Indian Journal of Anaesthesia

LETTER TO EDITOR
Year
: 2013  |  Volume : 57  |  Issue : 6  |  Page : 634--635

Use of laryngeal mask airway in premature infant


Pramod Velankar1, Milind Joshi2, Preety Sahu2,  
1 Pad. Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
2 Department of Anaesthesiology, Pune, Maharashtra, India

Correspondence Address:
Pramod Velankar
Pad. Dr. D. Y. Patil Medical College, Pimpri, Pune - 411 018, Maharashtra
India




How to cite this article:
Velankar P, Joshi M, Sahu P. Use of laryngeal mask airway in premature infant.Indian J Anaesth 2013;57:634-635


How to cite this URL:
Velankar P, Joshi M, Sahu P. Use of laryngeal mask airway in premature infant. Indian J Anaesth [serial online] 2013 [cited 2020 Oct 22 ];57:634-635
Available from: https://www.ijaweb.org/text.asp?2013/57/6/634/123354


Full Text

Sir,

Anaesthesia for neonates and infants require special considerations because of anatomical, physiological and pharmacological differences from adults. Their airway anatomy is quite different from that of adults [1] and therefore need utmost care while securing the airway under general anaesthesia (GA). It is our common practice to secure the airway using endotracheal tube (ETT). In children, Laryngeal Mask Airway (LMA) has also been used as an alternative to ETT for GA and it has now replaced ETT as well as a face mask for short surgical procedures. [2],[3] Here, we would like to share our experience of using LMA for GA in a premature baby.

A 40-day-old female infant diagnosed as retinopathy of prematurity (ROP) was posted for vitrectomy right eye under GA. Her gestational age at birth was 28 weeks and birth weight 800 g. Her pre-anaesthetic evaluation 1 day prior to this surgery was unremarkable except small mouth opening and low body weight of 1335 g (normal weight of infant at this age is 4-4.5 kg). Her haemoglobin was 9.2 g%. The baby was accepted for surgery under GA as a high risk case because of prematurity and low body weight.

On the operation table, a vein was secured on the dorsum of the left hand and the baby was connected to electrocardiography monitor, pulse oximeter and temperature (temp) monitor. She was pre-medicated with glycopyrrolate 5 mcg intravenously (IV). Following preoxygenation GA was induced with ketamine 3 mg IV supplemented with sevoflurane 3% in oxygen. After confirming bag and mask ventilation atracurium 0.5 mg was given IV to facilitate insertion of LMA (Ambu TM laryngeal mask) size 1 which could be inserted with some difficulty due to small mouth opening. GA was maintained with nitrous oxide in oxygen (50:50) and sevoflurane 1-2% using Ayre's T piece breathing system and controlled ventilation using 'thumb technique'. Throughout surgery, which lasted for 45 min pulse rate remained steady between 145/min and 156/min. SpO 2 99% and body temp 34-35°C. A total volume of 15 ml paediatric electrolyte solution was infused IV in small boluses. After surgery residual effect of atracurium was reversed with glycopyrrolate 10 mcg/kg and neostigmine 50 mcg/kg body weight. LMA was removed after gentle oral suction when child regained good muscle tone and limb movements. Recovery from anaesthesia was rapid and uneventful. Post-operatively the baby was observed for 24 h and vital parameters monitored closely, especially respiratory rate for any apnoeic spells and was discharged from the hospital next day.

In our institute, LMA (Ambu TM Laryngeal Mask) is used routinely for all intraocular surgeries in paediatric age group. However, this was the first time we used LMA in a premature baby as it has the advantage of ease of insertion. It can be inserted with or without using the index finger or thumb as advocated for LMA classic or unique. Its insertion causes minimum trauma and is associated with minimum effect on intraocular pressure and pressor response as compared with ETT. [4] We found that use of LMA was associated with steady haemodynamic parameters and good oxygenation.

As the baby was prematurely born with low body weight at the time of surgery, we considered it as a premature baby and planned our anaesthesia keeping in mind prematurity of all body systems and altered pharmacokinetics of drugs used in anaesthesia. We took all precautions to prevent hypothermia perioperatively.

To conclude, use of Ambu TM Laryngeal Mask was safe in this premature infant for ROP surgery under GA.

References

1Adewale L. Anatomy and assessment of the pediatric airway. Paediatr Anaesth 2009;19 Suppl 1:1-8.
2Ramesh S, Jayanthi R. Supraglottic airway devices in children. Indian J Anaesth 2011;55:476-82.
3Bhardwaj N, Yaddanapudi S, Singh S, Pandav SS. Insertion of laryngeal mask airway does not increase the intraocular pressure in children with glaucoma. Paediatr Anaesth 2011;21:1036-40.
4Jamil SN, Alam M, Usmani H, Khan MM. A study of the use of Laryngeal Mask Airway (LMA) in children and its comparison with endotracheal intubation. Indian J Anaesth 2009;53:174-8.