Review article: cuff volume and size selection with the laryngeal mask.

By the year 2000, the laryngeal mask will have been used in approximately 100 million patients worldwide. Currently, at least 30% of anaesthetised patients in the UK [1] and 20% of patients in the USA [2] are managed using the laryngeal mask. The popularity of the device stems from its ease of use, its role in the difficult airway and the advantages it offers over the face mask and tracheal tube [3, 4]. The advent of the laryngeal mask has certainly forced anaesthetists to re-consider the practice of routine airway management as a whole. In many circumstances in which intubation and ventilation was once considered mandatory, the laryngeal mask has been used safely, and may even offer advantages. For example, the laryngeal mask can be used during adenotonsillectomy and is associated with fewer complications, such as aspiration of blood, than tracheal intubation [5]. Although the laryngeal mask has a low failure and complication rate, considerable efforts have been made to improve its clinical success and to make its use even safer. One recent advance is in the selection of appropriate size and cuff volume of the laryngeal mask. We felt it appropriate to summarise current knowledge of this issue and to make evidencebased recommendations for clinical practice.