Abstract
BackgroundLaryngeal 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.MethodsIn 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.ResultsOverall 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).ConclusionMalposition was not associated with impaired clinical performance (audible leak, complications) of the LMAU or the need for alternative airway management.Trial registrationClinicaltrials.gov (NCT02940652) Registered 18 October 18 2016.
Highlights
Laryngeal mask UNIQUE® (LMAU) is supraglottic airway device with good clinical performance and low failure rate
Goudsouzian et al [8] defined correct position of the LMA based on the results of the observational study (50 children undergoing computer tomography or magnetic resonance imaging (MRI)) as the proximal cuff lies opposite to the C1 or C2 vertebrae the position of the distal cuff of the LMA, contrary to the Brain recommendation [9], was located between C4 and T1 vertebrae
Another evaluation of the radiologically correct position was published by Monclus et al [10], where the authors describe the position of the Ambu AuraOnce mask in 121 children who underwent MRI
Summary
Laryngeal mask UNIQUE® (LMAU) is supraglottic airway device with good clinical performance and low failure rate. Goudsouzian et al [8] defined correct position of the LMA based on the results of the observational study (50 children undergoing computer tomography or MRI) as the proximal cuff lies opposite to the C1 or C2 vertebrae the position of the distal cuff of the LMA, contrary to the Brain recommendation (correct distal position opposite to the C6 or C7 vertebrae) [9], was located between C4 and T1 vertebrae Another evaluation of the radiologically correct position was published by Monclus et al [10], where the authors describe the position of the Ambu AuraOnce mask in 121 children who underwent MRI. Airway in paediatric patients undergoing MRI exam is predominantly secured by LMA, due to lower invasivity and lower rate of associated complications compared to tracheal tube [11]
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