Study of the adjustment of the Ambu laryngeal mask under magnetic resonance imaging

Authors


Enric Monclus, Pediatric Anesthesiology Unit, Hospital Sant Joan de deu, Paseo Sant Joan de deu, Barcelona 08196, Spain (email: emonclus@hsjdbcn.org; e_monclus@terra.es).

Summary

Background:  Our aim in this study was to analyze the adjustment of the laryngeal mask, Ambu AuraOnce, in pediatric patients during magnetic resonance imaging (MRI) and to look for a correlation between clinical parameters such as the sealing pressure and the ease of introduction with radiological parameters.

Methods:  One-hundred and twenty-one pediatric patients from 4 months to 17 years who required a cranial MRI for other reasons were enrolled in the study. General anesthesia was induced with sevofluorane and no relaxant was used. Insertion attempts, sealing pressure, desaturation episodes and maintenance of anesthesia were recorded. Spontaneous ventilation was maintained throughout all procedures and no episodes of desaturation below 95% were seen. Patients without cough or pharyngeal pain were discharged after 1 h. Data were classified into three groups according to the size of the used laryngeal mask (group 1 for laryngeal mask number 1½; group 2 for laryngeal mask number 2, and group 3 for laryngeal mask number 2½). Sagittal MRI cuts were reviewed to calculate neck flexion, laryngeal mask position and its relationship with the trachea.

Results:  First-attempt introduction rate of the laryngeal mask was 96%, and it was 100% after a second attempt. Sealing pressure was 22.1 ± 4.15 mmHg for group 1, 22.23 ± 3.94 for group 2, and 23.83 ± 3.28 for group 3. The angles between the laryngeal mask and the four first cervical vertebrae were calculated (group 1, 33.65 ± 8.05; group 2, 28.09 ± 6.65; group 3, 25.79 ± 4.26). Distances between trachea and proximal and distal cuffs were measured to evaluate proper fitting of the laryngeal mask. Anomalous placement seen on MRI, using distances from proximal and distal cuff to trachea, occurred in 23.5% in group 1, 10.9% in group 2, and 13.8% in group 3. We found no correlation between this anomalous position of the laryngeal mask and sealing pressure or ease of introduction.

Conclusions:  The Ambu AuraOnce can be regarded as a safe product for airway maintenance in pediatric patients. No relationship was found between radiological measurements and sealing pressures.

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