Trapezius squeeze test as an indicator for depth of anesthesia for laryngeal mask airway insertion in children

BACKGROUND: Clinical tests, such as loss of verbal contact, eyelash reflex, corneal reflex, and jaw relaxation, are used to assess the depth of anesthesia. “Trapezius squeeze test” (TST) is one such clinical test. It is a simple test to perform in which 1–2 inches of trapezius muscle is held and squeezed in full thickness and response is evaluated in the form of toe/body movement. MATERIALS AND METHODS: One hundred pediatric patients between 3 and 5 years of age, scheduled to undergo elective surgery, were included in this study. We evaluated negative TST as an indicator for optimal anesthesia depth for laryngeal mask airway (LMA) insertion in anesthetized spontaneously breathing children. Anesthesia was induced using 4% sevoflurane in oxygen. As the child lost the verbal contact or loss of body movement, TST was performed. Test was repeated every 15 s till it became negative. When the TST became negative, a well lubricated, appropriate-size LMA was inserted. RESULTS: Mean time for TST to become negative in our study was 271.80 ± 55.8 s and ease of insertion was excellent in 91 patients and acceptable in 9 patients. LMA was successfully inserted in first attempt in 96% patients. CONCLUSIONS: Negative TST is a reliable indicator for placement of LMA in spontaneously breathing children. Excellent conditions for LMA placement are present in majority of the patients without any untoward effects at this point of time.