Caudal and intravenous dexamethasone could provide longer duration of postoperative analgesia and reduced the incidence of postoperative vomiting with comparable adverse effects than plain caudal block. However, any additive to the caudal space carries with it the potential for neurotoxicity and that caution should always be exercised when weighting the risks and benefits of any additive. The result was influenced by small numbers of participants and significant heterogeneity.

The shortcomings of laryngeal mask airway (LMA™), such as upper airway obstruction and gastric distension or airway leakage, may limit its application in small children. The I-gel™ (I-gel), LMA-Supreme™ (LMA-S), and Ambu AuraOnce™ (Ambu) are three improvements upon these shortcomings. This study adopted respiratory dynamic monitoring to observe the ventilation parameters of the three laryngeal masks in small children. A total of 105 children were randomized into Ambu (n = 35), I-gel (n = 35), and LMA-S (n = 35) groups. Primary outcomes included leak pressure and respiratory dynamic data. Secondary outcomes included hemodynamic data and bispectral index values after induction (T0), time after successful laryngeal mask insertion (T1) and at three recording points every 10 min after insertion (T2, T3, and T4), as well as laryngeal mask related adverse reactions. The inspiratory/expiratory tidal volume per kilogram of body weight in the Ambu group was significantly different from those in the other groups (P < 0.05), while the leak pressure in the Ambu group was significantly lower (P < 0.05). At T3 and T4, the expiratory resistance values in the Ambu group were significantly lower than those in the LMA-S group (P < 0.05). We have shown that the three laryngeal masks provided secure ventilation in children <6 years of age by using continuous respiratory dynamic monitoring. We concluded that the I-gel presented a better sealing effect and fewer adverse reactions.

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