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Laryngeal Mask Airway has been used in paediatric anaesthesia since the 1990's. Clinical practice in paedeatric anaesthesia for Laryngeal Mask Airway removal varies and there is no standard of care.
In children removing the Laryngeal Mask Airway under deep inhalational anaesthesia has some advantages compared to awake, but may be associated with higher rate of complications when Laryngeal Mask Airway is removed in supine compared to lateral position. On the other hand deep anaesthesia may cause airway obstruction due to reduction in tone of upper airway muscles in some patients. An oropharangeal airway may prevent this. This aspect had not been studied before and represent a gap in literature.
Study Hypothesis:
Airway complications associated with Laryngeal Mask Airway removal under deep anaesthesia are same with or without insertion of an oral airway. Alternate hypothesis is that airway complications be less if an air way is inserted at the end of anaesthesia.
Objective:
The present study was designed to observe any difference in immediate complication after removal of LMA in supine head down position under deep anaesthesia with or without insertion of an oro-pharyngeal airway. Airway complications that we will observe are desaturation <92%, stridor, excessive secretions, laryngospasm, retching, vomiting, coughing, trauma to the soft tissues and damage to the teeth.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A | An appropriate size oropharyngeal airway (GUEDEL) will be inserted immediately after removal of LMA and time will be noted. (Size will be chosen by placing the flange at the corner of the mouth and tip at the angle of the jaw). |
| |
| Group B | In Group B No oropharyngeal airway (GUEDEL) will be inserted. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| GUEDEL Airway | Other | GUEDEL Airway of size '000,00,0,' and '1' will be used. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Oxygen saturation | Oxygen saturation <92% will be considered as complication | Day 1 |
| Stridor | The presence of noisy breathing occurring through obstructed airflow. We clinically measure it by auscultation of the nose, oropharynx, neck and chest. | Day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| laryngospasm | The occurrence of a transient and reversible spasm of the vocal cords. We will evaluate laryngospasm by observing a high pitch inspiratory stridor followed by partial or complete airway obstruction. | Day 1 |
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Inclusion Criteria:
Exclusion Criteria:
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Children aged 2-10 years undergoing surgery where anaesthesia with Laryngeal Mask Airway insertion.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Khalid Maudood Siddiqui, FCPS | Contact | +922134862896 | khalid.siddiqui@aku.edu | |
| Shemila Abbasi, FCPS | Contact | +922134864632 | shemila.abbasi@aku.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Aga Khan University Hospital | Recruiting | Karachi | Sindh | 74800 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 2100990 | Background | Mason DG, Bingham RM. The laryngeal mask airway in children. Anaesthesia. 1990 Sep;45(9):760-3. doi: 10.1111/j.1365-2044.1990.tb14449.x. | |
| 26086281 | Background | Thomas-Kattappurathu G, Kasisomayajula A, Short J. Best position and depth of anaesthesia for laryngeal mask airway removal in children: A randomised controlled trial. Eur J Anaesthesiol. 2015 Sep;32(9):624-30. doi: 10.1097/EJA.0000000000000286. |
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| 17040303 | Background | Sinha A, Sood J. Safe removal of LMA in children - at what BIS? Paediatr Anaesth. 2006 Nov;16(11):1144-7. doi: 10.1111/j.1460-9592.2006.01978.x. |