ASPO054 - Utility of LMA in Pediatric Tonsillectomy: A Randomized Trial
Saturday, April 30, 2022
5:00 PM – 5:30 PM CT
Location: Landmark B
Matthew Lelegren, MD1, John C. M. Kenerson, MD1, Craig C. Brawley, MD2, Phoebe Yu, MD3, Turaj Vazifedan, PhD1, Cristina Baldassari, MD1;
1Otolaryngology-Head and Neck Surgery, Eastern Virginia Med. Sch., Norfolk, VA, 2Otolaryngology-Head and Neck Surgery, Northwestern, Chicago, IL, 3Otolaryngology-Head and Neck Surgery, Harvard Med. Sch., Boston, MA.
Introduction: While use of laryngeal mask airway (LMA) for pediatric adenotonsillectomy may decrease operating room time, routine use of LMA has been limited by intraoperative tube occlusion and kinking. The objective of our study was to assess the utility of LMA in pediatric adenotonsillectomy when used in conjunction with a novel mouth gag. We compared rates of tube obstruction between LMA and traditional endotracheal tube (ETT) and examined differences in operating and extubation times.
Methods:Children 3 to 16 years of age that were undergoing outpatient adenotonsillectomy for sleep disordered breathing and/or chronic tonsillitis were randomized to either ETT or LMA. Children with severe comorbidities including obesity and craniofacial syndromes were excluded. A standardized anesthetic protocol was utilized along with a specially designed mouth gag with a wider groove. Extubation time was defined as the time between mouth gag and ETT/LMA removal.
Results: Eighty children were randomized. The mean age was 6.4 years. There were no instances of tube obstruction in the 41 patients who underwent ETT intubation and 3 instances (7.7%) of tube obstruction in the 39 patients who underwent LMA (p=0.070). There was no difference in the odds of laryngospasm between LMA and ETT groups (OR=0.51, 95% CI (0.05, 5.90), p=0.99). The mean surgical time for the two groups was similar (p=0.500). Extubation time was significantly decreased in the LMA group at 2.6 minutes compared to 7.7 minutes in the ETT group (p < 0.0001). However, the differences in total operating room time were similar (p=0.149) between the LMA (49.9 minutes) and ETT (53.8 minutes) groups.
Conclusion: Use of a novel mouth gag decreases the rate of LMA obstruction in children undergoing adenotonsillectomy. Extubation times can be shortened by using LMA. When used in conjunction with a novel mouth gag, LMA is an alternative to ETT in healthy children undergoing adenotonsillectomy.