J Anesth Perioper Med. 2016;3(6):241-246. https://doi.org/10.24015/ebcmed.japm.2016.0033
From 1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, United States, and Department of Anesthesiology, Children's Health, Children's Medical Center Dallas, Dallas, United States; 2Department of Data Intelligence and Analytics, Children's Health, Children's Medical Center Dallas, Dallas, United States; 3Outcomes Research Consortium, Cleveland, United States.
Correspondence to Dr. Patrick N. Olomu at Patrick.Olomu@Childrens.com
EBCMED ID: ebcmed.japm.2016.0033 DOI: 10.24015/ebcmed.japm.2016.0033
BackgroundThe laryngeal mask airway (LMA) Supreme (LMAS) is a sophisticated, second-generation supraglottic airway device, with an improved seal, and gastric access. It is a capable device for use in more complex procedures and in younger children. No study has been able to analyze a large pediatric sample of patients to assess how the LMAS is being utilized. In this retrospective audit, we evaluated the use of the LMAS in routine clinical practice. In addition to this, utilization of LMAS performance test was evaluated.
A retrospective audit was performed of a major tertiary children's hospital's electronic medical record database to identify all children in whom the LMAS was utilized for airway management over a two- year period. In addition to demographic data, we collected the following LMAS data: size of the LMAS, the number of insertion attempts, volume of air injected into the cuff, the cuff pressure, and the oropharyngeal leak pressure. We also recorded the performance of tests for proper position and function, the mode of lung ventilation, the use of muscle relaxants and use of any alternative airway devices.
The LMAS was used in 418 children accounting for only 4% of all LMA usage and only 0.6% of all usage for general anesthesia. The first-attempt placement success rate was 96.4% (382/396). Five of 418 (1.2% ) insertions were reported as failures. Mechanical ventilation was used in only 26% of cases with a vast majority (74%) breathing spontaneously. Cuff pressure was measured in 74/418 (18%) of cases. Oropharyngeal leak pressures were measured in 90/418 (21.5% ) cases. Maneuvers performed to verify correct placement and performance of the LMAS were rarely performed. Use of the LMAS for invasive procedures occurred in only 5 cases (1.2%).
This study shows the LMAS to be highly successful in the hands of various cadres of anesthesia providers at a major tertiary hospital and performs reliably well. Our data reveals many areas of potential improvement for use of the LMAS in the pediatric population, as a device capable for usage in more invasive surgical procedures, younger patients, and mechanical ventilation.
Declaration of Interests
One of the authors (PO) serves as a Consultant for Teleflex Medical, Inc., maker of the laryngeal mask airway. None of the additional authors of this study have any disclosures.
This was a non-funded research project.
This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.