Removal of Laryngeal Mask Airway in Adults Under Target-Controlled, Propofol–Fentanyl Infusion Anesthesia

Abstract

After emergence from anesthesia, the incidence and severity of adverse airway effects caused by the laryngeal mask airway (LMA) can vary, depending on when the device was removed; nonetheless, reports differ regarding the exact optimal timing of LMA removal. The purpose of this study was to compare the rate of adverse events between 2 groups: those whose LMA was removed under general anesthesia (“deep” group) or under target-controlled infusion (TCI) of propofol (“awake” group).Institutional Review Board approval and written informed consent were obtained; 124 patients were then randomly allocated into either the “awake” group or the “deep” group. Anesthesia was induced and maintained using TCI of propofol, as well as intravenous fentanyl. In the “deep” group, the LMA was removed after surgery while the patients were deeply anesthetized using a target effect-site propofol concentration of 2 μg/mL, whereas in the “awake” group, the device was removed while the patients followed verbal instructions. The incidence of the following adverse events was recorded: coughing, straining, bronchospasm, laryngospasm, clenching, breath holding, gross purposeful movement, airway obstruction, retching, vomiting, and oxygen desaturation. If any such event occurred, the LMA removal was considered a failure. Airway hyperreactivity was recorded and graded – based on the severity of cough, breath holding, and oxygen desaturation.The failure rate was higher in the “awake” group (15/61; 24.6%) than in the “deep” group (5/60; 8.3%). Airway hyperreactivity was mild (score, <3) in both groups.Removal of the LMA under deep anesthesia using a target-controlled, effect-site propofol concentration of 2 μg/mL may be safer and more successful than removal when patients are fully awake after surgery.

A Comparison of Awake Versus Deep Removal of Laryngeal Mask Airway in Children Aged 2 to 8 Years Who Underwent Ophthalmic Procedures at Menilik II Hospital: A Prospective Observational Cohort Study

“…Some of them conclude that removal of LMA in anaesthetized state was associated with lesser complications than in awake condition 13,16,17,19 where as others reported removal of LMA in awake condition better than in deep condition. 16,22,23,27…”

Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery

“…[ 11 ] Continuous infusion of propofol was delivered subsequently using Schneider's kinetic model of target-controlled infusion (TCI; Fresenius Orchestra Primea; Fresenius Kabi AG, Bad Homburg, Germany) with the effect-site concentration (Ce) of 4.0 μg/mL. [ 12 ] Anesthesia was maintained using TCI with propofol infusion and spontaneous breathing with 1.0 L/min flow (100% oxygen). In the P/S group, the anesthesia induction were as the TIVA group patients, whereas anesthesia was maintained using propofol infusion and fixed 1% sevoflurane (inhaled concentration) with an oxygen flow of 1 L/min with 100% oxygen.…”

Analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in functional endoscopic sinus surgery

“…Cisatracurium (2 mg) or rocuronium (10 mg) was administered as required to antagonize the return of neuromuscular function. [ 5 – 9 , 12 – 17 ]…”

“…When the patient regained consciousness with spontaneous and smooth respiration, the endotracheal tube was removed. [ 5 – 9 , 12 – 17 ] We defined an extubation time ≥15 minutes as prolonged extubation. [ 3 , 18 – 20 ]…”