Arafa Sherif Kamal, ElSharkawy Mohammed Said, Shaheen Mostafa Mohamed, Shama Ahmed
Faculty of Medicine, Anesthesia, Surgical Intensive Care and Pain Management Department, Kafr Elsheikh University, Kafr Elsheikh, 33512, Egypt.
Faculty of Medicine, Anesthesiology, Surgical Intensive Care and Pain Medicine Department, Tanta University, Tanta, Egypt.
BMC Anesthesiol. 2025 Aug 25;25(1):419. doi: 10.1186/s12871-025-03303-8.
Typically, when choosing a size for a child’s laryngeal mask airway (LMA), weight is considered; however, this approach has limitations. This study evaluated the efficacy of ultrasonography (US) measured hyomental distance (HMD) compared to weight-based criteria for optimizing the selection of LMA size in pediatrics.
This randomized controlled trial included 60 children aged 3–14 years scheduled for surgery requiring LMA. Patients were randomized equally to two groups. LMA size was selected based on either US-measured HMD [< 2 cm for size 2, 2–3 cm for size 2.5, and > 3 cm for size 3] in the HMD group or weight-based [size 2 for 10 to 20 kg, size 2.5 for 20 to 30 kg, and size 3 for 30 to 50 kg] in the control group (C Group).
The success rate (the proportion of cases where the first-selected LMA size required no adjustment or alternative devices) was significantly higher in the HMD group compared to the control group (93.33 vs. 70%, = 0.041). LMA placement five-point optimization scores (1: easiest insertion, 5: impossible) and a two-point scale (0: optimal cuff symmetry/esophageal alignment, 1: suboptimal) were significantly better in the HMD group ( < 0.05). The HMD method demonstrated superior predictive value for successful intubation with 98% sensitivity and 72.7% specificity, compared to weight-based criteria with 87.8% sensitivity and 9.1% specificity ( < 0.001).
US-measured HMD in pediatrics provides a superior method for choosing LMA size in children than traditional weight-based criteria, resulting in improved intubation success rates, better optimization scores, and higher predictive accuracy, aligning with prior studies in neonates and adults. We recommend HMD as a more reliable metric for pediatric LMA sizing.
The Pan African Clinical Trial Registry was notified about the trial before patient recruitment (PACTR202306740935710, registration date: 09 Jun 2023).
通常，在为儿童选择喉罩气道（LMA）尺寸时会考虑体重；然而，这种方法存在局限性。本研究评估了超声（US）测量的颏下距离（HMD）与基于体重的标准相比，在优化儿科LMA尺寸选择方面的有效性。
这项随机对照试验纳入了60名年龄在3至14岁、计划进行需要使用LMA的手术的儿童。患者被平均随机分为两组。在HMD组中，根据US测量的HMD选择LMA尺寸[2号尺寸HMD<2 cm，2.5号尺寸HMD为2至3 cm，3号尺寸HMD>3 cm]，而在对照组（C组）中根据体重选择[10至20 kg用2号尺寸，20至30 kg用2.5号尺寸，30至50 kg用3号尺寸]。
与对照组相比，HMD组的成功率（首次选择的LMA尺寸无需调整或更换设备的病例比例）显著更高（93.33%对70%，P = 0.041）。HMD组的LMA放置五点优化评分（1：最容易插入，5：不可能）和两点量表（0：最佳袖带对称性/食管对齐，1：次优）明显更好（P<0.05）。与基于体重的标准相比，HMD方法在成功插管方面显示出更高的预测价值，敏感性为98%，特异性为72.7%，而基于体重的标准敏感性为87.8%，特异性为9.1%（P<0.001）。
儿科中通过US测量的HMD为选择儿童LMA尺寸提供了一种优于传统基于体重标准的方法，从而提高了插管成功率、优化评分并提高了预测准确性，这与之前关于新生儿和成人的研究一致。我们建议将HMD作为儿科LMA尺寸确定的更可靠指标。
在招募患者之前已将该试验通知泛非临床试验注册中心（PACTR202306740935710，注册日期：2023年6月9日）。
