[Use of the laryngeal mask in adenoidectomy in childhood--a comparison with endotracheal intubation].
OBJECTIVE
Anaesthesia for adenoidectomy is possible during infancy without succinylcholine. One possibility is intubation with vecuronium bromide, whereas another possibility is the use of the laryngeal mask (LMN). The conditions for intubation as well as further details during anaesthesia are listed and compared.


METHODS
200 children are divided into 4 groups. Group A: intubation with thiopental and vecuronium bromide. Group B: LMN with thiopental, Group C and D: as A and B but the thiopental replaced by propofol. The following aspects are compared: the conditions of intubation; circulation conditions; oxygen saturation; the behaviour when coming out of anaesthesia; complications; the assessment by the surgeons. A further control of 100 routine LMN covers the complications which arose.


RESULTS
Adenoidectomy can be carried out successfully with both kinds of anaesthesia. Tracheal intubation attained a better assessment by most surgeons and is easier to administer. Brief declines in the saturation of oxygen occur more frequently when using LMN. LMN has its advantages in the low irritation of the respiratory mucous membranes and results in improved behaviour on coming out of the anaesthesia, especially if used with propofol. Problems arise mainly through the use of the mouth clamp which can result in obstructions of the respiratory tract and re-intubation. These problems arise less frequently when the use of this method has become routine.


CONCLUSIONS
LMN takes time to get used to, and places greater demands on the anaesthetist. Success of LMN depends on the cooperation and collaboration to the surgeon to lower the risk of complications. Once specific improvements in the LMN have been made, it may become the standard method for adenoidectomy in future. It is already used by us and in some outpatient departments, as well as in England and America. Our suggestions are as follows: Aims at convincing the surgeons and improving their co-operation; No routine fixation of the laryngeal mask. The laryngeal mask should be kept slightly taut before opening--preferably slowly--the mouth clamp; possible technical modifications of the mouth clamp itself, which produce a wider gap, could be adapted to the new conditions of the wider LM; reaching the necessary depth of anaesthesia through higher doses of propofol or possibly by total intravenous anaesthesia; routine wearing of the LM in the recovery room until it is no longer tolerated by the child.
Schnurer
U
U
Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Städtisches Krankenhaus Hildesheim.
Gassner
F
F
el Khatib
M
M
Tolksdorf
W
W
D000233:Adenoidectomy; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D009467:Neuromuscular Depolarizing Agents; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000209:etiology; D015742:Propofol; D011446:Prospective Studies; D013874:Thiopental; D014673:Vecuronium Bromide
D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D014673:Vecuronium Bromide; D013874:Thiopental; D010100:Oxygen; D015742:Propofol