Zastosowanie maski krtaniowej u dzieci

*Iwona Dšbrowska-Wójciak

Summary
A laryngeal mask airway is used frequently in paediatric anaesthesia. Among those most commonly used are: the classic - CLMA, ProSeal - PLMA, or Soft Seal - SLMA devices. The CLMA is easy to introduce and provides excellent conditions for fiberoptic endoscopy. Introduction of a gastric tube may be difficult. Leakage around the cuff and gastric distention occurs more frequently with the CLMA than with the PLMA. Pressure-controlled ventilation seems be more effective than volume-controlled ventilation, and the peak inspiratory pressure should not exceed 30 cm H₂O (3 kPa) to avoid gastric insufflation. Spontaneous ventilation via the LMA should be avoided, because of the large dead space and early onset of respiratory fatigue.
The mask cuff should not be overinflated, to avoid excessive pressure and subsequent pain and oedema. Cuffs should be inflated with only the minimum volume of air required to form an effective seal. The cuff pressure should be controlled, as nitrous oxide diffusion into the LMA cuff may markedly increase the pressure.
The LMA should always be at hand when a difficult intubation is expected. It can enable satisfactory ventilation and/or facilitate introduction of a bougie guide wire.
LMAs should never be used in patients who have gastroesophageal reflux, a full stomach, morbid obesity, or low pulmonary compliance.

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