Reinforced laryngeal mask airway compared with endotracheal tube for adenotonsillectomies.
BACKGROUND
The endotracheal tube (ETT) has traditionally been considered the best airway device during adenotonsillectomy because a well protected and secured airway is provided. This has been challenged by the introduction of the reinforced laryngeal mask airway (RLMA). It does not kink, is less traumatic during insertion and better tolerated during emergence. The purpose of this study was to compare the use of the RLMA with ETT with regards to postoperative pain, nausea, vomiting and perioperative efficacy in a series of children due for adenotonsillectomy.


METHODS
One hundred and thirty-four children, aged 3-16 years and scheduled for ambulatory adenotonsillectomies, were randomly assigned to two groups where the airways were secured with either the ETT (n = 62) or the RLMA (n = 69). We registered the incidence of peroperative and postoperative anaesthesiological complications and time consume, in addition to postoperative pain, nausea and overall satisfaction.


RESULTS
The Group RLMA scored significantly lower for maximal pain during the first 4 h postoperatively (P = 0.015). There were no significant differences in pain scores at 24 h or rescue pain medication postoperatively. The Group RLMA spent mean 4.2 min less in the operating room after surgery (P = 0.001). There were no significant differences in postoperative nausea. In those patients finally treated with ETT, including five conversions from RLMA, significantly more patients (10 vs. 2) had airway irritations (P < 0.02).


CONCLUSIONS
The RLMA, when feasible, is a well tolerated and effective alternative to the ETT for use during adenotonsillectomies in children, with beneficial effects on airway irritations, operating room efficiency and early postoperative pain.
Doksrød
Simen
S
Departement of Emergency Medicine, Telemark Hospital, Skien, Norway. dots@sthf.no
Løfgren
Brith
B
Nordhammer
Anita
A
Svendsen
Martin V
MV
Gisselsson
Lars
L
Raeder
Johan
J
D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*