The Laryngeal Mask Airway: Is It Safe for Pediatric Adenotonsillectomy?
Abstract
Tonsillectomy with or without adenoidectomy (T&A) is one of the most common pediatric surgical procedures performed in the United States. Traditionally an endotracheal tube is used to secure the airway in these cases. However, the laryngeal mask airway (LMA) is also being used for pediatric T&As. This review explores the question: In pediatric patients undergoing tonsillectomy with or without adenoidectomy, does the laryngeal mask airway compared to the endotracheal tube provide a safe and effective means of airway management?
While all evidence sourcesconcluded it was possible to use an LMA for pediatric T&A, not all of the investigators fully supported its use in this setting. The authors of six of the seven evidence sources determined that the LMA was an overall safe and viable alternative for this procedure, but one of the RCTs indicated the issues with kinking and visualization and called for further study.
Future investigation should compare different types of laryngeal mask airways to determine superiority in terms of surgical access, visualization,and reduced displacement or kinking with insertion of the mouth gag.
References
2. Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia. Paediatr Anaesth. 2008;18(4):289-296.
3. Hernandez MR, Klock PA Jr, Ovassapian A. Evolution of the extraglottic airway:a review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349-368.
4. Peng A, Dodson KM, Thacker LR, Kierce J, Shapiro J, Baldassari CM. Use of laryngeal mask airway in pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg. 2011;137(1):42-46. 5. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based practices. ACP J Club. 1995;123(3):A12-A13.
6. Sierpina DI, Chaudhary H, Walner DL, et al. Laryngeal mask airway versus endotracheal tube in pediatric adenotonsillectomy. Laryngoscope. 2012;122(2):429-435.
7. Ranieri D, Neubauer AG, Ranieri DM, Nascimento P. The use of disposable laryngeal mask airway for adenotonsillectomies. Rev Bras Anestesiol. 2012;62(6):788-798.
8. Doksrod S, Lofgren B, Nordhammer A, Svendsen MV, Gisselsson L, Raeder J. Reinforced laryngeal mask airway compared with endotracheal tube for adenotonsillectomies. Eur J Anaesthesiol. 2010;27(11):941-946.
9. Webster AC, Morley-Foster PK, Dain S, Ganapathy S, Ruby R, Au A, Cook MJ. Anaesthesia for adenotonsillectomy: a comparison between tracheal intubation and the armoured laryngeal mask airway. Can J Anaesth. 1993;40(12):1171-1177.
10 Gravningsbraten R, Nicklasson B, Raeder J. Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy. ACTA Anaesthesiol Scand. 2009;53(2):218-222.
11. Lalwani K, Richins S, Aliason I, Milczuk H, Fu R. The laryngeal mask airway for pediatric adenotonsillectomy: Predictors of failure and complications. Int J Pediatr Otorhinolaryngol. 2013;77(1):25-28.
12. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing and healthcare: A guide to best practice. 2nd ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins. 2011:3-24.
Keywords
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors agree to the Creative Commons License listed below, which can be viewed by clicking the link below.
This work will be licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.