title: The use of disposable laryngeal mask airway for adenotonsillectomies.
abstract: OBJECTIVE
  Tracheal intubation associated with airway operations can cause complications such as laryngospasm, bronchospasm and periods of reduced oxygen saturation. Such complications are frequently reported during adenotonsillectomies, a procedure that by nature increases the incidence of airway complications. The objective of this study was to compare the occurrence of respiratory problems during adenotonsillectomies while using either a disposable laryngeal mask airway (LMA) or an endotracheal tube (TT).
  
  
  METHODS
  We evaluated 204 pediatric patients undergoing general anesthesia for adenotonsillectomies. The patients were randomly allocated into either the tracheal intubation group (TT, n=100) or the laryngeal mask airway group (LMA, n=104). It was measured the level of oxygen saturation by pulse oximetry (SpO(2)) after the induction of anesthesia (SpO(2)-1), after establishing the operative field (SpO(2)-2), at the end of the surgical procedure (SpO(2)-3), three minutes after the removal of the contained breathing apparatus (SpO(2)-4) and upon admission to the post-anesthesia care unit (SpO(2)-5). All respiratory complications were recorded.
  
  
  RESULTS
  The mean SpO(2) values and standard deviations for the TT and LMA groups were as follows: SpO(2)-1: 98.9±1.0 and 98.7±0.8 (p>0.25), SpO(2)-2: 97.4±1.0 and 94.9±4.3 (p<0.001), SpO(2)-3: 96.9±1.1 and 97.2±1.1 (p=0.037), SpO(2)-4: 91.7±9.0 and 95.2±2.2 (p<0.001) and SpO(2)-5: 94.0±2.1 and 95.8±2.6 (p<0.001), respectively. In the LMA group, 12 patients required some maneuvering to fix positioning and leaks during surgery. In four patients, the LMA had to be replaced with a TT. Respiratory complications were similar between groups.
  
  
  CONCLUSIONS
  Performing adenotonsillectomies in pediatric patients using a LMA resulted in a lower intraoperative SpO(2), compared to using a TT. In some cases, the LMA had to be replaced with an endotracheal tube. Although the surgery may be performed with LMA, the use of a TT is preferred for safety.
authors.affiliation: Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (FMB, UNESP), SC, Brazil. deranieri@terra.com.br
authors.forename: Dante
authors.initials: D
authors.lastname: Ranieri
authors.forename: Adecir Geraldo
authors.initials: AG
authors.lastname: Neubauer
authors.forename: Denise Marchi
authors.initials: DM
authors.lastname: Ranieri
authors.forename: Paulo
authors.initials: P
authors.lastname: do Nascimento
mesh_terms: D000233:Adenoidectomy; D000758:Anesthesia; D002648:Child; D002675:Child, Preschool; D004209:Disposable Equipment; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D012120:Respiration Disorders / Q000209:etiology*; D014068:Tonsillectomy