Early versus late removal of the laryngeal mask airway (LMA) for general anaesthesia

Mathew, Preethy J; Mathew, Joseph L

doi:10.1002/14651858.cd007082.pub2

Cited by 23 publications

(20 citation statements)

References 32 publications

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“…It remains controversial whether the use of the LMA is associated with a higher incidence of laryngospasms. Moreover, removal of the LMA early or after the return of airway reflexes is still debatable [ 45 ]. Our data have shown that there were no statistically significant differences between the FLMA and ETT groups in laryngospasms following the removal of the airway in either the adult or pediatric subgroups during adenotonsillectomy, which is the most common type of surgery.…”

Section: Discussionmentioning

confidence: 99%

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Lian

2016

PLoS ONE

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ObjectiveFlexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials.MethodsA comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data.ResultsTen RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70–4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13–6.18) and RR = 0.95, 95% CI = (0.81–1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27–1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58–14.33)]; aspiration [RR = 0.76, 95% CI = (0.06–8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10–1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15–0.62)]; coughing [RR = 0.28, 95% CI = (0.15–0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26–0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44–11.18)].ConclusionThis systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.

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Section: Discussionmentioning

confidence: 99%

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Lian

2016

PLoS ONE

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“…A Cochrane review by Mathew and colleagues in 2015 concludes that the quality of evidence available is either low or very low and that there is a "paucity of well-designed RCTs (randomised controlled trials) and a need for large scale RCTs to demonstrate whether early removal or late removal of the LMA is better after general anaesthesia". 7 Traditionally, age or even more commonly the personal preference of the anaesthetist guides practice.…”

mentioning

confidence: 99%

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

Ramgolam

Hall

Zhang

et al. 2018

British Journal of Anaesthesia

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“…During sevoflurane anesthesia, the LMA can be safely removed at an approximate minimum alveolar concentration of 0.86 in 95% of anesthetized children; 19 the EC 95 in anesthetized adults is an end-tidal sevoflurane concentration of 1.18%, 20 and that of end-tidal desflurane to allow smooth LMA removal is 3.9% in adults. 21 However, according to a recent systematic review, the current best evidence is inconclusive regarding whether the LMA should be removed early or late in patients undergoing GA. 8 They concluded that there was a smaller risk of coughing after early removal (13.9%) than after late removal (19.4%), and the risk of airway obstruction was higher with early removal (15.6%) than with late removal (4.6%). In addition, there was no difference in the risk of desaturation between early removal (7.9%) and late removal (10.1%), and laryngospasm occurred at similar rates (early removal: 3.3%, late removal: 2.7%).…”

Section: Discussionmentioning

confidence: 99%

“…3–7 In this way, it is currently unclear whether the LMA should be removed at the end of the surgical procedure while the patient remains anesthetized (deep removal) or after the patient is fully awake (awake removal). 8 The quality of evidence available in this regard is considered “low” or “very low;” therefore, well-designed, randomized controlled trials are warranted to demonstrate whether early removal of the LMA after general anesthesia (GA) is better than late removal.…”

Section: Introductionmentioning

confidence: 99%

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Huang

Hung

Lu³

2016

Medicine

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After emergence from anesthesia, the incidence and severity of adverse airway effects caused by the laryngeal mask airway (LMA) can vary, depending on when the device was removed; nonetheless, reports differ regarding the exact optimal timing of LMA removal. The purpose of this study was to compare the rate of adverse events between 2 groups: those whose LMA was removed under general anesthesia (“deep” group) or under target-controlled infusion (TCI) of propofol (“awake” group).Institutional Review Board approval and written informed consent were obtained; 124 patients were then randomly allocated into either the “awake” group or the “deep” group. Anesthesia was induced and maintained using TCI of propofol, as well as intravenous fentanyl. In the “deep” group, the LMA was removed after surgery while the patients were deeply anesthetized using a target effect-site propofol concentration of 2 μg/mL, whereas in the “awake” group, the device was removed while the patients followed verbal instructions. The incidence of the following adverse events was recorded: coughing, straining, bronchospasm, laryngospasm, clenching, breath holding, gross purposeful movement, airway obstruction, retching, vomiting, and oxygen desaturation. If any such event occurred, the LMA removal was considered a failure. Airway hyperreactivity was recorded and graded – based on the severity of cough, breath holding, and oxygen desaturation.The failure rate was higher in the “awake” group (15/61; 24.6%) than in the “deep” group (5/60; 8.3%). Airway hyperreactivity was mild (score, <3) in both groups.Removal of the LMA under deep anesthesia using a target-controlled, effect-site propofol concentration of 2 μg/mL may be safer and more successful than removal when patients are fully awake after surgery.

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Early versus late removal of the laryngeal mask airway (LMA) for general anaesthesia

Cited by 23 publications

References 32 publications

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

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

Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

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