Anesth Analg 2004;98:557
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000077716.21575.5B
LETTERS TO THE EDITOR
Endotracheal Intubation and a Laryngeal Mask Airway in a Child with Mallampati Class Zero Airway
Eriko Okamoto, MD,
Tadakazu Sakuragi, MD,
Yasuyuki Sugi, MD,
Shinjiro Shono, MD, and
Kazuo Higa, MD
Department of Anesthesiology, School of Medicine, Fukuoka University, Fukuoka, Japan
To the Editor:
Assessment as a Mallampati class zero airway has recently been proposed when the epiglottis is seen on mouth opening and tongue protrusion (1). The frequency of Mallampati class zero airway was estimated to be about 1% in adults (1). While endotracheal intubation is easy in adults with Mallampati class zero airway, there are no reports of children with Mallampati class zero airway; thus it is not known whether or not endotracheal intubation in such children would be easy. Furthermore, the ease of insertion of a laryngeal mask airway in adults and children with Mallampati class zero airway has not been reported. We have twice managed a child with Mallampati class zero airway with general anesthesia: the first anesthesia was managed with endotracheal intubation and the second with a laryngeal mask airway.
A 9-yr-old boy, 129 cm in height and 24 kg in weight, was scheduled for arthroscopy of the left elbow and osteosynthesis because of a fracture of the left lateral epicondyle of the humerus. Routine oral examination showed that he had a Mallampati class zero airway. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen. After IV vecuronium, the larynx was visualized with a Macintosh blade 2. Laryngoscopy grade according to Cormack and Lehane was 1, and the trachea was easily intubated. One and half months later, removal of the nails used for osteosynthesis was planned. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen, and a laryngeal mask airway of size 2.5 was easily inserted and fitted. Inflation of the cuff at a pressure of 15 cm H2O resulted in there being no gas leakage throughout the procedure.
Although both endotracheal intubation and insertion of a laryngeal mask airway was easy in our child, further clinical studies will be needed to clarify whether or not endotracheal intubation and insertion of a laryngeal mask airway is actually an easy procedure in children with Mallampati class zero airway.
Reference
- Ezri T, Warters RD, Szmuk P, et al. The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade. Anesth Analg 2001; 93: 1073–5.[Abstract/Free Full Text]
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