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

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.