We studied 60 children, aged 12 months to 8 yr, undergoing plastic surgery under general anaesthesia supplemented by regional anaesthesia. Patients were allocated randomly to have the laryngeal mask airway removed either on awakening or while anaesthetized. Subsequent observation of respiratory factors and oxygen saturation showed a significant difference between the groups for coughing (P < 0.001), with a greater incidence (17 of 33) in the awake group compared with those from whom the laryngeal mask airway was removed while anaesthetized (two of 27). There were no differences in the incidences of laryngospasm, desaturation (< 95%) and excess salivation between the groups. Removed of the laryngeal mask airway during deep anaesthesia reduced coughing in the immediate postoperative period.

The endoscopic dexterity required to proficiently drive a bronchoscope in human subjects to an anatomic endpoint relevant to fibreoptic intubation is achievable after 2-4 h of specialized bench training. Training in the local environment may be more conducive to success than in time-limited workshops. Achieving a defined proficiency standard on bench models contributes to the development of basic bronchoscopic competence. This has the potential to protect patients from novice learning curves, optimize clinical education and efficiency, and assist compliance with difficult airway algorithms.