Laryngeal Mask as Primary Airway Device in Pediatric Laryngotracheal Surgery

Background Laryngotracheal surgery in pediatric patients poses a significant challenge due to the anatomically narrower and more obstruction-prone airway. Airway stenoses in children frequently arise from congenital anomalies or post-intubation injuries, often requiring complex surgical interventions. While the laryngeal mask (LMA) has become increasingly established as a primary airway management device in adult laryngotracheal procedures, systematic data on its use in pediatric patients remain scarce. Although case reports suggest successful application, comprehensive studies on the safety and efficacy of this approach are lacking.

Methods & Materials This retrospective single-center analysis included all pediatric patients (< 12 years) who underwent laryngotracheal surgery at the Medical University of Vienna between February 2011 and December 2024. Airway management was standardized using an LMA until cross-table ventilation was established. Patients with a preexisting tracheostomy or alternative primary airway management were excluded. Clinical parameters, perioperative complications and airway complications were analyzed. This study was approved by the Ethics Committee of the Medical University of Vienna (Project Code: 1116/2025).

Results A total of 19 pediatric patients (6 female, 13 male) were included. Surgical procedures compromised 13 cricotracheal resections, 4 tracheal resections, one cartilage graft reconstruction following a previous cricotracheal resection and one repair of a membranous tracheal rupture, all performed for benign underlying pathology. LMA ventilation was successfully maintained until cross-table ventilation in all cases, with no need to switch to an alternative airway device. The mean pulse oximetry (SpO₂) and mean end-tidal CO₂ during LMA ventilation was 99.4% ± 0.81% and 33.87mmHg ± 7.93mmHg, respectively.

Conclusion Our findings suggest that the laryngeal mask is a safe and effective primary airway device in pediatric laryngotracheal surgery. Ventilation was successfully maintained in all cases until cross-table ventilation was established, with stable perioperative oxygenation and CO2 elimination.

Publikationsverlauf

Artikel online veröffentlicht:
25. August 2025