A Comparison of Awake Versus Deep Removal of Laryngeal Mask Airway in Children Aged 2 to 8 Years Who Underwent Ophthalmic Procedures at Menilik II Hospital: A Prospective Observational Cohort Study

Abstract

Background: Laryngeal mask airway (LMA) is a useful airway device which provides an alternative to ventilation through a face mask or endotracheal tube during ophthalmic surgery. It can be removed either when a child awakens or deeply anesthetized. But there is little evidence for best practice on the timing of their removal after ophthalmic surgery in the pediatric population. It has been studied by various investigators but with conflicting results and conclusions. Objective: The aim of this study was to evaluate the effect of depth of anesthesia (awake or deep anesthesia) on the incidence of airway associated complications during LMA removal. Methodology: A prospective observational cohort study was conducted from January to April 2018. Sixty-two American Society of Anesthesiologists physical status I and II pediatric (aged 2–8 years) patients who underwent ophthalmic procedures under general anesthesia with LMA were recruited. Grouping (awake group or deep group) was done based on independent decision of on duty anesthetist and halothane 1–1.5% was used as maintenance anesthesia. The incidence of airway-related adverse events like coughing, upper airway obstruction (Laryngospasm), breath holding, desaturation, excessive salivation, biting, vomiting, and retching with LMA removal were evaluated. Collected data were entered into Epi Info™ version 7.0 and transported to the SPSS version 22 for analysis. Fisher’s exact test and Chi-square test were used to analyze dependent variables and P-values less than 0.05 were considered statistical significance. Results: There were no significant differences in airway-related adverse events. The incidence of coughing (12.9%, 6.5%), upper airway obstruction (41.9%, 35.5%), breath holding (9.7%, 3.2%), desaturation (16.1%, 22.6%), excessive salivation (19.4%, 12.9%), and biting (6.5%, 0%) between awake and deep groups respectively with (p > 0.05). Laryngospasm, vomiting, and retching did not occur in either group. Conclusion: There was no significant difference in the incidence of airway-related adverse events whether the LMA was removed in a deep or awake condition.