October 17, 2023Experimental and Therapeutic MedicineOpen Access

Comparison of laryngeal mask airway and endotracheal tube in general anesthesia in children

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Why the study?

There is no expert consensus on which ventilation device is more efficient for general anesthesia in children.

Does laryngeal mask airway reduce airway complications compared to endotracheal intubation in pediatric patients undergoing general anesthesia?

Structured PICO

Does laryngeal mask airway reduce airway complications compared to endotracheal intubation in pediatric patients undergoing general anesthesia?

Population

Pediatric patients undergoing general anesthesia (16 RCTs pooling 1,320 patients).

Intervention

Laryngeal mask airway (LMA)

Comparator

Endotracheal intubation (ETT)

Outcome

Airway complications during general anesthesia (including heart rate variation, bronchospasm, throat pain, mucosal injury, hypoxemia, postoperative cough, nausea and vomiting, reflux aspiration, and one-time success rate of implantation)safety

In pediatric patients undergoing general anesthesia, the use of a laryngeal mask airway reduces perioperative complications such as hypoxemia and postoperative cough and improves first-attempt insertion success compared to endotracheal intubation.

Limitations

Some included studies did not describe random sequence generation, allocation concealment, and blinding methods in detail
Duration of surgery in children was generally low (30-90 min), which may be conducive to the use of the laryngeal mask airway and cause bias

Implication

Supports preferring laryngeal mask airway in pediatric anesthesia; confirms lower complication rates versus endotracheal intubation.

Abstract

At present, there is no relevant expert consensus indicating which ventilation device is more efficient for general anesthesia. The present literature review and meta-analysis compared the effects of the laryngeal mask airway and endotracheal intubation on airway complications during general anesthesia. The keywords 'laryngeal mask airway', 'endotracheal tube', 'tracheal tube', 'children', 'pediatric', 'anesthesia', 'randomized controlled trials' (RCTs) and 'randomized' were used to perform the literature search in PubMed. Quality assessment was performed by two reviewers according to domains defined by the Cochrane Collaboration tool. Data extraction, risk of bias assessment and quality of evidence assessment were performed with the Cochrane tool. A total of 16 RCTs were included. The results indicated that the effects of the laryngeal mask airway group on heart rate variability [mean difference=-13.76; 95% CI, -18.19-(-9.33); P<0.00001], the incidence of hypoxemia [odds ratio (OR)=0.52; 95% CI, 0.28-0.97; P=0.04] and the incidence of postoperative cough (OR=0.22; 95% CI, 0.12-0.40; P<0.0001) were significantly lower than those of the endotracheal intubation group. The success rate of one-time implantation in the laryngeal mask airway group was significantly higher than that noted in the endotracheal intubation group (OR=0.20; 95% CI, 0.07-0.59; P=0.003). However, no significant differences were noted between the two groups in bronchospasm, sore throat, mucosal injury, nausea and vomiting and reflux aspiration. In conclusion, the results indicated that laryngeal mask airway application can reduce complications during general anesthesia compared with endotracheal intubation.