Laryngeal Mask Airway and Adenotonsillectomy

Objective: To compare the use of flexible laryngeal mask airway (LMA) and endotracheal tube (ETT) in pediatricadenotonsillectomy.Design: Prospective randomized trial.Setting: Tertiary care hospital.Patients: One hundred thirty-one children (aged 2-12 years). Exclusion criteria were body mass index (calculatedas 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 standardizedanesthesia 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 differencebetween groups with regard to age (P = .76), ethnicity (P = .75), body mass index (P = .99), or American Societyof 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 kinkingor 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 patientswho used LMA (P = .01) by 4.06 minutes. There were no differences (P = .49) in postanesthesia care unit recoverytimes.Conclusions: An LMA is an efficient alternative to ETT in pediatric adenotonsillectomy. When comparing LMAand ETT, there is no difference in rates of laryngospasm. Time to extubation is significantly shorter in patientsusing LMA. Before adopting the routine use of LMA in pediatric adenotonsillectomy, further study is needed toaddress visualization and kinking issues associated with this device.