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The use of supraglottic airway devices in pediatric laparoscopic surgery.

T Laryngeal Mask AirwayTM (LMA) and subsequently other supraglottic airway devices have virtually revolutionized the way we secure the airway perioperatively in adult and paediatric patients. In a recent review in this journal, Jan Jakobsson 1 described the unique values of supraglottic airway devices in daily airway management. The classic laryngeal mask airway (cLMA) found its place into everyday paediatric and adult surgical procedures and has been used for many years now. Nowadays LMAs are used more and more in sophisticated or, at least for some people, more questionable situations (e.g. long anaesthesia duration).2 The use of laryngeal masks as first devices in the prone position is another such example even if this application is supposed to be reserved for experienced users that are most familiar with supraglottic airway devices. However, the feasibility to do so has been shown in many published papers, for example by Weksler et al.3 The prudent anaesthesiologist will rely on an endotracheal tube (ETT) in these circumstances. But even well-accustomed LMA-users would prefer in such cases a laryngeal mask that provides high seal pressures and whose use has been described to be successful in the prone position in a large number of patients: the ProSealTM LMA. It features the additional possibility for suctioning gastric content and in general provides an airway seal pressure exceeding the seal measured for the cLMA. Brimacombe et al. offered a review of 245 cases of ProSeal insertion in the prone position, stating its safe use.4 In contrast to the challenges presented in the prone position, the use of supraglottic airway devices in laparoscopic procedures for adults has almost become routine in institutions where clinicians are thoroughly familiar with laryngeal masks. Indeed, the use of a ProSeal in laparoscopic gynecology procedures even has been associated with less postoperative opiate consumption and less postoperative nausea and vomiting.5 In pediatric patients however, there is much less evidence available. In this edition of the Minerva Anestesiologica, Ozdamar et al.6 present a clinical study on 40 children undergoing laparoscopic procedures with either a cLMA or an ETT to secure the airway. Using a monometer attached to nasogastric tubes placed before insertion of cLMA or ETT, they showed that the choice of airway management does not vastly influence intragastric pressure. The authors conclude about their randomized controlled trial that it demonstrates correctly placed cLMA may be a feasible and effective alternative to ETT in healthy children undergoing laparoscopic surgery. What can the anesthesiologist working everyday with paediatric patients draw from that conclusion? First, as research on paediatric anesthesiology is especially cumbersome to perform, any such research merits at least our acknowledgment for the accomplished task. Paediatric studies tend to be heavily underpowered mostly because of the difficulty to consent enough patients in reasonable time, which leads to the temptation of conMINERVA MEDICA COPYRIGHT®