title: A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years.
abstract: OBJECTIVE
  To compare the frequency of airway complications during removal of the Laryngeal Mask Airway (LMA) in 2 to 6 year old pediatric patients.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Operating room at a university hospital.
  
  
  METHODS
  92 ASA physical status 1 and 2 pediatric patients, aged 2 to 6 years.
  
  
  METHODS
  Participants were randomized to two groups: anesthesia state (anesthesia group) and awake state (awake group). Anesthesia was induced and maintained with sevoflurane. Patients were allowed to maintain spontaneous respiration. In the anesthesia group, the LMA was removed during anesthesia with 2.2% of sevoflurane. In the awake group, the LMA was removed when patients met the recovery criteria, including facial grimace, spontaneous eye opening, and purposeful arm movement.
  
  
  METHODS
  During and after removal of the LMA, the frequencies of airway-related complications including cough, severe salivation, LMA biting or teeth clenching, breath holding, laryngospasm, desaturation (SpO(2) < 95%), and vomiting, were recorded. The frequencies of upper airway obstruction and duration of emergence from anesthesia also were compared.
  
  
  RESULTS
  The frequency of airway-related complications was significantly less in the anesthesia group than the awake group (4.8% vs 37.2%, P = 0.001). Of the complications, cough, desaturation, excessive secretion, and LMA biting were less common in the anesthesia group. No differences between groups were noted in the frequency of upper airway obstruction and duration of emergence from anesthesia.
  
  
  CONCLUSIONS
  In 2 to 6 year old pediatric patients, an adequate anesthetic state is preferable to the awake state during LMA removal, producing fewer complications.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 120-752, Seoul, Korea.
authors.forename: Jeong-Soo
authors.initials: JS
authors.lastname: Park
authors.forename: Ki-Jun
authors.initials: KJ
authors.lastname: Kim
authors.forename: Jung-Tak
authors.initials: JT
authors.lastname: Oh
authors.forename: Eun-Kyeong
authors.initials: EK
authors.lastname: Choi
authors.forename: Jeong-Rim
authors.initials: JR
authors.lastname: Lee
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D000077149:Sevoflurane; D013997:Time Factors; D014851:Wakefulness
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane