The Use of Disposable Laryngeal Mask Airway for Adenotonsillectomies

Ranieri Jr D, Neubauer AG, Ranieri DM, Nascimento Jr P - The Use of Disposable Laryngeal Mask Airway for Adenotonsillectomies. Background and objectives: Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT). Methods: We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n = 100) or the laryngeal mask airway group (LMA, n = 104). It was measured the level of oxygen saturation by pulse oximetry (SpO(2)) after the induction of anesthesia (SpO(2)-1), after establishing the operative field (SpO(2)-2), at the end of the surgical procedure (SpO(2)-3), three minutes after the removal of the contained breathing apparatus (SpO(2)-4) and upon admission to the post-anesthesia care unit (SpO(2)-5). All respiratory complications were recorded. Results: The mean SpO(2) values and standard deviations for the TT and LMA groups were as follows: SpO(2)-1: 98.9 +/- 1.0 and 98.7 +/- 0.8 (p > 0.25), SpO(2)-2: 97.4 1.0 and 94.9 +/- 4.3 (p < 0.001), SpO(2)-3: 96.9 +/- 1.1 and 97.2 +/- 1.1 (p = 0.037), SpO(2)-4: 91.7 +/- 9.0 and 95.2 +/- 2.2 (p < 0.001) and SpO(2)-5: 94.0 +/- 2.1 and 95.8 +/- 2.6 (p < 0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a U. Respiratory complications were similar between groups. Conclusions: Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO(2), compared to using a U. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a IT is preferred for safety.