Evaluation of auricle size based method for sizing of ProSeal LMA in paediatric population: A prospective observational study

• Author Details:   
• Anshul Goyal
• Munisha Agarwal
• Rohit Priyadarshi
• Ruchi Kumari
• Lalit Gupta ^*

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Background and Aims: The weight-based method is the most commonly used approach for sizing the ProSeal laryngeal mask airway (PLMA) in paediatric patients. However, this method may not always be practical or reliable, particularly in situations where a patient’s weight is unknown. This study aimed to evaluate the effectiveness of an auricle size-based method for PLMA sizing in children and its agreement with the conventional weight-based method. Additionally, we explored the association between Body Mass Index (BMI) and PLMA sizing using both methods.

Materials and Methods: This prospective observational study included 56 paediatric patients aged 2–12 years, classified as ASA I/II, undergoing elective surgeries under general anaesthesia. The auricle size-based method involved selecting a fully inflated PLMA that visually approximated the patient’s auricle size. The first attempt at insertion was performed using the auricle size-based method, and if unsuccessful, the weight-based method was employed. The agreement between the two methods was assessed using Cohen’s Kappa coefficient, and qualitative variables were analysed using the Chi-square test.

Results: Successful first-attempt PLMA insertion and effective ventilation were achieved in 40 out of 56 patients (71.43%) using the auricle size-based method. Among younger children (aged 2–7 years), the success rate was notably higher at 91.18% (31/34 patients). The agreement between the auricle size-based and weight-based methods was minimal (? = 0.21). However, for patients aged ?7 years, the agreement improved to fair (? = 0.39, p = 0.001). There was no significant association between BMI and PLMA size determined by either the auricle size-based method (??2;, p = 0.379) or the weight-based method (??2;, p = 0.128).

Conclusions: The auricle size-based method can serve as a viable alternative for PLMA sizing in paediatric patients, particularly in scenarios where weight-based estimation is not feasible.

Keywords: ProSeal laryngeal mask airway, Pediatrics; Airway management; Supraglottic airway device.