Comparison of Removal of Laryngeal Mask Airway in Deeply Anaesthetised and Awake Paediatric Patients and their Associated Complications: A Randomised Clinical Study

Abstract

Introduction: The Laryngeal Mask Airway (LMA) is frequently used for managing paediatric airways for short surgical procedures. While it is easy to insert, it can lead to several complications if not removed at the appropriate plane of anaesthesia. Aim: To establish better timing for the removal of the LMA in deeply anaesthetised and awake paediatric patients by comparing the complications associated with each approach. Materials and Methods: The present randomised clinical study, enrolled 90 American Society of Anaesthesiologists (ASA) I and II paediatric patients aged 1 to 12 years, posted for elective short surgical procedures under general anaesthesia with airway management by Classical LMA. The patients were allocated into two groups: Group D (LMA removal under a deep plane/surgical plane of anaesthesia) and Group A (LMA removal in a fully awake state). At emergence from anaesthesia and during LMA removal, both groups were studied for complications including cough, desaturation (SpO2 < 95%), excessive salivation, vomiting, and laryngospasm. Descriptive statistics were reported using mean±standard deviation or median (range) for continuous variables. Comparison of continuous variables was done using the Student’s t-test or Wilcoxon rank sum test. Results: Demographic data like age, weight, duration of surgery, heart rate, and respiratory rate were comparable in both groups. A significantly higher incidence of cough was found in group A compared to group D (p-value=0.001). The incidences of desaturation (p-value=1.000), excessive salivation (p-value=0.361), vomiting (p-value=1.000), and laryngospasm (p-value=0.142) were comparable between the two groups. Cough was the most frequent complication in group A (16 out of 45 patients), while laryngospasm was the most frequent complication in group D (8 out of 45 patients). The total number of complications (p-value=0.043) was significantly higher in group A compared to group D. Conclusion: The removal of the Classical LMA in paediatric patients can be safely carried out in a deeply anaesthetised state. Based on the results of present study, the removal of the LMA in deeply anaesthetised paediatric patients is associated with fewer complications compared to its removal in the awake state.