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      Comparison of weight-based and pinna size method for ProSeal laryngeal mask airway size selection in children receiving general anesthesia: A randomized clinical study

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          Abstract

          Background and Aims:

          Several methods are in use for LMA ProSeal™ size selection in pediatric patients. Weight-based method is most commonly used. Pinna size–based method is a promising new technique for accurate size selection.

          Material and Methods:

          A total of 146 children aged between 6 months and 12 years undergoing surgery under general surgery were included. They were randomized into either pinna-based group (group X) or weight-based group (group Y). Both groups were compared for accurate placement of ProSeal™ laryngeal mask airway (PLMA), ease of insertion, number of attempts needed, and peak airway pressures.

          Results:

          A Comparable number of patients had a Brimacombe score of 3 and above, indicating correct placement in both groups ( P = 0.407). PLMA was easily inserted in 79.5% and 87.7% of patients of groups X and Y, respectively ( P = 0.180). Insertion was found to be difficult in 20.5% of patients in group X, whereas it was difficult in only 12.3% of patients of group Y ( P = 0.180). The two groups were comparable as per the number of attempts needed for insertion ( P = 0.161). Mean peak airway pressures too were comparable between both groups. Ease of insertion too, was statistically insignificant between both groups.

          Conclusions:

          Pinna size–based estimation of LMA size is an effective alternative method to weight-based selection.

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          Most cited references21

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          A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position.

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            Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.

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              Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial.

              Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (<44 mmHg) with patients under routine care. Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 +/- 6 vs. 114 +/- 57 mmHg, P < 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P < 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.
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                Author and article information

                Journal
                J Anaesthesiol Clin Pharmacol
                J Anaesthesiol Clin Pharmacol
                JOACP
                J Anaesthesiol Clin Pharmacol
                Journal of Anaesthesiology, Clinical Pharmacology
                Wolters Kluwer - Medknow (India )
                0970-9185
                2231-2730
                Jan-Mar 2024
                14 March 2024
                : 40
                : 1
                : 63-68
                Affiliations
                [1]Department of Anaesthesia, ABVIMS and Dr. RML Hospital, New Delhi, India
                [1 ]Department of Critical Care Medicine, ABVIMS and Dr. RML Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Rupesh Yadav, Associate Professor, ABVIMS and Dr. RML Hospital, New Delhi, India. E-mail: drrupesh.yadav98@ 123456gmail.com
                Article
                JOACP-40-63
                10.4103/joacp.joacp_217_22
                11042100
                38666166
                930b94b0-9162-47cc-b192-b9574b11f01e
                Copyright: © 2024 Journal of Anaesthesiology Clinical Pharmacology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 14 June 2022
                : 31 July 2022
                : 31 July 2022
                Categories
                Original Article

                Anesthesiology & Pain management
                airway,ear pinna,laryngeal mask airway
                Anesthesiology & Pain management
                airway, ear pinna, laryngeal mask airway

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