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- DOI 10.18231/j.ijca.2025.065
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CrossMark
Evaluation of auricle size based method for sizing of ProSeal LMA in paediatric population: A prospective observational study
- Author Details:
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Anshul Goyal
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Munisha Agarwal
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Rohit Priyadarshi
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Ruchi Kumari
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Lalit Gupta *
Anshul Goyal
Lalit Gupta *
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.
References
- White MC, Cook TM, Stoddart PA. A critique of elective pediatric supraglottic airway devices. Paediatr Anaesth. 2009;19 Suppl 1:55–
- Ramachandran K, Kannan S. Laryngeal mask airway and the difficult airway. Curr Opin Anaesthesiol. 2004;17(6):491–3.
- Ho AM, Karmakar MK, Dion PW. Choosing the correct laryngeal mask airway sizes and cuff inflation volumes in pediatric patients. J Emerg Med. 2008;35(3):299–300.
- Van TZ, Hagberg CA, Cattano D. Inconsistent size nomenclature in extraglottic airway devices. Minerva Anaestesiol. 2014;80(6):692–
- Haliloglu M, Bilgen S, Uzture N, Koner O. Simple method for determining the size of the ProSeal laryngeal mask airway in children: a prospective observational study. Rev Bras Anaestesiol. 2017;67(1):15–20.
- Zahoor A, Ahmad N, Sereche G, Riad W. A novel method for laryngeal mask airway size selection in pediatric patients. Eur J Anaesthesiol. 2012;29(8):386–90.
- Ravi R, Mohan VK, Badhe AS, Mishra SK, Bidkar PU. Comparison of weight-based and pinna size-based selection of ProSeal laryngeal mask airway in pediatric population–A prospective exploratory trial. Indian J Anaesth. 2019;63(1):36–41. Goyal et al. / Indian Journal of Clinical Anaesthesia 2025;12(3):413–419 419
- Jha A, Jacob NSM, Mathew S, Duggappa AKH, Muhamed S, Udupi S. A randomized controlled trial to compare the auricle size-based method for ProSeal laryngeal mask airway selection with the weight-based method among pediatric patients. Trends Anaesth Crit Care. 2021;37:50–4.
- Wong JG, Heaney M, Chambers NA, Erb TO, Von Ungern‐ Sternberg BS. Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children. Pediatr Anaesth. 2009;19(5):464–9.
- Nott MR, Noble PD, Parmar M. Reducing the incidence of sore throat with the laryngeal mask airway. Eur J Anaesthesiol. 1998;15(2):153–7.
- Burgard G, Möllhoff T, Prien T. The effect of laryngeal mask cuff pressure on postoperative sore throat incidence. J Clin Anaesth. 1996;8(3):198–201.
- Brimacombe JR. Positive pressure ventilation with the size 5 laryngeal mask. J Clin Anaesth. 1997;9(2):113–7.
- Voyagis GS, Batzioulis PG, Secha-Doussaitou PN. Selection of the proper size of laryngeal mask airway in adults. Anaesth Analg. 1996;83(3):663–4.
- Berry AM, Brimacombe JR, McManus KF, Goldblatt M. An evaluation of the factors influencing selection of the optimal size of laryngeal mask airway in normal adults. Anaesthesia. 1998;53(6):565–70.
- Brimacombe J, Keller C, Judd DV. Gum elastic bougie-guided insertion of the ProSeal™ laryngeal mask airway is superior to the digital and introducer tool techniques. Anesthesiology. 2004;100(1):25–9.
- Lopez-Gil M, Brimacombe J, Barragan L, Keller C. Bougie-guided insertion of the ProSeal™ laryngeal mask airway has higher first- attempt success rate than the digital technique in children. Br J Anaesth. 2005;96(2):238–41.
- Farkas LG, Posnick JC, Hreczko TM, Pron GE. Growth patterns of the nasolabial region: A morphometric study. Cleft Palate Craniofac J. 1992;29(4):318–24.
- Kalcioglu MT, Miman MC, Toplu Y, Yakinci C, Ozturan O. Anthropometric growth study of normal human auricle. Int J Pediatr Otorhinolaryngol. 2003;67(11):1169–77.
- DALC. Children and size of laryngeal masks. Can J Anaesth. 1994;41(4):354–8.