Evaluation of Flexible Laryngeal Mask Airway® in Tongue Trauma Repair: A Randomized Trial

Abstract

BackgroundFlexible laryngeal mask airway may be used instead of the endotracheal tube in children presented for elective repair of tongue trauma, as it may shorten the time for extubation and recovery with the amelioration of stress response to airway management.ObjectivesThis study aimed to evaluate the extubation time and hemodynamic response to the endotracheal tube or flexible laryngeal mask airway in children presented for tongue trauma repair.MethodsThe study recruited 90 children presented for elective repair of tongue trauma that were randomly assigned into the following groups: the ETT group for which the airway was controlled by a cuffed endotracheal tube and the LMA group for which the airway was controlled by a flexible laryngeal mask. The intubation time, surgical time, total anesthesia time, extubation time, recovery time, changes in the hemodynamic parameters, and the incidence of complications were measured.ResultsThe use of flexible laryngeal mask airway instead of endotracheal tube significantly decreased the extubation time to 7.47 ± 2.74 min (P < 0.0001) and the recovery time to 52.67 ± 11.16 min (P = 0.001) while no significant differences were observed in the intubation time (P = 0.874), surgical time (P = 0.411), and total anesthesia time (P = 0.725). In addition, the changes in the hemodynamic parameters were significantly lower with flexible laryngeal mask airway both during airway securing and at the start of the surgery (P < 0.05). Moreover, it significantly decreased the incidence of postoperative cough, stridor, and sore throat (P = 0.039, 0.006, and 0.027, respectively).ConclusionsThe flexible laryngeal mask airway can be used instead of the endotracheal tube in children undergoing the repair of tongue trauma, as it decreases the extubation time, recovery time, and hemodynamic changes to the airway control.

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“…In terms of difficult airway management, the upper airway nerve block method may be proper for tracheal stenosis patients who are rigid bronchoscopy candidates (63). Also, it is suggested that video laryngoscopy in comparison to direct laryngoscopy can provide better visualiza-tion for intubation of the trachea in congenital heart disease.…”

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“…A study by Mohamed in 90 Egyptian children involving oral surgeries, such as tonsillectomy in whic h laryngeal masks were used, reported minor complication compared to those receiving an endotracheal tube in which nausea 8.89%, cough 6.67%, laryngospasm 2.22%, odynophagia 4.44% were found. Extubation and recovery times were significantly shorter with the mask thus indicating that the laryngeal mask is safe in airway surgeries [4].…”

“…In a 2013 meta-analysis, Barreira analyzed 29 prospective and randomized clinical trials and showed that patients undergoing general anesthesia with the use of the laryngeal mask have fewer opportunities to develop complications, such as hoarseness, cough, and laryngospasm [3]. In addition, extubation and recovery times and hemodynamic responses were significantly shorter compared to those of the endotracheal tube [4].…”

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“…Therefore, if the patient is nil per os (NPO), the classical LMA can be an appropriate solution (16,17). Furthermore, in short surgeries, the use of classical LMA with narcotics, midazolam, and propofol without muscle relaxants and with the help of inhaled gasses allows reducing the complications of anesthesia and recovery time at the end of the operation (18,19).…”