The use of the laryngeal mask airway in pediatric anesthesia.

Laryngeal mask airway (LMA) insertion was tried in 120 pediatric cases, from 2 months to 12 years of age. Initial indications for LMA were the same as for a face mask, except for two additional conditions; anticipation of difficulty with intubation and difficulty in management by a face mask. Size 2 LMA was used in the vast majority of cases. The insertion was successful on the first trial in 108 cases. More than one trial was necessary in 9 cases but only 3 cases required more than 3 trials. Insertion could not be completed in 3 cases. The relationship between the depth of LMA at the front teeth and age could be roughly described by "depth = 10 cm + 0.3 x Age". LMA was found to provide a better and more secure airway than the face mask without direct tracheal intervention. Heart rate did not increase with LMA insertion. It is easy to use and can be used in place of the face mask, but complications such as stomach air inflation due to too vigorous manual ventilation, slight pharyngeal injury, and airway obstruction due to kinking of LMA can occur. These complications can be avoided and must be kept in mind during it's use. LMA itself can be used to obtain a patent airway where an endotracheal airway is difficult to obtain. LMA-aided tracheal intubation can be extremely useful in obtaining endotracheal airways. Non-blind techniques can be used with LMA to increase safety. LMA is a very useful addition to pediatric anesthesia practice.