Perioperative respiratory adverse events in children undergoing adenotonsillectomy with laryngeal mask airway versus endotracheal tube ventilation: multicentre, randomised controlled trial.
Yuan Han, Xiuwen Yi, Junming Xia et al.
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In 30 seconds
This multicentre, randomised, parallel-group trial compared laryngeal mask airway (LMA) with endotracheal tube (ETT) ventilation during adenotonsillectomy under general anaesthesia in 400 children aged 2 to under 7 years at four tertiary hospitals in China. Perioperative respiratory adverse events occurred in 22.5% (45/200) of the LMA group and 57.5% (115/200) of the ETT group, an absolute risk difference of -35.0 percentage points (95% confidence interval -43.5 to -25.7; P<0.001). The LMA group had fewer events both intraoperatively and postoperatively; neither group had serious adverse events.
Key findings
- Any perioperative respiratory adverse event occurred in 22.5% (45/200) with LMA versus 57.5% (115/200) with ETT; absolute risk difference -35.0 percentage points (95% confidence interval -43.5 to -25.7; P<0.001).
- Intraoperative events occurred in 9.0% (18/200) with LMA versus 17.5% (35/200) with ETT; postoperative events occurred in 16.5% (33/200) versus 49.5% (99/200), respectively.
- LMA was associated with lower proportions of laryngospasm (0.0% v 3.0%), desaturation (15.0% v 28.0%), airway obstruction (3.5% v 12.5%), and severe cough (10.5% v 42.0%).
- Neither group experienced serious adverse events; LMA was converted to ETT in three participants.
Why it matters
Airway choice is relevant to respiratory complications during and after paediatric adenotonsillectomy. In this randomised comparison, LMA ventilation was associated with substantially fewer recorded respiratory adverse events than ETT ventilation, including postoperative events. These findings provide comparative evidence for this procedure and age group, while the absence of serious adverse events in either group does not establish that either approach is risk-free.
What to keep in mind
The trial was conducted in children aged 2 to under 7 years at four tertiary hospitals in China, and the conclusion specifies use by experienced anaesthesiologists; applicability beyond this population and setting is uncertain.