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

Supraglottic airway devices vs tracheal intubation in children: a quantitative meta‐analysis of respiratory complications

“…The incidence of laryngospasm was influenced by the depth of anesthesia when removing airway devices (laryngeal mask airway was associated with a decrease in this complication when removed in deep‐sedated patients but not when they were fully awake, Table ), as previously described . This result probably involves the stimulating effect of the laryngeal mask on the upper respiratory tract during recovery triggering the laryngospasm reflex, particularly strong in children.…”

The effects of Anesthesia and opioids on the upper airway: A systematic review

“…A clinical study using sevoflurane found that two of 70 children with SDB undergoing T&A developed brief hypoxia . Lastly, in a study of 60 patients undergoing surgery, 22% developed airway irritation (cough or hiccups) during induction; airway irritation was associated with the presence of an artificial oral airway, lack of premedication, and use of desflurane …”

“…50 Lastly, in a study of 60 patients undergoing surgery, 22% developed airway irritation (cough or hiccups) during induction; airway irritation was associated with the presence of an artificial oral airway, lack of premedication, and use of desflurane. 51 The nine included studies on opioids reported that fentanyl depresses upper airway reflexes, and that…”

Deep or awake removal of laryngeal mask airway in children at risk of respiratory adverse events undergoing tonsillectomy—a randomised controlled trial

“…A broad range of definitions have been used to differentiate between these two states in the literature. 9,10,13,19,20 They range from the MAC of the volatile anaesthetic agent to the effective dose of sevoflurane for smooth LMA removal and Length of stay (min) in the PACU for each group with and without perioperative respiratory adverse events over the combined period of emergence and recovery.…”

“…8 Patients having awake removal (active airway protection by innate reflexes) seem to be more prone to coughing and straining leading to an increased incidence of sore throat. 9,10 Moreover, Valsalva manoeuvre and breath-holding associated with coughing and bucking may cause a decrease in oxygen saturation. 11 While in healthy children (ASA status I and II), the incidence of perioperative respiratory adverse events seems to be independent of the timing of LMA removal, it is unclear if children with respiratory symptoms (e.g.…”