Laryngeal Mask Airway Compared with Endotracheal Tube

Clinical Question: How do the safety and postoperative outcomes of laryngeal mask airway (LMA) during pediatric tonsil surgery compare with use of the endotracheal tube (ETT)?

Background: Despite documentation of numerous advantages of LMA use in this and other settings, widespread adoption of the device for pediatric adenotonsillectomy has stalled over concerns involving limitation of surgical access, aspiration, laryngospasm and obstruction of the tube caused by kinking, which may lead to difficulty ventilating and decreased oxygenation.

Study design: Randomized controlled trial.

Setting: MacNeal Hospital, Berwyn, Ill.; Henry Ford Clinic, Detroit; Advocate Health Care, Chicago; Division of Pediatric Otolaryngology, Advocate Lutheran General Children’s Hospital, Park Ridge, Ill.

Synopsis: A population-based sample of 117 patients aged two to 18 years requiring adenotonsillectomy, adenoidectomy or tonsillectomy was studied, looking at safety, surgery duration and patient comfort, followed by a phone survey. The authors noted that LMA and ETT were comparable overall, with few statistically significant differences for the variables of safety, comfort and duration. There were no statistically significant differences for surgery duration, coughing, gagging, vomiting, pain, breathing problems, fentanyl dose, population, desaturation and hoarse voice/stridor. Some statistically significant variables were seen in noisy breathing, cough or gagging during the anesthesia phase and in the method of ventilation. The authors said the study was limited in several ways: Findings cannot be applied to patients with abnormal airways, the homogeneity of the groups was limited, both cuffed and uncuffed ETTs were used and the significance of any nonequivalent finding between the LMA and ETT deteriorates with an increase in the quantity of statistical comparisons performed.

Bottom line: Use of the LMA during administration of general anesthesia for adenotonsillectomy, tonsillectomy and adenoidectomy does not appear to have any major disadvantages compared to the use of ETT under the same conditions. In some variables, LMA may be superior.

Reference: Sierpina DI, Chaudhary H, Walner DL, et al. Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy. Laryngoscope. 2012;122(2)429-435.