Airway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways.
BACKGROUND
We sought to characterize the airway responses to desflurane during maintenance of and emergence from anesthesia in children whose airways were supported with laryngeal mask airways (LMAs).


METHODS
Four hundred healthy children were randomized in a 3 : 1 ratio to either desflurane or isoflurane (reference group) during anesthetic maintenance. After induction of anesthesia, anesthesia was maintained with the designated anesthetic. The investigator chose the airway (LMA and facemask), ventilation strategy and when to remove the LMA. The incidence of airway events during maintenance, emergence and recovery was recorded.


RESULTS
Ninety percent of children received LMAs. The frequency of major airway events after desflurane (9%) was similar to that after isoflurane (4%) (number needed to harm [NNH] 20), although the frequency of major events after the LMA was removed during deep desflurane anesthesia (15%) was greater than during awake removal (5%) (NNH 10) (P < 0.006) and during deep isoflurane removal (2%) (NNH 8) (P < 0.03). The frequency of airway events of any severity after desflurane was greater than that after isoflurane (39% vs 27%) (P < 0.05). The frequencies of laryngospasm and coughing of any severity after desflurane were greater than those after isoflurane (13% vs 5% and 26% vs 14%, respectively) (P < 0.05).


CONCLUSIONS
When an LMA is used during desflurane anesthesia in children, fewer airway events occur when it is removed when the child is awake. Although the time to discharge from recovery was not delayed and no child required overnight admission, caution should be exercised when using an LMA in children who are anesthetized with desflurane.
Lerman
Jerrold
J
Department of Anesthesia, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, Buffalo, NY 14222, USA. jerrold.lerman@gmail.com
Hammer
Gregory B
GB
Verghese
Susan
S
Ehlers
Melissa
M
Khalil
Samia N
SN
Betts
Eugene
E
Trillo
Raul
R
Deutsch
Jonathan
J
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000009:adverse effects; D018685:Anesthetics, Inhalation; D002648:Child; D002675:Child, Preschool; D000077335:Desflurane; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D017214:Laryngeal Masks; D007826:Laryngismus / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D009609:Nitrous Oxide; D016017:Odds Ratio; D010100:Oxygen / Q000008:administration & dosage; D018401:Sample Size; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide; D010100:Oxygen