Laryngeal mask placement in a teaching institution: analysis of difficult placements.

Anastasia D Katsiampoura,Carin A Hagberg,Peter V Killoran,Chunyan Cai,Ruggero M Corso,Davide Cattano

doi:10.12688/f1000research.6415.1

Anastasia D Katsiampoura, Carin A Hagberg + Show 4 more

Open Access

https://doi.org/10.12688/f1000research.6415.1

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Abstract

Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program. This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved. Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%. In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.

Highlights

Since its introduction into clinical practice in 19831, the laryngeal mask airway (LMA) has found a place in everyday anesthesia practice[2,3,4], including its use as a primary airway device in the elective or pre-hospital emergency settings, as well as a rescue airway device in either settings[5,6]
Based on recorded outcomes at a major teaching hospital that utilized a comprehensive airway assessment[19] we aimed to identify predictive factors for difficult Laryngeal mask airway (LMA) placement
Of the airway evaluations performed using a comprehensive airway assessment tool 69 LMAs were utilized as a primary airway device (Table 3)

Summary

Introduction

Since its introduction into clinical practice in 19831, the laryngeal mask airway (LMA) has found a place in everyday anesthesia practice[2,3,4], including its use as a primary airway device in the elective or pre-hospital emergency settings, as well as a rescue airway device in either settings[5,6]. Even if the LMA is considered a very safe airway device[9] with a low incidence of complications, there may be situations where it either does not function properly or is difficult to place[10]. Appropriate sizing is critical for correct LMA application[12], while the selection of the device type seems to play a less significant role, yet the prediction of the correct size is not easy. This can be attributed to the absence of a coherent and universal standard sizing system[13]. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program.

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