Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway.
A prototype armoured laryngeal mask airway (LMA) was compared with tracheal intubation (ETT) for anaesthesia for adenotonsillectomy. Fifty-five children were randomised into the LMA group and 54 into the ETT group. During insertion of the LMA, peripheral oxyhaemoglobin desaturation (SpO2) < 94% occurred in ten patients (18.2%) and in seven patients (13%) during tracheal intubation (NS). After opening the Boyle-Davis gag, airway obstruction occurred in ten patients (18.2%) in the LMA group and in three patients (6%) in the ETT group (P = 0.07). In five patients (9%) the LMA was abandoned in favour of tracheal intubation. In all others (91%), when the need for adequate depth of anaesthesia was realized, a satisfactory airway was achieved more rapidly than with tracheal intubation (P < 0.001), and maintained throughout surgery. Manually assisted ventilation was required in all patients in the ETT group, mean duration 373 +/- 385 sec, and in 26 patients (52%) in the LMA group, mean duration 134 +/- 110 sec, P < 0.001. Mean end-tidal CO2 (PetCO2) was 45.5 +/- 6.21 mmHg in the ETT group and 46.6 +/- 6.09 in the LMA group (NS). The LMA did not limit surgical access. Heart rate, MAP and blood loss in the LMA group were 110 +/- 21, 74 +/- 9 mmHg and 1.92 +/- 1.22 ml.kg-1 respectively, compared with 143 +/- 13 (P < 0.001), 85 +/- 12 mmHg (P < 0.001) and 2.62 +/- 1.36 ml.kg-1 (P < 0.05) with tracheal intubation. Fibreoptic laryngoscopy at the end of surgery in 19 patients in the LMA group revealed no blood in the larynx.(ABSTRACT TRUNCATED AT 250 WORDS)
Webster
A C
AC
Department of Anaesthesia, University of Western Ontario, St. Joseph's Health Centre, London.
Morley-Forster
P K
PK
Dain
S
S
Ganapathy
S
S
Ruby
R
R
Au
A
A
Cook
M J
MJ
D000233:Adenoidectomy; D000402:Airway Obstruction / Q000209:etiology; D000768:Anesthesia, General; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology; D001986:Bronchial Spasm / Q000209:etiology; D002245:Carbon Dioxide / Q000032:analysis; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects; D007828:Laryngoscopy; D008297:Male; D008876:Middle Ear Ventilation; D010100:Oxygen / Q000097:blood; D010108:Oxyhemoglobins / Q000032:analysis; D011175:Positive-Pressure Respiration; D015742:Propofol / Q000008:administration & dosage; D014068:Tonsillectomy
D010108:Oxyhemoglobins; D002245:Carbon Dioxide; D010100:Oxygen; D015742:Propofol