The selection of ventilation devices in children with mild or moderate upper respiratory tract infections: a randomised controlled trial.

Abstract

Purpose: Administering anaesthesia to children with upper respiratory tract infections (URTIs) increases the risk of perioperative respiratory adverse events (PRAEs). Several observational studies have suggested that the supraglottic airway (SGA) technique could be a potential alternative for airway management in children. This randomised controlled trial assesses whether using a SGA instead of an endotracheal tube (ETT) in children with mild or moderate URTIs affects the incidence of PRAEs.

Methods: A total of 78 paediatric patients with mild or moderate URTIs who received either a SGA or ETT were included. Patients were monitored for adverse events such as cough, laryngospasm, bronchospasm, breath-holding, postoperative stridor or desaturation (< 90%) during the following stages: induction of anaesthesia, tube placement, surgery, tube removal and postanaesthesia care.

Results: Throughout the perioperative period, 56.4% (44/78) of children experienced PRAEs. The incidence was 77.5% (31/40) in those receiving ETT and 34.1% (13/38) in those receiving SGA. The relative risk (RR) of PRAEs in children receiving SGA was 0.417 (95% CI: 0.248-0.701) compared with those receiving ETT (p < 0.001). Specifically, the incidence of minor PRAEs was significantly lower in the SGA group (28.9%, 11/38) compared with the ETT group (67.5%, 27/40) (RR: 0.429, 95% CI: 0.249-0.738, p < 0.001). There were significant differences between the groups in the incidence of perioperative cough (p = 0.043) and desaturation (p = 0.031).

Conclusion: Using a SGA reduced the incidence of coughing, bronchospasm and oxygen desaturation, providing an acceptable alternative to ETT in children with mild or moderate URTIs.