Adverse Respiratory Events After Removal of Laryngeal Mask Airway in Deep Anesthesia Versus Awake State in Children: A Randomized Trial

Abstract

Background The advent of the laryngeal mask airway (LMA) has reduced respiratory events in comparison to the conventional endotracheal tubes. Any manipulation under a light plane of anesthesia predisposes to increased airway sensitivity followed by adverse events. The reduced airway sensitivity in the deeply anesthetized state makes LMA removal feasible. In the past, the respective advantages and disadvantages of extubation in two planes of anesthesia have led to conflicting results. The primary objective of this study is to compare the incidence of adverse respiratory events at the time of LMA removal, in deeply anesthetized and awake groups. Our secondary objective was to record the management of complications. Materials and methods We conducted a prospective randomized control trial in 106 American Society of Anesthesiologists (ASA) I and II patients undergoing lower umbilical surgeries over a period of one year. The demographic details and intraoperative and postoperative variables, i.e., airway obstruction, laryngospasm, peripheral oxygen desaturations, cough, straining and vomiting, along with corrective measures were recorded by the primary research assistant in both groups. Regarding the management of peripheral oxygen desaturation (less than 90%), airway obstruction, and laryngospasm, 100% fractional inspired oxygen support and chin lift/jaw thrust were used. Results The average age was 32.58±15.81 months. The demographic characteristics of the patients were not significant between the two groups. The rate of adverse respiratory events like laryngospasm and airway obstruction was relatively high in the deep group but not statistically significant between the groups. A total of 7 (6.6%) patients had laryngospasm, 21 (20%) had airway obstruction, 16 (15%) had a cough and 11 (10%) patients had observed peripheral oxygen desaturation (less than 90%) between both groups. Conclusion We concluded that adverse respiratory events could happen in both awake and deep planes of anesthesia after the removal of LMA in children. Furthermore, both techniques have an acceptably low frequency of complications, and it does not affect the current clinical practice.

Airway management in neonates and infants

“…Subgroup analyses based on age remained underpowered despite the larger proportion of paediatric trials. A small RCT failed to detect a difference between awake and deep supraglottic airway device removal in children (average age 33 months), but was underpowered 136 …”

“…A small RCT failed to detect a difference between awake and deep supraglottic airway device removal in children (average age 33 months), but was underpowered. 136 …”

“…A small RCT failed to detect a difference between awake and deep supraglottic airway device removal in children (average age 33 months), but was underpowered. 136 In a systematic review, the feasibility of awake tracheal extubation or with deep anaesthesia was assessed in 1881 children across 17 RCTs, with six trials assessing tracheal extubation and 11 RCTs assessing removal of supraglottic airway devices. 137 Most of the studies had a mixed-age population and only one included infants.…”

Impact of Varied Anesthesia Maintenance Strategies on Postoperative Respiratory Complications in Pediatric Patients Undergoing Tonsillectomy and Adenoidectomy (AmPRAEC study)：study protocol for a multicenter randomized, double-blind clinical trial

“…Past research has delineated several high-risk factors for precipitating respiratory adverse events, including upper respiratory tract infections, pulmonary diseases, age younger than 6 years, OSA, type of airway device, obesity, type of surgery, and the involvement of specialized pediatric anesthesiologists [5][6][7] . Continuous exploration of perioperative strategies aimed at mitigating PRAE associated with anesthesia is underway, encompassing but not limited to the utilization of laryngeal masks [8,9] , intravenous anesthesia induction [10] , single or continuous intravenous lidocaine administration [11] , preoperative sedation with midazolam or dexmedetomidine, [12] preoperative anticholinergic use [13] , and extubation in deep Anesthesia versus awake state [14,15] . Nevertheless, the applicability of certain interventions may be restricted in speci c scenarios; for instance, di culties in venous access pose challenges in implementing intravenous induction in pediatric patients, while airway surgeries preclude the use of laryngeal masks.…”