A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years

Abstract

STUDY OBJECTIVE: To compare the frequency of airway complications during removal of the Laryngeal Mask Airway (LMA) in 2 to 6 year old pediatric patients.

DESIGN: Prospective randomized study.

SETTING: Operating room at a university hospital.

PATIENTS: 92 ASA physical status 1 and 2 pediatric patients, aged 2 to 6 years.

INTERVENTIONS: Participants were randomized to two groups: anesthesia state (anesthesia group) and awake state (awake group). Anesthesia was induced and maintained with sevoflurane. Patients were allowed to maintain spontaneous respiration. In the anesthesia group, the LMA was removed during anesthesia with 2.2% of sevoflurane. In the awake group, the LMA was removed when patients met the recovery criteria, including facial grimace, spontaneous eye opening, and purposeful arm movement.

MEASUREMENTS: During and after removal of the LMA, the frequencies of airway-related complications including cough, severe salivation, LMA biting or teeth clenching, breath holding, laryngospasm, desaturation (SpO(2) < 95%), and vomiting, were recorded. The frequencies of upper airway obstruction and duration of emergence from anesthesia also were compared.

MAIN RESULTS: The frequency of airway-related complications was significantly less in the anesthesia group than the awake group (4.8% vs 37.2%, P = 0.001). Of the complications, cough, desaturation, excessive secretion, and LMA biting were less common in the anesthesia group. No differences between groups were noted in the frequency of upper airway obstruction and duration of emergence from anesthesia.

CONCLUSION: In 2 to 6 year old pediatric patients, an adequate anesthetic state is preferable to the awake state during LMA removal, producing fewer complications.