Impact of laryngeal mask airway versus endotracheal intubation on emergence delirium in children undergoing same-day endoscopic-assisted coblation adenoidectomy: a randomized, single-center clinical trial

Postoperative emergence delirium (ED), a frequent complication following general anesthesia, poses significant clinical risks including traumatic injuries and cardiorespiratory compromise. The primary objective of this study is to evaluate the effects of laryngeal mask airway versus endotracheal intubation on the incidence of ED in pediatric patients undergoing endoscopic-assisted coblation adenoidectomy. The secondary objective of this study is to evaluate and compare additional intraoperative and postoperative outcomes. A total of 78 patients aged three - six years undergoing same-day endoscopic-assisted coblation adenoidectomy under general anesthesia were randomly allocated to either laryngeal mask airway group (Group L) or endotracheal intubation group (Group T). ED and pain were assessed using the Pediatric Anesthesia Emergence Delirium (PAED) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale, respectively. The primary outcome was the incidence of ED within 30 minutes post-extubation. The secondary outcomes included the highest FLACC score, vital signs, the duration of surgery, anesthesia time, extubation time, length of Post-Anesthesia Care Unit (PACU) stay, adverse events post-extubation, sore throat score, and the satisfaction levels of ward nurses and caregivers. The incidence of ED was significantly lower in Group L than in Group T (15.4% vs. 41%, P<0.05). The systolic blood pressure (106.8±14.4 mmHg vs. 122.5±17.6 mmHg), diastolic blood pressure (60.9±12.6 mmHg vs. 76.8±16.7 mmHg), and heart rate (99.8±15.4 beats/min vs. 111.4±16.6 beats/min) in Group L were significantly lower than those in Group T at post-intubation (P<0.05 for all). The extubation time (6.1±2.0 min vs. 8.6±2.1 min) and length of stay in PACU (12.5±6.1 min vs. 15.8±7.1 min) were significantly shorter in Group L compared with Group T (P<0.05 for both). The incidence of airway complications (2.6% vs. 30.8%) and hypoxemia (2.6% vs. 20.5%) were significantly lower in Group L compared to Group T after extubation (P<0.05 for both). The sore throat score at discharge was significantly lower in Group L than in Group T (0 [0 to 2] vs. 2 [0 to 4], P<0.05). Additionally, nurses' overall satisfaction was significantly higher in Group L than Group T (5 [5 to 5] vs. 5 [2 to 5], P<0.05). The use of laryngeal mask airway effectively reduces the incidence of ED in children undergoing same-day endoscopic-assisted coblation adenoidectomy compared to endotracheal intubation. Additionally, it provides several advantages, including shorter extubation time, attenuated hemodynamic responses to intubation stress, and reduced rates of airway complications and postoperative sore throat.