USE OF THE LARYNGEAL MASK AIRWAY IN CHILDREN WITH UPPER RESPIRATORY-TRACT INFECTIONS - A COMPARISON WITH ENDOTRACHEAL INTUBATION

Several studies suggest that placement of an endotracheal tube (ETT) i n a child with an upper respiratory infection (URI) increases the risk of complications. However, the development of the laryngeal mask airw ay (LMA) has provided anesthesiologists with an alternative means of a irway management. This study was therefore designed to evaluate the us e of the LMA in children with URIs and to compare it with the ETT. The study sample consisted of 82 pediatric patients (3 mo to 16 vr of age ) who presented for elective surgery with an URI. Patients with URIs w ere randomly allocated to receive either an ETT (rr = 41) or a LMA (n = 41) and were followed for the appearance and severity of any periope rative complications. The two groups were similar with respect to age, gender, anesthesia and surgery times, number of attempts at tube plac ement, and presenting URI symptoms. There were no differences between groups in the incidence of cough, breath-holding, excessive secretions , or arrhythmias. Although one patient in the ETT group required a mus cle relaxant for laryngospasm, the overall incidence of laryngospasm w as similar between the two groups. There was, however, a significantly greater incidence of mild bronchospasm in the ETT group compared with the LMA group (12.2% vs 0%, P < 0.05). The incidence of major arteria l oxygen desaturation events (Spo(2) <90%) during placement of the air way device was also significantly increased in the ETT group (12.5% vs 0%, P < 0.05). Furthermore, the total number of all episodes of respi ratory complications, i.e., breath-holding, laryngospasm, bronchospasm , and major oxygen desaturation, was significantly greater in the ETT group (35 vs 19, P < 0.05). Despite this, all respiratory complication s were easily managed, and there were no adverse sequelae. Although th e risks associated with anesthetizing a child with an URI remain contr oversial, results from this study suggest that the LMA offers a suitab le alternative to the ETT for use in children with URIs. Implications: This study compares the use of the laryngeal mask airway with the end otracheal tube for airway management in children with upper respirator y infections. Results suggest that if the decision is made to proceed with anesthesia for the child with an upper respiratory infection, the n the laryngeal mask airway provides a suitable alternative to the end otracheal tube.