Laryngeal Mask Airway and Adenotonsillectomy

Abstract

Objective: To compare the use of flexible laryngeal mask airway (LMA) and endotracheal tube (ETT) in pediatric
adenotonsillectomy.
Design: Prospective randomized trial.
Setting: Tertiary care hospital.
Patients: One hundred thirty-one children (aged 2-12 years). Exclusion criteria were body mass index (calculated
as the weight in kilograms divided by the height in meters squared) greater than 35 and craniofacial anomalies.
Obstructive sleep apnea was the most common indication for surgery.
Intervention: Children undergoing adenotonsillectomy were randomized to use of an LMA or ETT. A standardized
anesthesia protocol was used.
Main Outcome Measures: Primary outcome measure was laryngospasm. Secondary measures included anesthesia,
operative, and recovery times.
Results: Sixty children were randomized to the LMA group and 71 to the ETT group. There was no difference
between groups with regard to age (P = .76), ethnicity (P = .75), body mass index (P = .99), or American Society
of Anesthesiologists grade (P = .46). Incidence of postoperative laryngospasm between LMA (12.5%) and ETT
(9.6%) was similar (P = .77). In 10 patients, the LMA was changed to ETT intraoperatively owing to tube kinking
or difficulty with visualization. Mean (SD) surgical times for LMA and ETT groups were 33.35 (13.39) and 37.76
(18.26) minutes, respectively (P = .15). Time from surgery end to extubation was significantly shorter in patients
who used LMA (P = .01) by 4.06 minutes. There were no differences (P = .49) in postanesthesia care unit recovery
times.
Conclusions: An LMA is an efficient alternative to ETT in pediatric adenotonsillectomy. When comparing LMA
and ETT, there is no difference in rates of laryngospasm. Time to extubation is significantly shorter in patients
using LMA. Before adopting the routine use of LMA in pediatric adenotonsillectomy, further study is needed to
address visualization and kinking issues associated with this device.