Hyomental distance measured ultrasonography versus weight-based criteria for laryngeal mask size selection in children: a randomized controlled trial

Résumé

BACKGROUND: 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. METHODS: 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). RESULTS: 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%, p = 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 (p < 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 (p < 0.001). CONCLUSIONS: 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. TRIAL REGISTRATION: The Pan African Clinical Trial Registry was notified about the trial before patient recruitment (PACTR202306740935710, registration date: 09 Jun 2023).

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