 4 compared to LMAU 2 or LMAU 2.5 (p < 0.001). CONCLUSION: Malposition was not associated with impaired clinical performance (audible leak, complications) of the LMAU or the need for alternative airway management. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02940652) Registered 18 October 18 2016.

Department of Paediatric Anaesthesia and Intensive care University Hospital Brno Faculty of medicine Brno Czech Republic

Department of Paediatric Radiology University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Radiology and Nuclear Medicine Faculty of Medicine Masaryk University and University Hospital Brno Brno Czech Republic

Faculty of Medicine Masaryk University Brno Brno Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Brno Czech Republic

Zobrazit více v PubMed

Goldmann K. Recent developments in airway management of the paediatric patient. Curr Opin Anaesthesiol. 2006;19:278–284. doi: 10.1097/01.aco.0000192786.93386.d5. PubMed DOI

Luce V, Harkouk H, Brasher C, et al. Supraglottic airway devices vs tracheal intubation in children: a quantitative metaanalysis of respiratory complications. Paediatr Anaesth. 2014;24:1088–1098. doi: 10.1111/pan.12495. PubMed DOI

Lopez-Gil M, Brimacombe J, Alvarez M. Safety and efficacy of the laryngeal mask airway. A prospective survey of 1400 children. Anaesthesia. 1996;51:969–972. doi: 10.1111/j.1365-2044.1996.tb14968.x. PubMed DOI

Lopez-Gil M, Brimacombe J, Cebrian J, Arranz J. Laryngeal mask airway in pediatric practice: a prospective study of skill acquisition by anesthesia residents. Anesthesiology. 1996;84:807–811. doi: 10.1097/00000542-199604000-00007. PubMed DOI

Jagannathan Narasimhan, Ramsey Melissa A., White Michelle C., Sohn Lisa. An update on newer pediatric supraglottic airways with recommendations for clinical use. Pediatric Anesthesia. 2015;25(4):334–345. doi: 10.1111/pan.12614. PubMed DOI

Verghese C, Berlet J, Kapila A, Pollard R. Clinical assessment of the single use laryngeal mask airway—the LMA-unique. British Journal of Anaesthesia. 1998;80(5):677–679. doi: 10.1093/bja/80.5.677. PubMed DOI

Brimacombe J, von Goedecke A, Keller C, Brimacombe L, Brimacombe M. The laryngeal mask airway unique versus the soft seal laryngeal mask: a randomized, crossover study in paralyzed, anesthetized patients. Anesth Analg. 2004;99(5):1560–3; table of contents. PubMed

Goudsouzian Nishan G., Denman William, Cleveland Robert, Shorten George. Radiologic Localization of the Laryngeal Mask Airway in Children. Anesthesiology. 1992;77(6):1085–1089. doi: 10.1097/00000542-199212000-00007. PubMed DOI

Brain A.I.J. Laryngeal mask misplacement?causes, consequences and solutions. Anaesthesia. 1992;47(6):531–532. doi: 10.1111/j.1365-2044.1992.tb02285.x. PubMed DOI

MONCLUS ENRIC, GARCÉS ANTONIO, DE JOSE MARIA BELEN, ARTÉS DAVID, MABROCK MAGED. Study of the adjustment of the Ambu laryngeal mask under magnetic resonance imaging. Pediatric Anesthesia. 2007;17(12):1182–1186. doi: 10.1111/j.1460-9592.2007.02330.x. PubMed DOI

VIALET RENAUD, NAU ANDRÉ, CHAUMOÎTRE KATHIA, MARTIN CLAUDE. Effects of head posture on the oral, pharyngeal and laryngeal axis alignment in infants and young children by magnetic resonance imaging. Pediatric Anesthesia. 2008;18(6):525–531. doi: 10.1111/j.1460-9592.2008.02530.x. PubMed DOI

R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2017. URL http://www.R-project.org/.

Pournajafian A, Alimian M, Rokhtabnak F, Ghodraty M, Mojri M. Success rate of airway devices insertion: laryngeal mask airway versus supraglottic gel device. Anesth Pain Med. 2015;5(2):e22068. 10.5812/aapm.22068. PubMed PMC

BRAIN A.I.J. THE LARYNGEAL MASK—A NEW CONCEPT IN AIRWAY MANAGEMENT. British Journal of Anaesthesia. 1983;55(8):801–805. doi: 10.1093/bja/55.8.801. PubMed DOI

Airway Management in Pediatric Patients: Cuff-Solved Problem?

Zobrazit více v PubMed

ClinicalTrials.gov
NCT02940652