practitioners often
mistakenly hold the
mask too low, which
obstructs the nasal
passages.
On the rare occa-
sions that it's diffi-
cult, it's usually due
to intrinsic airway
obstruction — for
neonates and
infants, large
tongues or soft tis-
sue collapse around
the area of the
epiglottis; for older
children, large
tongues, tonsils or adenoids. As I'll discuss below, a sequential series
of corrective maneuvers can usually eliminate the obstruction. But one
relatively easy approach is to use an oral airway, which sits behind the
tongue and isn't as invasive as an LMA. It can establish airflow by
bypassing soft tissue obstruction, enlarged tonsils or adenoids.
Supraglottic devices
Laryngeal mask airways (LMAs) have revolutionized airway manage-
ment and saved countless lives. I use them for almost all elective
cases that don't involve surgery around the airway or neck.
There are many ways to place them in children. One is to push the flat-
tened LMA cuff against the hard palate and simultaneously guide the
4 9
J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
z PAST IS PROLOGUE The best predictor of intubation
difficulty in a child is the patient's history. If you expect a
difficult intubation, it's best not to try direct laryngoscopy.
Ronald
S.
Litman,
DO
