Ren Yaoyao, Cao Cuicui, Liang Xuan, Ju Zhihai, Zhang Ling, Cui Xu, Wang Guyan
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
School of Management, Huazhong University of Science and Technology, Wuhan, China.
Ann Transl Med. 2021 Feb;9(3):196. doi: 10.21037/atm-20-4838.
Laryngeal mask airway (LMA) is a prominent supraglottic airway device, widely used especially in difficult airway management. However, the LMA sizes recommended by the manufacturers are not always well matched in clinical practice, which leads to complications. To date, there are rare models to validate whether the manufacturers' standard is suitable for use in clinical practice.
A total of 58,956 patients undergoing general anesthesia using LMA device were included in the study between January 1, 2011 and December 31, 2018, to validate the adherence rate of LMA sizes according to the manufacturers' recommendations. A logistic regression analysis was performed based on the actual LMA size used in clinical practice to establish separately size selection guidelines with gender, weight, and age as variables in adults, adolescents, and children.
LMA insertions were analyzed in 50,776 (86.1%) adults, 3,548 (6%) adolescents, and 4,632 (7.9%) children. Suitability of manufacturers' recommendations was higher in children [male: 86.02%; female: 85.09%] than adults [male: 72.75%; female: 78.13%] or adolescents [male: 73.4%; female: 70.79%]. For adults and adolescents, LMA size was better predicted using the regression model rather than the manufacturers' recommendations [male adults: 82.4% (81.16-83.57%) 73.21% (71.79-74.59%), P<0.05; female adults: 87.82% (86.65-88.9%) 77.07% (75.6-78.48%), P<0.05; male adolescents: 79.45% (74.86-83.4%) 72.05% (67.09-76.53%), P<0.05; female adolescents: 78.4% (71.11-84.31%) 72.22% (64.54-78.82%), P<0.05]. For children, there was equal performance suitability using the regression model and the manufacturers' recommendations.
The model-based guidelines may provide more accurate directions for LMA size selection for adolescents and adults than the manufacturers' weight-based recommendations, whereas the manufacturers' recommendation in children is consistent with clinical practice.
喉罩气道（LMA）是一种重要的声门上气道装置，尤其在困难气道管理中广泛应用。然而，制造商推荐的LMA尺寸在临床实践中并不总是匹配良好，这会导致并发症。迄今为止，很少有模型来验证制造商的标准是否适用于临床实践。
2011年1月1日至2018年12月31日期间，共有58956例使用LMA装置进行全身麻醉的患者纳入研究，以验证根据制造商建议的LMA尺寸的符合率。基于临床实践中实际使用的LMA尺寸进行逻辑回归分析，分别以性别、体重和年龄为变量，建立成人、青少年和儿童的尺寸选择指南。
分析了50776例（86.1%）成人、3548例（6%）青少年和4632例（7.9%）儿童的LMA插入情况。制造商建议的适用性在儿童中更高[男性：86.02%；女性：85.09%]，高于成人[男性：72.75%；女性：78.13%]或青少年[男性：73.4%；女性：70.79%]。对于成人和青少年，使用回归模型比制造商的建议能更好地预测LMA尺寸[成年男性：82.4%（81.16 - 83.57%）对73.21%（71.79 - 74.59%），P<0.05；成年女性：87.82%（86.65 - 88.9%）对77.07%（75.6 - 78.48%），P<0.05；青少年男性：79.45%（74.86 - 83.4%）对72.05%（67.09 - 76.53%），P<0.05；青少年女性：78.4%（71.11 - 84.31%）对72.22%（64.54 - 78.82%），P<0.05]。对于儿童，使用回归模型和制造商的建议在适用性方面表现相当。
基于模型的指南可能比制造商基于体重的建议为青少年和成人的LMA尺寸选择提供更准确的指导，而制造商对儿童的建议与临床实践一致。
