Removal of the laryngeal mask airway:factors affecting the incidence of post-operative adverse respiratory events in 300 patients

Baird, M.; Mayor, A. H.; Goodwin, A. P. L.

doi:10.1046/j.1365-2346.1999.00476.x

Cited by 13 publications

(15 citation statements)

References 16 publications

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“…Another seven trials were excluded since they were studies of adult patients. A total of 17 full-text randomized trials [ 7 , 10 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] were included in the final analysis ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Koo

Lee

Chung

et al. 2018

JCM

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The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172). Electronic databases were searched, without discrimination of publication year and language, to identify all randomized controlled trials investigating airway complications following deep or awake extubation after general anesthesia. The Cochrane tool was used to assess the risk of bias of trials. Randomized trials investigating airway complications of deep extubation compared with awake extubation after general anesthesia with an endotracheal tube and laryngeal mask airway (LMA) were sought. Overall airway complications, airway obstruction, cough, desaturation, laryngospasm and breath holding were analyzed using random-effect modelling. The odds ratio was used for these incidence variables. Seventeen randomized trials were identified, and a total of 1881 pediatric patients were enrolled. The analyses indicated deep extubation reduces the risk of overall airway complications (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33–0.96, p = 0.04), cough (OR 0.30, 95% CI 0.12–0.72, p = 0.007) and desaturation (OR 0.49, 95% CI 0.25–0.95, p = 0.04) in children after general anesthesia. However, deep extubation increased the risk of airway obstruction compared with awake extubation (OR 3.38 CI 1.69–6.73, p = 0.0005). No difference was observed in the incidence of laryngospasm and breath-holding between the two groups regardless of airway device. The result of this analysis indicates that deep extubation may decrease the risk of overall airway complications including cough and desaturation but may increase airway obstruction compared with awake extubation in pediatric patients after general anesthesia. Therefore, deep extubation may be recommended in pediatric patients to minimize overall airway complications except airway obstruction and the clinicians may choose the method of extubation according to the risk of airway complications of pediatric patients.

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Section: Resultsmentioning

confidence: 99%

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Koo

Lee

Chung

et al. 2018

JCM

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“…Baird, et al 3 reported that desaturation and airway obstruction following the LMA removal after full recovery occurred in 31% and 7% of adult patients, respectively. On the other hand, several previous studies on adults reported that the occurrence of such major complications was rare during LMA removal in the awake state.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of respiratory complications during LMA removal in awake patients has been reported as 48.7%. 3 A minimum sample size of 26 patients per group was required to achieve a power of 0.8 and an α value of 0.05 on the assumption that a 50% reduction of complications would be clinically significant. Statistical analysis was performed with SPSS 21.0 (IBM, Armonk, NY, USA).…”

Section: Methodsmentioning

confidence: 99%

“… 1 However, complications such as coughing or airway obstruction may accompany LMA removal after the return of airway reflexes. 2 , 3 Remifentanil has recently been shown to suppress the airway reflex and facilitate smooth extubation during recovery from general anesthesia. 4 , 5 Therefore, smooth LMA removal may be possible even in the awake state by using remifentanil.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

2015

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PurposeThis randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence.Materials and MethodsThis study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated.ResultsThe number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05).ConclusionMaintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

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“… 1 3 However, in a deep anesthetic state, suppression of airway reflexes may increase the incidence of aspiration and airway obstruction. 4 5 Therefore, providing an appropriate depth of anesthesia to achieve airway reflex suppression without delayed awakening is important for safe removal of a LMA.…”

Section: Introductionmentioning

confidence: 99%

Predicted EC₅₀and EC₉₅of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

et al. 2015

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PurposeThe purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia.Materials and MethodsTwenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO2<90%.ResultsThe mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively.ConclusionOur results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.

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Removal of the laryngeal mask airway:factors affecting the incidence of post-operative adverse respiratory events in 300 patients

Cited by 13 publications

References 16 publications

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

Predicted EC₅₀and EC₉₅of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

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Removal of the laryngeal mask airway:factors affecting the incidence of post-operative adverse respiratory events in 300 patients

Cited by 13 publications

References 16 publications

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

Predicted EC50and EC95of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

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Predicted EC₅₀and EC₉₅of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia