Laryngeal mask airway use in children with acute burns: intraoperative airway management

Paediatric patients with acute burns often require many operative procedures in short succession; yet due to inhalation injury or recent extubation their airways may be susceptible to tracheal tube induced damage. We proposed the laryngeal mask airway (LMA) as a useful airway management tool in this setting. In this prospective study, 80 eight (88) patients with mean age (+/- SD) of 7.8 +/- 4.7 years and average percentage total body surface area burned (%TBSA) of 21 +/- 18% had their airways managed with an LMA while in the operating room for 141 procedures. Twenty-five patients (28.4%) had been previously intubated for burn management and 19 (21.6%) had evidence of inhalation injury. During each procedure, the patient was evaluated for airway obstruction, laryngospasm, inability to ventilate, hypoxaemia, evidence of aspiration/regurgitation or any situation which required intraoperative manipulation/removal of the LMA. Of the 141 procedures, 122 were without airway problems. Of the remaining 19, nine required only a simple reseating of the LMA for correction. The other 10 events include arterial desaturation (n = 3), partial laryngospasm (5), airway obstruction (1) and regurgitation without aspiration (1). In each case, corrective action led to resolution of the problem with no patient morbidity. This series demonstrates the LMA is a safe and efficacious airway management device in the paediatric burn population.