Background: The size selection of Supraglottic Airway Devices (SAD) is usually based on body weight and gender. Occasionally the anatomical changes due to ageing process may give childlike “small appearance” to the elderly patients which may lead to selection of inappropriate size of SAD.
Case: We share the case of 102-year-old female in which small appearance misguided the Airway manager in choosing smaller size of SAD leading to inadequate ventilation. However, it was quickly identified by failed ‘bubble test’ and managed by upscaling the SAD size. This case highlights that although the usual criteria of correct depth of insertion may not be reliable in very old, edentulous patients, the reliability of the tests for proper SAD position & function remains unchanged.
Conclusion: A “Gender-based Adult size SAD is the appropriate choice irrespective of the external appearance/ weight of the elderly patient.