The laryngeal mask airway in the difficult paediatric airway: an assessment of positioning and use in fibreoptic intubation.

The laryngeal mask airway (LMA) was used in 34 children who presented with difficult airways and difficulty in intubation. All 34 children were a grade 3 or grade 4 Cormack and Leehane view at conventional laryngoscopy. The laryngeal mask airway was used as part of the anaesthetic technique. It was either used as the method of airway maintenance during a short procedure or as an aid to fibreoptic intubation. The results of its use in this group of patients showed that overall a good airway was obtained in 73% of patients and an adequate airway in 27%, and in no patient was a poor airway obtained. The fibreoptic positioning of the LMA, taken from the distal aperture of the laryngeal mask airway showed that, overall, in 29.5% of patients a full view of the glottis (grade 1) was obtained, in 29.5% of patients a partial view of the glottis (grade 2) was obtained and in 41% a view of the epiglottis only (grade 3) was obtained. In no patient was a view excluding the epiglottis obtained. In children with a mucopolysaccharide disorder, the number of children who had a grade 3 view increased to 54%. Children with a disorder other than mucopolysaccharidosis had a grade 3 view in only 17% of cases. Children with mucopolysaccharidoses had a grade 1 view in only 14% of cases compared with 58% in the group with other disorders. Of the 34 patients, 21 patients were intubated on 31 separate occasions. There were no failures. The complications of the fibreoptic intubation technique described are outlined.