Oxygen Leakage Around the Laryngeal Mask Airway During Laser Treatment of Port-Wine Stains in Children

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Abstract
We are aware of four cases in which either the eyebrows or eyelashes were ignited during the administration of general anesthesia via a face mask. The laryngeal mask airway (LMA) recently has become widely available and this device might decrease the risk of fire during treatment of these lesions. We therefore designed this study to examine the extent of oxygen leakage under the mask during clinical cases, and to compare this with the leakage present with the LMA. A total of 20 patients aged 4 mo to 16 yr were studied on 26 separate occasions. During spontaneous ventilation, high concentrations of oxygen leaked around the mask in every case (mean 63% ± 16%), but in only one case was a concentration more than 21% detected around the LMA (P < 0.001). During controlled ventilation with the LMA, oxygen leaked around the mask in 19% of cases. Use of the LMA markedly decreases the incidence of potential oxygen leakage into the laser field, and is recommended for use, with preservation of spontaneous ventilation, during these cases. We suggest measuring oxygen concentrations at the mouth for laser treatment of facial port-wine stains to confirm that the larynx has been isolated. Anesthesia via a mask with oxygen and nitrous oxide should not be used while lesions around the eyes are treated, due to the risk of igniting the eyebrows or eyelashes. Address correspondence and reprint requests to Richard H. Epstein, MD, Department of Anesthesiology, Thomas Jefferson University, Suite 6275 New Hospital, 111 S. 11th St., Philadelphia, PA 19107. Presented in part at the 1993 Annual Meeting of the American Society of Anesthesiologists, Washington, DC. Accepted for publication November 16, 1993. © 1994 International Anesthesia Research Society...

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