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Br J Anaesth. 2018 Mar;120(3):571-580. doi: 10.1016/j.bja.2017.11.094. Epub 2018 Jan 27.

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

Author information

1
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia; Children's Lung Health, Telethon Kids Institute, Perth, Australia.
2
Children's Lung Health, Telethon Kids Institute, Perth, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Centre of Child Health Research, University of Western Australia, Perth, Australia.
3
School of Public Health, Curtin University, Perth, Australia; Centre for Genetic Origins of Health and Disease (GOHaD), University of Western Australia, Perth, Australia; Centre for Genetic Origins of Health and Disease (GOHaD), Curtin University, Perth, Australia.
4
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia.
5
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia; Medical School, Division of Anaesthesiology and Pain Medicine, University of Western Australia, Perth, Australia. Electronic address: Britta.regli-vonungern@health.wa.gov.au.

Abstract

BACKGROUND:

Laryngeal mask airways (LMA) are widely used during tonsillectomies. Contrasting evidence exists regarding the timing of the removal and the risk of perioperative respiratory adverse events. We assessed whether the likelihood of perioperative respiratory adverse events is influenced by the timing of LMA removal in children with at least one risk factor for these events.

METHODS:

Participants (n=290, 0-16 yr) were randomised to have their LMA removed either deep (in theatre by anaesthetist at end-tidal sevoflurane >1 minimum alveolar concentration) or awake (in theatre by anaesthetist or in postanaesthesia care unit by anaesthetist or trained nurse). The primary outcome was the occurrence of perioperative respiratory adverse events over the whole emergence and postanaesthesia care unit phases of anaesthesia. The secondary outcome was the occurrence of perioperative respiratory adverse events over the distinct phases of emergence and postanaesthesia care unit.

RESULTS:

Data from 283 participants were analysed.

PRIMARY OUTCOME:

even though a higher occurrence of adverse events was observed in the awake group, no evidence for a difference was found [45% vs 35%, odds ratio (OR): 1.5, 95% confidence interval (CI): 0.9-2.5, P=0.09]. Secondary outcome: there was no evidence for a difference between the groups during emergence [19 (14%) deep vs 25 (18%) awake, OR: 0.74, 95%CI: 0.39-1.42, P=0.37]. However, in the postanaesthesia care unit, children with an awake rather than deep removal experienced significantly more adverse events [55 (39%) vs 37 (26%); OR: 1.85, 95%CI: 1.12-3.07, P=0.02].

CONCLUSION:

We found no evidence for a difference in the timing of the LMA removal on the incidence of respiratory adverse events over the whole emergence and postanaesthesia care unit phases. However, in the postanaesthesia care unit solely, awake removal was associated with significantly more respiratory adverse events than deep removal.

TRIAL REGISTRATION NUMBER:

ACTRN12609000387224 (www.anzctr.org.au).

KEYWORDS:

laryngeal mask airway; paediatric anaesthesia; timing; tonsillectomy

PMID:
29452814
DOI:
10.1016/j.bja.2017.11.094

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